John Hundiak’s blue eyes averted, then came back to gaze awkwardly through bulletproof glass at his only visitor, aside from lawyers, in the three months since Christmas. He pressed his nose to the glass, revealing numerous freckles and a chin dotted with teenage acne.
He tugged from his pale wrist the yellow band bearing his name and other details pertinent to his Oakland County jailers. "We’re not supposed to have these off," he said, grinning, before quickly replacing it.
He displayed the excessive fidgeting associated with attention deficit hyperactive disorder (ADHD), one of a number of mental illnesses he had been diagnosed with over the years.
He talked about missing the sight of trees, about killing time in jail with cards, checkers and calculating his age in days. He was 18 years old then, "about 6,000 days old." He said he hated jail.
He detailed the crimes he’s been accused of over the years, admitting some, denying others, including the current assault charge. But there was no denying his problems.
"When I get pissed off, I get violent," he said. But he added that he is learning to handle his anger, that next time, he should "just walk away."
His naive, often childlike demeanor contrasted sharply with the vast, complicated systems that helped land him in jail with the prospect of eight years in prison.
He’s not alone.
According to the National Mental Health Association, roughly two-thirds of the 100,000 minors locked away in correctional facilities throughout the country suffer from some type of mental, emotional or behavioral disorder.
The situation is no better here in Michigan, where critics say children who need psychiatric care are routinely being funneled into jail cells instead of hospitals and other mental health treatment facilities.
Experts cite a variety of reasons, each working in combination with the others to create inmates of kids who should be patients. The list includes:
- A fractured mental health system that can make coordinating care impossible. Along with the state’s Department of Community Mental Health and Family Independence Agency, there’s a network of local community mental health boards, school systems and criminal justice officials involved. For many families, seeking treatment can become an exercise in futility.
- The state’s mental health system is severely underfunded and is even worse when it comes to dealing with kids, critics say. According to Mark Reinstein, associate executive director of the Mental Health Association in Michigan, children and adolescents constitute roughly 20 percent of community mental health clients, but receive only about 7 percent of the budget.
- The drastic reduction of publicly provided long-term hospital care. In particular, the Engler administration closed all but one of the state’s mental hospitals serving children and adolescents.
- A Medicaid system that is failing. When mental patients without insurance are forced to turn to the private sector, they are frequently turned away; they find that the psychiatrists, psychologists and other providers either don’t accept Medicaid or, if they do, are already so overburdened they can’t handle new patients.
- New get-tough criminal policies aimed at youthful offenders.
- Zero-tolerance school policies that expel children without providing alternatives, often putting those most in need of help on the streets with no supervision.
Seeking to halt a downward spiral that begins with inadequate treatment and ends with incarceration, the Michigan Association for Children with Emotional Disorders (MACED) in 1995 filed suit in Wayne County Circuit Court against the state on behalf of John Hundiak and 21 other children needing mental health services. These youths depend on the public mental health system. Many are on Medicaid. The suit, which is expected to go to trial later this year or early in 2001, is before Judge J.W. Callahan. It accuses the state Department of Community Health along with its director, James Haveman, and Medicaid Director Robert Smedes of violating the state mental health code and federal Medicaid law. In particular, it zeroes in on the lack of funding and hospital closures. The intent is to force the state to give long-term care to many children who need it but are not getting it.
In its formal response to the suit, the state denies any wrongdoing, contending that local community mental health agencies are responsible for the care. State officials argue that mental health care including long-term care is adequate in Michigan.
For Susan McParland, the Michigan Legal Services director who filed the lawsuit on behalf of MACED, the five years since the suit was filed have been long and frustrating. She has watched as children in need of help who were between the ages 5 and 15 when the suit was first filed become more deeply troubled as they go through what she calls "serial interventions" short-term hospitalization and other residential stays that tend to follow more and more rapidly over the years as their conditions worsen.
"Every kid in the MACED case was a kid who needed longer-term care and it was either denied entirely or forestalled for so long. ... Some of the kids waited for years to get care. When they finally did, they got better."
By, that time, she says, "They’ve lost a large part of their lives."
The interventions caused them to fall further and further behind in school. Several have threatened or attempted suicide; about a third have had run-ins with police. When they were younger, that meant juvenile justice.
