Building Broken Men: The Mental Health Implications of Juvenile Detention

1. Building Broken Men: The Mental Health Implications of Juvenile Detention Vasti Cedeño Fordham University Graduate School of Social Service New York, New York Social Work and The Law Dr, Tina Maschi

2. Presentation Overview Life Without Parole (LWOP) Isolation/Solitary Confinement Commonly used terms include; time out, room confinement, restricted engagement, protective custody, or the reflection cottage (ACLU, 2013). Generally, juveniles are sent to solitary for “failure to attend school” or “for their own protection” (ReasonTV, 2013). The ACLU reported that isolating a youth, even for a short period of time (in the range of an hour or more), elevates the youth’s risk of suicide and recidivism (2013). • There are currently at least 2,500 youthful offenders serving LWOP in U.S. prisons. Nationally: • 59% of these individuals received their sentences for their first ever criminal conviction. • 16% were between the ages of 13 and 15 when they committed their crimes • 26% were sentenced under a felony murder charge where their offense did not involve carrying a weapon or pulling a trigger. • Minority children are most aggressively and disproportionately affected(Dr. Jenna Saul, M.D. F.A.A.C.A.P).

3. Critical Assessment

4. Problem Background • Youths experience the passing of time differently than adults; twenty-two hours to an adult can feel like several days to a child or teen (ACLU, 2013). The physiological and psychological reactions to isolation and segregation have been widely examined amongst adult prisoners (p. 4). Some of the reactions exhibited in adult prisoners roused: Perceptual distortions and hallucinations, increased anxiety and nervousness, revenge fantasies, rage, and irrational anger; fears of persecution; lack of impulse control; severe and chronic depression; appetite loss and weight loss; heart palpitations; withdrawal; blunting of affect and apathy; talking to oneself; headaches; problems sleep; confusing thought processes; nightmares; dizziness; self-mutilation; and lower levels of brain function, including a decline in EEG activity after only seven days in solitary confinement ACLU, 2013, p.4). • In just seven days, adult prisoners presented with severe trauma induced symptomology. One day to a child or teen experiencing similar effects is enough to cause permanent mental and emotional harm (ACLU, 2013). Upon entry into the justice system, if an individual falls among the minority of youth without a mental health related diagnosis, the risk of developing one or more mental related illnesses are amplified by 99% (ACLU, 2013). Instead of building strong children, as Fredrick Douglas so intelligibly stated as the foundation of a promising future, we are perpetuating the augmenting cycle of incarceration by building broken men (Minow, 2014). • It is important to note that juveniles entering the justice system with SED/SMI or presenting with treatable behavioral disorders alike are further broken down by conditions exposing them to traumatic periods of isolation or solitary confinement. Such conditions have been proven to cause harm, psychologically, developmentally, physically, and have often resulted in severe and persistent mental illnesses (SPMI) or suicide (ACLU, 2013).

5. Theory/Perspective • Social learning theory. Bandura’s social learning theory subscribes to the notion that people learn from one another through observation, imitation, and the modeling of behavior. Displayed behavior is learned through observing the actions of others. The theory posits people learn deviant behaviors the same way they learn acceptable and normal behaviors. Social learning theory is said to be “the bridge between behaviorist and cognitive learning theories,” due to the all-encompassing elements of responsiveness, memory, and motivation (Learning-Theories.com, 2014). The theory specifies more precisely how people learn these behaviors and the prompts that elicit a process of differential reinforcement. Akers (1998, p. 50) provides a succinct statement of social learning theory as it relates to criminology and deviance, The probability that person will engage in criminal and deviant behavior is increased and the probability of their conforming to the norm is decreased when they differentially associate with others who commit criminal behavior and espouse definitions favorable to it, are relatively more exposed in-person or symbolically to salient criminal/deviant models, define it as desirable or justifies in a situation discriminative for the behavior, and have received in the past and anticipate in the current or future situation relatively greater reward than punishment for the behavior. • Vygotsky’s social development theory is also closely related as it pertains to social interaction and its influence on cognitive development, as well as social functioning and communication. Both social development and learning theories establish an individual’s environment and social interactions shape their behavior and communication facilities (Learning-Theories.com, 2014). • Institutional syndrome. Also relating to this population, is the theory of institutional syndrome, best described as “deficits in social and life skills, which develop after a person has spent a long period living in mental hospitals, prisons, or other remote institutions” (Boundless Open Textbook, 2014). These individuals often lack the ability to manage responsibilities or live independently. Institutionalized individuals are disposed to developing a mental health illness. The psychological effects of being institutionalized can be severe and deinstitutionalization can become a challenge for some individuals. The process of deinstitutionalization is taking an institutionalized individual and transferring them into “less isolated” community mental health services (2014).

