Susan Bigelow recently posted an opinion piece on CT News Junkie regarding the opening of an all-girls locked psychiatric unit in Middletown in which she questioned both the need for and the effectiveness of such a treatment facility. Clearly Ms. Bigelow has no direct knowledge of the current state of mental health and her piece illustrates such. I have worked in the field of mental health, on locked units, for nearly six years now and my wife for nine. I have seen the effectiveness of “community based” mental health care, particularly for adolescents and I can tell you that it is failing and cannot possibly address or handle the adolescents that will be housed in this facility.

It is clear Ms. Bigelow recoils at the idea of a locked unit but the truth of the matter is that these patients run away, cause themselves and others harm, engage in drug use, prostitution, and suffer rape and assault. While many choose not to acknowledge this inconvenient fact, these are highly troubled individuals. The fact that they are not technically adults makes them more difficult to handle rather than less. They have not only been emotionally traumatized in the past by their biological families as well as foster families but also have psychological and personality problems that are beyond the ability of modern medicine to address. Long-term therapy and institutionalization are the only recourses left they may offer some hope for their future, and that hope is slim at best. While this may sound like a pessimistic viewpoint, it is hard to maintain an optimistic one while working in this field when dealing with a recidivism rate of ninety percent and more.

Secondly, the idea that these girls can be cycled through the foster system ignores the reality of trying to live with and raise these adolescents. They often hurt and threaten, not only their foster parents, but the biological children of those parents. There are instances of sexual assault on siblings by these troubled girls, physical assault, and even attempted murder. The girls that this facility would house are the ones who have been in the foster care system and are repeatedly rejected by foster families due to the danger they represent. Some may object and say that the examples I give (of course I cannot give specific cases due to HIPAA laws) are isolated incidents, but this facility only houses twelve girls; if you think that we can’t find twelve “isolated incidents” of such behavior then I have a bridge to sell you.

This isn’t for lack of trying but the “community based” system of mental healthcare has been an abject failure since its inception. The idea that somehow, psychiatric patients will be able to adjust to normal life with the help of an army of government employees and the community’s good will is preposterous and the effects of this form of “treatment” can be chronicled in newspapers across the nation.

She cites Martha Stone of the Center for Children’s Advocacy who states, “It’s gridlock at Journey House.”  Well, welcome to reality. It’s gridlock in nearly all of mental health treatment but particularly among the adolescents because they cannot be released under their own care and supervision the way that adults can. Most of these adolescents have been rejected by their biological families or removed from them due to abuse and negligence; foster families cannot handle them and they constantly run away from unlocked housing facilities. So what, then, should be done with them? The piece offers criticism but no answer based on the reality of these situations.

Stone also says that placement in a locked facility is, “the worst thing that can be done to a child that has been traumatized.” I would argue, opposed to what? Jumping from foster family to foster family? Being constantly re-traumatized by engaging in risky behavior when they runaway from unlocked facilities? Or, perhaps, prison where many of them will find themselves after reaching eighteen? Secondly, there are locked facilities across the state, not just “two” as cited by Matthew Lesser –D Middletown. Nearly every hospital has a locked psychiatric unit and patients can stay there for months depending on their specific situation. Middletown has a locked facility as does Bridgeport, which are both state run. But Danbury Hospital, Waterbury Hospital (one of the nation’s largest), St. Mary’s, Yale, and Charlotte-Hungerford also have locked behavioral health units. While they are not run by the state, they are indeed inspected by it and paid for, largely, with tax-payer dollars through Medicaid and Social Security/Disability. Trauma cannot be relieved by inflicting trauma on society and others through allowing these adolescents to act out repeatedly with no means of controlling them.

Sarah Eagan asks, “What is the quality assurance plan for this facility?” Frankly, if you are looking for assurances that this treatment will work, there are none, but there are no such assurances in all of healthcare, particularly in mental health. There is no assurance that a surgery will be successful and no assurance that broken limb will heal correctly. Mental health is even more complex than normal medical care, we cannot give someone a particular treatment or particular medication and be assured of the outcome and, when the individual is finally discharged, there is zero assurance that they will continue with said medication or treatment and zero ways to enforce such treatment until the individual commits a crime.

Part of the problem of mental health in the state of Connecticut is that the treatment facilities are handcuffed by the concerns and hand-wringing of such people like Ms. Bigelow. They know nothing about the state of mental health and are unwilling to subject themselves to the dangers, ambiguities, frustrations, ineffectiveness, and, most of all, the lack of assurance to put in place the necessary laws and measures in place to actually make a difference.

It is interesting that Ms. Bigelow’s article comes on the heels of Mr. Lanza’s interview in the New Yorker. Lanza had never committed a crime nor been violent in any way and therefore could not be hospitalized against his will. Adam Lanza’s issues were dealt with by a caring family and a “community” of doctors and therapists with horrific results. To believe that other adolescents who have not even had the advantage of a caring family will fare much better is as naïve as it is ludicrous.