"Now," McParland says, "I’m appearing in criminal court with the same kids."
John Hundiak is one of them.
John’s problems began before he even drew his first breath in California on July 6, 1981. His psychiatric records show that he suffered a lack of oxygen at birth, a cause for concern, and was hospitalized for a month afterward. It’s not clear whether those crucial moments were the root of the mental disorders that have haunted his life.
By the age 3, he was already in the mental health care system. During a visit to assist John’s older brother with a hearing aid, a social worker was concerned enough about John’s behavior to recommend he be evaluated. Doctors diagnosed attention deficit hyperactivity disorder, a widely diagnosed many believe overdiagnosed and poorly understood disorder that affects far more than a child’s ability to sit still. It commonly affects impulse control, which was particularly significant for John.
He has been on and off medications, including the stimulant Ritalin and its variants, for most of his life. When he was a child, and when medication worked, it could make the difference between his coloring inside the lines of a coloring book and covering pages with frenzied scribbles.
Despite the medications, problems continued. He would smash toys, destroy furniture, punch holes in walls. At school he was frequently disciplined.
He qualified for special education at age 7 as "emotionally handicapped."
Emotional wounds began to pile up as well. He had trouble making friends. Small for his age, other children taunted and teased him. Frustrations mounted.
It didn’t help that his father, David, was in the Navy and often away at sea, leaving John and his older brother at home alone with a mother who was chronically ill with high blood pressure and kidney problems.
David Hundiak’s frequent transfers forced the family to move often. Finally, in 1991, when John was 10 years old, the Hundiaks landed in Southfield, and John began attending a special education program located at Southfield-Lathrup High School which included counseling provided through Oakland County Community Mental Health Services.
One clinician who saw John there, Mary McLeod, said he received support from state and local agencies.
After he set fire to his family’s home in spring 1995, McLeod said, community mental health staff in Oakland County arranged for John to be briefly hospitalized, sent back to the day-treatment program and enrolled in a summer program. For a time, a mental health worker visited the home for several hours weekly. Despite the efforts at "pointing him in a positive direction," said McLeod, John "was not following. ... At some point, he crossed over the line."
According to McLeod, the summer program ended in July and the at-home worker was on vacation when, at age 14, John pulled a knife on neighborhood kids who had been throwing rocks at his home. He was arrested and placed in Children’s Village, a juvenile detention facility in Oakland County.
"Had he not been incarcerated, I assume he would’ve come back to the day-treatment program," McLeod says. "But at that point, it was out of our jurisdiction."
At that point, attorney McParland says, John should have been in long-term residential treatment.
"They offer and try all these interventions that prove ineffectual," said McParland. "Kids are just spun around through different treatments. If something isn’t working, you don’t keep forcing the kids to go through what they call their 'hierarchy of care.'
"Kids need help, and not just help for two days or a week," she said. "It takes a lot of resources and time to get a life back on track."
John pleaded no contest to the assault charges in September and spent approximately three more months at Children’s Village.
Then, despite the court’s recommendation that he be committed to "secure psychiatric services," John was transferred to Bay Pines, a 40-inmate, maximum-security detention facility in Escanaba in mid-January 1996. John’s father said it was too far to visit. He recalls that John called home with horror stories, saying he was often locked in his room all day except for meals. David Hundiak says he never knew how much was true and how much might have been stories being told by a boy who just wanted to come home.
What John didn’t comprehend was that winding up in a detention facility instead of a treatment center was the natural outcome of a shift in state policy that began escalating three years earlier.
In 1991, the same year the Hundiaks came to Michigan, Gov. John Engler’s new administration rolled out its vision for mental health care in the state, signaling a dramatic shift away from state-supported institutions toward community-based care.
"Michigan’s Department of Mental Health must champion the needs of children and families," announced James Haveman, the incoming director of Michigan’s Department of Community Health. "Those programs based on the earliest possible intervention and the preservation of the family hold the most promise of being effective. It must be children and families first."