6. United Nations Documents UN and International Law. Solitary confinement, isolation, and life without parole sentences violate numerous international treaties. These include but are not limited to, • International Covenant on Civil and Political Rights • United Nations Standard Minimum Rules for the Administration of Juvenile Justice • United Nations Guidelines for the Prevention of Juvenile Delinquency (Riyadh Guidelines) • United Nations Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment • American Declaration of the Rights and Duties of Man • Inter-American Convention to Prevent and Punish Torture • International law proscribes solitary confinement and prolonged isolation for youths under the age of 18. Measured as inhuman, degrading treatment, and cruel punishment, these practices are thereby condemned by international law. Outlined through various treaties and international instruments, international law and standards influence policy and legislation. It is also used as an expert source in interpreting the law as it pertains to juvenile criminal justice practices. In an attempt to protect State sovereignty as well as the said autonomy of the family unit, the US has abstained from ratifying the United Nations (UN) Convention on the Rights of the Child (CRC). The US and Somalia are the only two [UN] member states that have not yet ratified the CRC. The CRC delineates the child as anyone under the age of 18, and requires the State to provide “heightened measures of protection” especially when the child becomes involved in the juvenile justice system (UN General Assembly, Convention on the Rights of the Child [CRC], 1989). • The CRC demands the State to treat children humanely and with regard even when incarcerated (Article 37). The CRC also obliges the State to protect children from “torture and other forms of cruel, inhuman or degrading punishment” (Article 37). The Committee on the Rights of the Child, the group assigned to monitor, enforce and interpret the CRC, has identified the use of solitary confinement as a violation of Article 37. • Similarly, the U.N. Guidelines for the Prevention of Juvenile Delinquency also referred to as the Riyadh Guidelines, identifies disciplinary solitary confinement of juveniles as a form of cruel, inhuman, or degrading treatment (UN General Assembly, United Nations Guidelines for the Prevention of Juvenile Delinquency ("The Riyadh Guidelines"), 1990). Additionally, the UN Rules for the Protection of Juveniles Deprived of their Liberty also referred to as the Beijing rules unequivocally forbid solitary confinement of youths (UN General Assembly, United Nations Rules for the Protection of Juveniles Deprived of Their Liberty, 1991). Based on the aforementioned detrimental physical and psychological effects of solitary confinement and the precise susceptibility of children to those effects, the Office of the UN Special Rapporteur on torture has repeatedly called for “the abolition of solitary confinement of persons under age 18” since 2008 (Office of the High Commissioner for Human Rights, 2014).

7. Federal and State Policy • US Federal and State Law. The juvenile justice system is moving toward an alternative adjudication process undertaken by dedicated teams of “judges, lawyers, law enforcement officers, probation offices, community leaders, and mental health providers,” who are aiming to address the origins of delinquent behaviors (Kessler & Kraus, 2007, p. 385). Kessler describes such behaviors are brought on by mental health illness, substance use and abuse, low academic achievement, and collapse of the family unit (p. 385). A2003 report recommended that first-line interventions where clinical indications allow should consist of behavioral management and psychotherapy (Pappadopulosetal, 2003). Then, only after these methods have been unsuccessful should psychopharmacological interventions be considered (Pappadopulosetal, 2003; Schuretal, 2003). Unfortunately, if these methods also prove to be unsuccessful or if physical restraints are needed, perhaps then, medications may be warranted. • For example, an acutely manic offender who presents with pressured speech, aggressive behavior, and delusional thoughts would merit anti-psychotic medications for stabilization followed by psychotherapy and medications if needed, whereas a youth offender presenting with mild anxiety symptoms might merit psychotherapy as initial treatment. Similarly, acute aggression should first be managed with non-pharmacological interventions, such as stimulus reduction (Pappadopulosetal, 2003; Schuretal, 2003). • Under the 8th and 14th Amendments incarcerated juveniles with SMI have a constitutional right to service provision. The US Supreme Court's current position on juvenile offenders is that mandatory life sentences without the possibility of parole violates the Eighth Amendment prohibition on cruel and unusual punishment with respect to juvenile offenders. Very few states have abolished LWOP practices, while many others have not yet turned the new leaf.

