COMMISSION ON MENTAL HEALTH LAW REFORM REPORT OF THE TASK FORCE ON CHILDREN AND ADOLESCENTS DECEMBER 2008 2 COMMISSION ON MENTAL HEALTH LAW REFORM PREFACE The Commonwealth of Virginia Commission on Mental Health Law Reform (“Commission”) was appointed by the Chief Justice of the Supreme Court of Virginia, The Honorable Leroy Rountree Hassell, Sr., in October 2006. Commission members include officials from all three branches of state government as well as representatives of many private stakeholder groups, including consumers of mental health services and their families, service providers, and the Virginia State Bar. The Commission was directed by the Chief Justice to conduct a comprehensive examination of Virginia’s mental health laws and services and to study ways to use the law more effectively to serve the needs and protect the rights of people with mental illness, while respecting the interests of their families and communities. Goals of reform include reducing the need for commitment by improving access to mental health services, avoiding the criminalization of people with mental illness, making the process of involuntary treatment more fair and effective, enabling consumers of mental health services to have greater choice regarding the services they receive, and helping young people with mental health problems and their families before these problems spiral out of control. During the first phase of its work, the Commission was assisted by five Task Forces charged, respectively, with addressing gaps in access to services, involuntary civil commitment, empowerment and self-determination, special needs of children and adolescents, and intersections between the mental health and criminal justice systems. In addition, the Commission established a Working Group on Health Privacy and the Commitment Process (“Working Group”). Information regarding the Commission and its Reports is available at http://www.courts.state.va.us/cmh/home.html. The Commission also conducted three major empirical studies during 2007 under the supervision of its Working Group on Research. The first was an interview study of 210 stakeholders and participants in the commitment process in Virginia. The report of that study, entitled Civil Commitment Practices in Virginia: Perceptions, Attitudes and Recommendations, was issued in April 2007. The study is available at http://www.courts.state.va.us/cmh/civil_commitment_practices_focus_groups.pdf. 3 The second major research project was a study of commitment hearings and dispositions (the “Commission’s Hearings Study”). In response to a request by the Chief Justice, the special justice or district judge presiding in each case filled out a 2-page instrument on every commitment hearing held in May 2007. (There were 1,526 such hearings). Findings from the Commission’s Hearing Study served an important role in shaping the Commission’s understanding of current commitment practice. The study can be found at http://www.courts.state.va.us/cmh/2007_05_civil_commitment_hearings.pdf. Finally, the Commission’s third project was a study of every face-to-face crisis contact evaluation conducted by Community Service Board (“CSB”) emergency services staff during June 2007 (the “Commission’s CSB Emergency Evaluation Study”). (There were 3,808 such evaluations.) Final reports of the Hearing Study and the CSB Emergency Evaluation Study will be released in late 2008. Based on its research and the reports of its Task Forces and Working Groups, the Commission issued its Preliminary Report and Recommendations of the Commonwealth of Virginia Commission on Mental Health Law Reform (“Preliminary Report”) in December, 2007. The Preliminary Report, which is available on-line at http://www.courts.state.va.us/cmh/2007_0221_preliminary_report.pdf, outlined a comprehensive blueprint for reform (“Blueprint”) and identified specific recommendations for the 2008 session of Virginia’s General Assembly. The General Assembly enacted a major overhaul of the commitment laws in 2008, and the Commission moved into the second phase of its work. Three new Task Forces were established – one on Implementation of the 2008 reforms, another on Future Commitment Reforms, and one on Advance Directives. This document is the Report of the Commission’s Task Force on Children and Adolescents (“CA Task Force”). Although the Commission embraced many of the Recommendations of the CA Task Force in its Preliminary Report and will continue to consider the issues raised by the Task Force during future deliberations, this Report is the work of the CA Task Force and has not been adopted or endorsed by either the Commission or the Supreme Court. It was prepared as a resource for the Commission and for the public. Richard J. Bonnie, Chair Commission on Mental