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95–193 PDF 2004

S. Hrg. 108–696

JUVENILE DETENTION CENTERS: ARE THEY

WAREHOUSING CHILDREN WITH

MENTAL ILLNESS?

HEARING

BEFORE THE

COMMITTEE ON 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

JULY 7, 2004

Printed for the use of the Committee on Governmental Affairs

(

(II)

COMMITTEE ON GOVERNMENTAL AFFAIRS 

SUSAN M. COLLINS, Maine, Chairman 

TED STEVENS, Alaska 

GEORGE V. VOINOVICH, Ohio 

NORM COLEMAN, Minnesota 

ARLEN SPECTER, Pennsylvania 

ROBERT F. BENNETT, Utah 

PETER G. FITZGERALD, Illinois 

JOHN E. SUNUNU, New Hampshire 

RICHARD C. SHELBY, Alabama 

JOSEPH I. LIEBERMAN, Connecticut 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

RICHARD J. DURBIN, Illinois 

THOMAS R. CARPER, Delaware 

MARK DAYTON, Minnesota 

FRANK LAUTENBERG, New Jersey 

MARK PRYOR, Arkansas

MICHAEL D. BOPP, Staff Director and Chief Counsel 

PRISCILLA HANLEY, Professional Staff Member 

JOYCE A. RECHTSCHAFFEN, Minority Staff Director and Counsel 

DONNY WILLIAMS, Minority Professional Staff Member 

AMY B. NEWHOUSE, Chief Clerk 

(III)

C O N T E N T S 

Opening statements: Page 

Senator Collins ................................................................................................. 1

Senator Lautenberg .......................................................................................... 3

Senator Carper ................................................................................................. 4

Senator Durbin ................................................................................................. 26

WITNESSES 

WEDNESDAY, JULY 7, 2004

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California .............................................................................................................. 7

Carol Carothers, Executive Director, National Alliance for the Mentally Ill 

of Maine ................................................................................................................ 10

Tammy Seltzer, Staff Attorney, Judge David L. Bazelon Center for Mental 

Health Law ........................................................................................................... 12

Leonard Dixon, President, National Juvenile Detention Association, and Executive Director, Wayne County Juvenile Detention Facility, Detroit, Michigan ......................................................................................................................... 14

Hon. Ernestine S. Gray, Chief Judge, Orleans Parish Juvenile Court, New 

Orleans, Louisiana ............................................................................................... 17

Kenneth J. Martinez, Psy.D., Director, Children’s Behavioral Health, Department of Children, Youth and Families, State of New Mexico .......................... 19

ALPHABETICAL LIST OF WITNESSES

Carothers, Carol: 

Testimony .......................................................................................................... 10

Prepared Statement ......................................................................................... 57

Dixon, Leonard: 

Testimony .......................................................................................................... 14

Prepared Statement ......................................................................................... 76

Gray, Hon. Ernestine S.: 

Testimony .......................................................................................................... 17

Prepared Statement ......................................................................................... 87

Martinez, Kenneth J., Psy.D.: 

Testimony .......................................................................................................... 19

Prepared Statement ......................................................................................... 89

Seltzer, Tammy: 

Testimony .......................................................................................................... 12

Prepared Statement ......................................................................................... 63

Waxman, Hon. Henry A.: 

Testimony .......................................................................................................... 7

Prepared Statement with attachments ........................................................... 31

APPENDIX 

National Council on Disability, prepared statement ............................................ 99

Edward J. Loughran, Executive Director, Council of Juvenile Correctional 

Administrators (CJCA), prepared statement ..................................................... 117

(1)

JUVENILE DETENTION CENTERS: ARE THEY 

WAREHOUSING CHILDREN WITH MENTAL 

ILLNESS? 

WEDNESDAY, JULY 7, 2004

U.S. SENATE, 

COMMITTEE ON GOVERNMENTAL AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 10:01 a.m., in room 

SD–342, Dirksen Senate Office Building, Hon. Susan M. Collins, 

Chairman of the Committee, presiding. 

Present: Senators Collins, Lautenberg, Carper, and Durbin. 

OPENING STATEMENT OF CHAIRMAN COLLINS 

Chairman COLLINS. The Committee will come to order. 

Good morning. Last summer, the Committee on Governmental 

Affairs held a series of hearings to examine the difficult challenges 

faced by families with children with mental illness. We heard compelling testimony from families who described their personal struggles to get mental health services for their severely ill children. 

They told us about the limitations in both public and private insurance coverage, the shortage of mental health professionals, and the 

long waiting list for desperately needed mental health services. 

They discussed the lack of coordination and communication 

among the various agencies and programs that serve children with 

mental health needs. And most disturbingly, they told us that some 

parents are actually advised that the only way to get the intensive 

care and services that their children need is to relinquish custody 

and place them in the child welfare or juvenile justice system. This 

is a wrenching decision that no family should ever have to make. 

No parent should have to give up custody of his or her child just 

to get the health care services that that child so desperately needs. 

Today, we will be examining another consequence of our tattered 

safety net for children with mental illness, and that is the inappropriate use of juvenile detention centers as holding areas for people 

who are waiting for mental health services. Like custody relinquishment, these inappropriate detentions are a regrettable 

symptom of a much larger problem, which is the lack of available, 

affordable, and appropriate mental health services and support systems for these young people and their families in the communities 

in which they live. 

Serious mental illness afflicts millions of our Nation’s children 

and adolescents. It is estimated that as many as one in five American children under the age of 17 suffers from a mental, emotional, 

2

or behavioral illness. What is even more disturbing is the fact that 

two-thirds of all young people who need mental health treatment 

are not getting it. 