8. Prevention and Intervention Strategies

9. Case Vignette—Promising Practice • Charlie has been referred to the Bergen County Juvenile Fire Prevention Program for engaging in firesetting events since he was 11 years-old. Charlie’s previous FireRisk assessments took place on September 2009 and April 2013. Following the previous FireRisk evaluation Charlie was placed in a residential treatment center and has attempted to engage in two firesetting events since being placed in the residential. When asked to elaborate, Ms. Brent stated over the past 11-months Charlie “threw water on a light fixture,” and “stuck something in back of the dryer to see it burn.” Charlie acknowledged both events and further stated he was bored on both occasions but did not wish the engage in a real firesetting event. Charlie shared it is easier not to engage in firesetting behaviors at the residential because he lacks access to ignition sources (i.e. lighters, matches, and stove). • Charlie has an extensive history of engaging in firesetting behaviors. According to Charlie, he began engaging in firesetting at age eleven and would do so when he was angry or sad “to melt the pain away.” Charlie reported he used to write the name(s) of the person(s) he was upset with or hurt by “on a paper, crumble it up, and light it on fire.” Charlie mentioned it helped him relieve his anger, but also stimulated his impetuous firesetting behaviors. Charlie also shared that he usually engaged in firesetting because he liked “watching the friction” and enjoyed “putting out the fire.” Charlie mentioned that he has less frequent urges to engage in fireplay and is able to control the thoughts better in the residential setting. Ms. Brent shared that Charlie has a criminal record for arson. Ms. Brent stated that the arson charge was due to an incident which occurred in a school bathroom in 2010, where Charlie took tissue papers, ignited them and threw them in the garbage bin. Ms. Brent mentioned Charlie was placed in a residential facility as “part of his sentence.” • After completing his sentence, Ms. Brent noted another event that occurred which worried her one evening; Charlie took ignited paper and threw it into his captain’s bed drawer and walked away. Ms. Brent mentioned she was in the next room when she smelled smoke and fire. Upon searching for the source of the smell Ms. Brent opened the captain bed drawer, and described that it was engulfed in flames. Ms. Brent noted the fire was put out by emergency personnel, and was most frightened that Charlie did not react nor try to put out the fire. Ms. Brent mentioned he was hospitalized after that event and determined a danger to himself and others, which resulted in his current residential treatment placement. • Charlie has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder and Bipolar Disorder since the age of 7. He is currently prescribed medication and attends several programs and groups at his residential placement. While Charlie is 17 years-old, he is cognitively and developmentally delayed and presented as a child under the age of ten. Charlie has an extensive history of antisocial behaviors including sexually exposing himself, animal abuse, excessive lying, stealing, property damage, and other severely disruptive behaviors. Charlie reported that while living at home he smoked marijuana frequently to help him “escape the pain.” Charlie also admitted to drinking alcohol frequently while living at home as a coping mechanism. The recommendations for Charlie was to remain placed in a residential treatment facility to safeguard his well-being as well as the community.

10. Levels of Oppressionengagement and collaboration • As an evaluator recommending this youth to remain placed in a residential treatment facility to safeguard his well-being and the community’s was one of the hardest to deliver in my short tenure as a risk assessor. There is no question that Charlie would end up in prison upon being released back into the community. Charlie’s urges to set fires and abuse drugs and alcohol overwhelms him at this stage of his life. He needs continued assistance in learning how to navigate and cope with those feelings embedded into his DNA. Saving Charlie from the likelihood of inappropriate incarceration for a juvenile with severe mental illnesses, as well as assisting and reinforcing his next goal in transitioning into independent living in a treatment facility against going back out into the community was a powerful and sobering moment.

11. Final Reflection

12. Reflection • This assignment allowed me to process the hard decision I made as an evaluator a few months ago for Charlie to remain in a treatment facility instead of going back home. Delving into the literature on this population allowed me to make peace with that decision and take on a different perspective. It is disheartening to learn afflicted youths are inappropriately detained and often times neglected and treated inhumanely. Having worked with children, adolescents, and their families in the mental health community it truly makes me think twice about my recommendations and referrals. • I see a large portion of children presenting with antisocial behaviors and challenging social skill interactions. While I have always had a keen interest with this population, the urgency for intervention and prevention has become more apparent to me. One of the challenges of my role is to get the family onboard and educate them on mental health conditions affecting their child. Getting families to open up to evaluations and treatment has now become something I want to focus more on. • Assessment is the essence of intervention, and it is a skill I have been fortunate to continue practicing now as a crisis response worker in Bergen County, NJ. It is very rewarding to work with children and adolescents, especially if you make an impact right before another bad decision or event takes place. I would like to hone in on utilizing various scales in my assessments, and this class has heavily encouraged that interest. Utilizing research and assessment tools will build my assessment skills, which in turn will facilitate fitting recommendations and referrals.