Health Law Reform December 2008 4 MEMBERS OF THE CHILD AND ADOLESCENT TASK FORCE Sandra O. Bryant, RNCS, LPC Virginia Federation of Families Director of Child and Family Services Richmond, VA Cenral Virginia Community Services Lynchburg, VA Timothy J. Howard Deputy Director of Community Programs Carolyn Clark, Esquire Department of Juvenile Justice Staff Attorney Richmond, VA Legal Aid Justice Center Charlottesville, VA Terry Jenkins, Ph.D. Director of Human Services Margaret Nimmo Crowe City of Virginia Beach Chair Virginia Beach, VA Richmond Behavioral Health Authority Richmond, VA The Honorable Judith A. Kline Judge, Newport News Juvenile and Rebecca W. Currin Domestic Relations Court Disability Rights Advocate Newport News, VA Virginia Office for Protection and Advocacy Richmond, VA *Charlotte V. McNulty Executive Director J. Patrick Dorgan, Ed.D. Harrisonburg-Rockingham Community Licensed Clinical Psychologist Services Board Director, Youth and Family Services Harrisonburg, VA Gloucester, VA William C. Mims, Esquire Vicki Hardy-Murrell Chief Deputy Attorney General Director Office of the Attorney General Richmond, VA Carolyn Clark served on the CA Task Force until John R. Morgan, Ph.D. November of 2007. She was replaced by Abigail Senior Policy Analyst Turner, an Attorney with Just Children in Voices for Virginia's Children Charlottesville, Virginia. Richmond, VA John E. Oliver, Esquire Charlottesville, VA Deputy City Attorney Lisa A. Scott, RN Office of the City Attorney Acting Administrator and Director of Chesapeake, VA*The Honorable Deborah Nursing M. Paxson Snowden at Fredericksburg Judge, Juvenile and Domestic Relations Fredericksburg, VA District Court Virginia Beach, VA Thomas L. Shortt, Ed.D. Executive Director John J. Pezzoli Virginia Association of Elementary Senior Inspector/Project Manager School Principals Office of the Inspector General Richmond, VA Richmond, VA Barbara P. Shue Ray Ratke Commonwealth Center for Children Deputy Commissioner and Adolescents Department of Mental Health, Mental Staunton, VA Retardation, and Substance Abuse Services Naomi Verdugo, Ph.D. Richmond, VA NAMI-Arlington Arlington, VA Scott Reiner, M.S. Program Development Manager The Honorable Janice J. Wellington Department of Juvenile Justice Judge, Thirty-first District Juvenile and Richmond, VA Domestic Relations Court Manassas, VA Joanne B. Rome, Esquire Staff Attorney Commission Editor Office of the Chief Staff Attorney Katherine L. Acuff, JD, PhD, MPH Richmond, VA Health Policy Consultant Charlottesville, VA Eileen P. Ryan, D.O. Associate Professor of Psychiatry *Co-chairs of CA Task Force and Neurobehavioral Sciences University of Virginia School of Medicine 6 TABLE OF CONTENTS Contents Page Preface 3 Child and Adolescent Task Force Members 5 Introduction 9 Chapter I. Access to Services and Relinquishment of Custody 15 Chapter II. Children with Mental Health Needs in the Juvenile Justice System 41 Chapter III. Involuntary Commitment 69 Conclusion 85 Appendices Appendix A. System of Care for Children and Families Comprehensive Services Act, Hampton, Virginia 87 Appendix B. Steps in the Virginia Juvenile Justice System 91 Appendix C. Virginia Beach Family Crisis Team 93 Appendix D. State Executive Counsel of the Comprehensive Services Act Guidelines for Relinquishment of Services 95 Appendix E. Crisis Intervention Teams and Other Police-Based Diversion and Intervention Programs for Persons with Mental Illness 97 Appendix F. Comprehensive Service Programs For Delinquent Youth 101 Appendix G. Acronyms 103 Appendix H. Recommendations 105 THIS PAGE INTENTIONALLY LEFT BLANK 8 INTRODUCTION Childhood is a critical time for the onset of behavioral and emotional disorders. In the U.S., 1 in 10 children and adolescents suffers from mental illness severe enough to cause some level of impairment at home, school or in the community.1 Mental health impairments adversely affect how children and adolescents relate to their families and peers, their performance in schools, and if not treated, are precursors to dropping out of school, placements outside of the home, encounters with juvenile justice, suicide and other dangerous behaviors. The costs of failing to treat children and adolescents are high in both human and financial terms. A sub-population of children and adolescents with mental health impairments are characterized with more severe functional limitations, known as serious emotional disturbance (“SED”), a term that refers to children under the age of 18 with a diagnosable mental health problem that severely disrupts their ability to function socially, academically, and emotionally. Approximately five to nine percent of children between ages 9 and 17 exhibit behaviors that meet the diagnosis of having an SED. 2 To be diagnosed