Haveman’s vision wasn’t original. The plan took its lead from a decades-old movement away from mental institutions. In the 1960s, the advent of powerful and effective psychotropic drugs, combined with exposés of dismal conditions in many mental institutions and a burgeoning patients’ rights movement, set in motion profound changes regarding treatment of the mentally ill. The new goal was to return patients to their communities, where a network of local programs would meet their needs.
The Engler administration adopted this philosophy, then took it to an extreme.
According to the Senate Fiscal Agency, the governor has overseen the closure of 19 state hospitals and centers, cutting Michigan’s mental hospital population by 60 percent. This ax wielding has had an even more dramatic effect on facilities serving juveniles, closing six out of seven psychiatric hospitals that served children and adolescents.
"I have children in our cases who indisputably have emotional disorders, mental illnesses, some of whom may be, frankly, psychotic, who are not being provided adequate care ... because the hospitals closed and all this downsizing occurred," says attorney McParland.
State Department of Community Health spokeswoman Geralyn Lasher counters critics by pointing out that the state has hundreds of private hospital beds available through contracts with local community mental health programs.
But that usually means, at most, a few weeks of care.
It’s not that advocates disagree with the basic philosophy that people should be treated outside of institutions if at all feasible. What they do say is that there will always be those for whom long-term residential care is an absolute necessity, particularly for patients with persistent, perhaps lifelong, mental disorders.
The tragedy now is that those types of facilities are almost completely absent in Michigan. In a state where an estimated 300,000 children suffer some form of mental illness, there remains only one publicly operated psychiatric hospital for minors Northville’s Hawthorn Center, which has about 110 beds.
Officials in the Engler administration say that local community mental health programs and boards are now the system’s gatekeepers.
But the state still controls the purse strings.
The Department of Community Health’s proposed $8 billion budget for fiscal year 2000-2001 allocates approximately $1.75 billion to community mental health programs. According to the Senate Fiscal Agency’s Steve Angelotti, it is up to community mental health officials to decide how much of that money they want to spend hospitalizing patients.
Those local officials say they’re doing their best to reach as many patients as possible with limited money.
Unfortunately, residential and hospital care are two of the costliest forms of treatment. So the local officials face a dilemma: Should they cut down on the total number of people served to put those most in need in hospitals, or spend that money to serve as many people as possible, as best they can?
Their answer can be found in a recent Mental Health Association in Michigan study that revealed Michigan uses publicly operated beds for long-term psychiatric care at a rate of only half the national average.
But that doesn’t tell the whole story. The hospital closings have created ripples that are being felt throughout the state mental health system, observes Sam Davis MACED’s former director and an advocate for children with emotional disorders.
According to Davis, some children in need of long-term hospitalization but unable to obtain it are funneled into residential programs that aren’t adequately equipped to help them. Making matters worse, children who previously would have received residential care are squeezed out. Downward pressure is applied to the entire system, leaving some youths with no care at all.
Which means that, for a while at least, John Hundiak was one of the more fortunate people caught up in Michigan’s mental health system.
By January 1996, John had been incarcerated for approximately four months when his mother got MACED to intervene. John was transferred from Bay Pines to a residential treatment facility. The Children’s Home of Detroit would become his home for the next three years. By now the state’s Family Independence Agency was responsible for his care.
By this point the list of mental afflictions confronting John were piling up. Along with ADHD, he was diagnosed as having "oppositional defiant disorder," which involves conflict with authority figures. Records also indicated mood problems that defied categorization and possibly bipolar illness, which involves excessive mood swings.
But after years of turmoil, Children’s Home turned out to be a relatively peaceful oasis, offering structure, supervision, education, medication and other treatment.
According to facility records, John’s self-esteem "improved significantly" when he made the leap from on-grounds schooling to a community junior high, and then on to high school, sometimes even making the honor roll.
Records note that John preferred hands-on tasks, such as the vocational program that allowed him to work at the Selfridge Air Force Base motor pool a few days a week.
"He loved it," says David Hundiak, who keeps a video of his son at the base. "He was busy. There were people there who actually liked him. He made friends there."
Toward the end of 1998, problems reappeared.
He was accused of pulling a knife on his brother during a trip home, and Children’s Home staffers discovered he was skipping his medications. Since the home rarely keeps residents beyond age 18 and John had passed his 17th birthday, his release was all but inevitable. Despite the warning signs, he was sent home in January.