13. Resources

14. References Akers, Ronald L. 1998. Social Learning and Social Structure: A General Theory of Crime and Deviance. Boston: Northeastern University Press American Civil Liberties Union. (2013, November). Alone & Afraid: Children Held in Solitary Confinement and Isolation in Juvenile Detention and Correctional Facilities (Working paper). Retrieved July 6, 2014, from http://www.njjn.org/uploads/digital-library/ACLU-Alone-and-Afraid_Nov2013.pdf Boundless Open Textbook. (2014). Institutionalized Children. Retrieved July 11, 2014, from https://www.boundless.com/sociology/understanding-socialization/the-role-of-socialization/institutionalized-children/ Erickson, C. D. (2012). Using systems of care to reduce incarceration of youth with serious mental illness. American Journal of Community Psychology,49(3-4), 404-416. doi: 10.1007/s10464-011-9484-4 Gaynor, J., Ph.D. (2002, January). Juvenile Firesetter Intervention Handbook. Federal Emergency Management Agency, US. Fire Administration. Retrieved November 19, 2013, from http://www.usfa.fema.gov/downloads/pdf/publications/fa-210.pdf Juvenile Law Center. (2001, July 1). A.M. v. Luzerne County Juvenile Detention Center. Retrieved July 7, 2014, from http://www.jlc.org/legal-docket/am-v-luzerne-county-juvenile-detention-center Kessler, C. L., & Kraus, L. (2007). The mental health needs of young offenders: Forging paths toward reintegration and rehabilitation. Cambridge, MA: Cambridge University Press. Learning-Theories.com. (2014). Social Learning Theory (Bandura) | Learning Theories. Retrieved July 11, 2014, from http://www.learning-theories.com/social-learning-theory-bandura.html Mental Health America. (2014, June 7). Position Statement 58: Life without Parole for Juvenile Offenders. Retrieved July 4, 2014, from http://www.mentalhealthamerica.net/positions/life-without-parole-juveniles#_ednref2 Miller, G. (2012). Supreme Court Cites Science in Limiting Punishments for Juveniles. Science,337(6090), 25-25. doi: 10.1126/science.337.6090.25 Minow, M. (2014, July 6). "It is easier to build strong children than fix broken men:" At HLS summit, Edelman says we must move from punishment to justice" Lecture presented at Coming Together to Dismantle the Cradle to Prison Pipeline in Massachusetts: A Half-Day Summit of Community, Faith and Policy Leaders in Harvard Law School. Retrieved from http://today.law.harvard.edu/it-is-easier-to-build-strong-children-than-fix-broken-men-at-hls-summit-edelman-says-we-must-move-from-punishment-to-justice-video/ National Alliance on Mental Illness. (2013). Mental Illness: Facts and Numbers. Mental Illness FACTS AND NUMBERS. Retrieved July 7, 2014, from http://www.nami.org/factsheets/mentalillness_factsheet.pdf The National Council on Crime and Delinquency. (2012). Juvenile Detention in Cook County: Future Directions (Publication). Retrieved July 6, 2014, from http://nccdglobal.org/sites/default/files/publication_pdf/cook-county-report.pdf Office of the High Commissioner for Human Rights. (2014). Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. Retrieved July 9, 2014, from http%3A%2F%2Fwww.ohchr.org%2Fen%2Fissues%2Ftorture%2Fsrtorture%2Fpages%2Fsrtortureindex.aspx ReasonTV. (2013, September 26). "For Their Own Protection": Children in Long-Term Solitary Confinement. Retrieved July 9, 2014, from https://www.youtube.com/watch?v=ePEf4cOisDk Slavkin & Fineman, M., & Fineman, K. (2000). What every professional who works with adolescents should know about firesetters. Adolescence,35(140), 761-773. Retrieved February 27, 2014. UN General Assembly, Convention on the Rights of the Child, 20 November 1989, United Nations, Treaty Series, vol. 1577, p. 3, available at: http://www.refworld.org/docid/3ae6b38f0.html [accessed 8 July 2014] UN General Assembly, United Nations Guidelines for the Prevention of Juvenile Delinquency ("The Riyadh Guidelines"): resolution / adopted by the General Assembly, 14 December 1990, A/RES/45/112, available at: http://www.refworld.org/docid/3b00f21d1c.html [accessed 9 July 2014]

15. Contact Information Vasti Cedeño, MA vcedeno1@fordham.edu