Follow-up care was minimal. According to John’s father, a therapist made a few house calls, but that was all. Attempts to obtain a counselor failed; they either claimed to be carrying a full load of patients or refused to take on a Medicaid client because of problems obtaining payment from the state.
"It’s amazing how rapidly he spiraled down," recalled McParland. "You don’t just take a kid who has gone through enormous change like that and just let him go."
The same state that has ejected hundreds of children and adolescents from mental hospitals has made more room for them in incarceration facilities. Last summer, for instance, the state Department of Corrections opened the Youth Detention Facility in Baldwin, a "punk prison," with 450 beds for adolescent boys. Still more youths are kept in county detention facilities.
Helping to keep the state’s corrections facilities filled, in 1996 Engler signed one of the nation’s toughest juvenile sentencing laws, opening the door for more children to be tried as adults.
Juveniles with mental illnesses are incarcerated disproportionately.
A recent University of Michigan study, for example, found that up to 75 percent of the approximately 500 inmates at the state’s W.J. Maxey Training School have a "serious mental disorder." Those finding were in line with other national studies.
When asked about the Maxey study, both the university researcher and state Juvenile Justice Director Larry Miesner said that doesn’t mean those children belong in state mental hospitals.
"They would be treated in the community had they not committed an offense which has led a judge to send them to a juvenile justice facility," Miesner says. "They’re primarily with us because they have broken the law."
That’s not the way Brian Philson sees it.
Philson, president of the nonprofit Michigan Juvenile Detention Association, which represents 25 juvenile detention facilities throughout Michigan, says juvenile facilities nationwide have to deal with the influx of mentally ill kids released from hospitals in recent decades.
"All of those kids ended up in our facilities," says Philson, who also runs a youth detention facility in Jackson County.
It’s not difficult to find a reason why Engler, who has in large part staked his political success on tax cuts, supports such a transition.
It costs $400 per day to keep a child in a treatment facility such as Hawthorn Center. At one of the state’s secure juvenile detention facilities, that figure is generally between $220 and $250 per day.
One of the things that makes all this particularly difficult for advocates of the mentally ill to accept is that most of these kids are getting locked away for nonviolent offenses.
After leaving Children’s Home, John returned to a special-education program at Southfield-Lathrup High School. He was awaiting placement in a more structured program when, within two months, he was again under arrest, charged with two felonies: assaulting his brother with a bike chain and writing "bomb in building" on a school bathroom tile. (There was no bomb.)
McParland says the system failed John.
"There were those critical months after he was released (from the Children’s Home) when everything went wrong," McParland said. "He should have been moved into a step-down program. This isn’t the first time a kid has left a secure residential program and had trouble adjusting. None of this is a surprise."
Family Independence Agency spokeswoman Maureen Sorbet declined to comment on John’s case, saying, "We don’t believe it’s in the best interest of the youth."
While John was in jail awaiting trial, his mother died. According to David Hundiak, John believed his being in jail led to his mother’s death.
On June 8, John pleaded guilty to both charges and received probation. A condition for his release required mental health treatment, and an arrangement was eventually made for John to attend a day program in Oxford.
According to McParland, John seemed to be doing well in the program, Crossroads for Youth, where he received education and counseling six days a week.
Then one day last October, police came to Crossroads, handcuffed John and took him back to jail. He was again charged with felony assault this time for allegedly pulling a knife on a neighborhood boy while they played video games.
Because of his previous conviction, John faced the possibility of eight years in prison.
He spent the next seven months languishing behind bars in the Oakland County Jail, waiting for trial and facing the prospect of prison.
He pleaded no contest, and on May 24, Oakland County Circuit Judge Barry Howard ordered the county probation department to work with MACED’s Davis on a treatment program.
John is currently home in Novi on an electronic tether while bureaucrats sort out who will finance and deliver his treatment. With a criminal record, few skills and no high school diploma, his future is uncertain.
Davis worries about what’s ahead for John, the other youths in the suit and the rest of Michigan’s children who suffer from mental illness.
"One day they’re all going to grow up. What will we have then?" asks Davis.Jennifer Bagwell is a Detroit-area freelance writer. Send comments to firstname.lastname@example.org