If two-thirds of children with cancer were not getting the treatment that they needed, there would be a huge public outcry. Yet 

we have a situation in this country where two-thirds of the children with serious mental illness are not getting the services that 

they need. 

When a child has a serious physical health problem like diabetes 

or cancer, the family turns to their doctor. But when a family includes a child with a serious mental illness it is often forced to go 

to child welfare or the juvenile justice system to secure treatment. 

Yet neither system is intended to serve children with serious mental illness. Child welfare systems are designed to protect children 

who have been abused or neglected. Juvenile justice systems are 

designed to rehabilitate children who have committed criminal or 

delinquent acts. While neither of these systems is equipped to care 

for a child with a serious mental illness, in far too many cases 

there simply is nowhere else for the family to turn. 

In extreme cases, families may feel forced to actually file charges 

against their child or to declare that they have abused or neglected 

them in order to get the care that they need. As one advocate observed, ‘‘beat them up, lock them up, or give them up’’ characterizes the choices that some families face in their efforts to get help 

for their children’s mental illness. Those are clearly no choices at 

all. 

According to a General Accounting Office study that I requested 

last year with Representatives Pete Stark and Patrick Kennedy, 

parents placed more than 12,700 children into the child welfare or 

juvenile justice systems in 2001 so that these children could receive 

mental health treatment. Of these 12,700 children, 9,000, the vast 

majority, entered the juvenile justice system. 

I believe that this statistic represents just the tip of the iceberg 

since 32 States, including five with the largest populations of children, did not provide the GAO with any data. Other studies indicate that the problem is even more pervasive. A 1999 survey by the 

National Alliance for the Mentally Ill found that 36 percent of the 

families surveyed placed their children in the juvenile justice system to access mental health services that otherwise were not available to them. 

The question is, what happens to these children when they are 

turned over to the juvenile justice system? Unfortunately, the report that Congressman Henry Waxman and I are releasing today 

shows that too often they are simply left to languish in juvenile detention centers which are ill-equipped to meet their needs while 

they wait for scarce mental health services. 

A compelling series of stories by Barbara Walsh of the Portland 

Press Herald in Maine detailed the obstacles that many Maine 

families have faced in getting care for their children with mental 

illness. One of her stories was entitled, ‘‘Locked Up, Waiting for 

Help.’’ It told the story of a clinically depressed 14-year-old boy who 

was held in limbo in the Cumberland County Jail while he waited 

for a bed in a residential treatment center. While he was supposed 

to be placed within a few weeks, he wound up sitting in a jail cell 

3

for 4 months without any treatment. While he waited his illness 

grew worse. He was also locked up with many older, more violent 

kids, and was ultimately sexually assaulted. Later he attempted 

suicide. 

Unfortunately, this sad story is not unique. The report we are releasing today demonstrates that this terrible problem exists nationwide. Based on a national survey of the juvenile detention center 

administrators, the report finds that the use of juvenile detention 

facilities to warehouse children with mental disorders is a serious 

national problem. Over the 6-month period covered by our report, 

nearly 15,000 incarcerated youth were detained solely because they 

were waiting for mental health services. Many were held without 

any charges pending against them, and the children who were incarcerated unnecessarily while waiting for treatment were as 

young as 7 years old. 

Finally, the report estimates that juvenile detention facilities are 

spending an estimated $100 million of taxpayer’s money each year 

simply to warehouse these children and teenagers while they are 

waiting for services. This morning’s hearing will provide an opportunity for representatives of the juvenile justice and mental health 

systems, as well as advocates for children and their families, to respond to this report. My hope is that this hearing will not only 

heighten public awareness of the difficult problems confronting 

these children and their families but also help us to make the case, 

help us to press for legislative and administrative reforms at both 

the State and the Federal level to reduce the barriers to care for 

children who suffer from mental illness. 

In closing, I want to commend Congressman Henry Waxman for 

his outstanding leadership on this issue. He has long been a leader 

on health care issues, and it has been a pleasure to work with him 

on this report. I am hoping that our bipartisan, bicameral efforts 

will produce real reform because it is desperately needed. I also 

want to salute the Congressman’s staff for the excellent research 

that they did in compiling this report. The Congressman will be 

our leadoff witness, just as soon as I turn to Senator Lautenberg 

for his opening comments. 

OPENING STATEMENT OF SENATOR LAUTENBERG 

Senator LAUTENBERG. I thank you, Madam Chairman, for holding this hearing and for your statement which I think is very accurate and at the same time descriptive, especially in that cryptic 

comment about give them up, beat them up. What was that exactly? 

Chairman COLLINS. Beat them up, lock them up, or give them 

up. It is awful. 

Senator LAUTENBERG. Terrible. It conveys a sense of the desperation that families go through. I am pleased also, Madam Chairman, 

that we have Congressman Waxman here and that the two of you 

have worked together. I think that is excellent. Congressman Waxman and I have worked on many things together and I always find 

him especially circumspect about the things we do, and searching 

for accuracy in his presentations. And the outcome often points to 

the research having been so effective. 

4

Right now, the results of the survey that you have conducted 

about juvenile detention centers and the population of those who 

are mentally ill in these institutions presents a sad picture of neglect. There is a national scourge with regard to treating our children who suffer from mental illness. Millions of our kids are going 

without the needed mental health care that they need. Studies 

show that 70 percent of our young people are in need of some mental health service and do not receive it. 

When children with mental or emotional disorders cannot get the 

help they need, appalling and often entirely preventable outcomes 

result. They and their families suffer through unnecessary crises 

which can lead to school failure, dramatic out-of-home placements, 

and in some cases, arrest or suicide. Families unable to pay for 

services through private insurance or ineligible for services through 

the public health systems relinquish custody of their children to obtain state-funded services. Again, these are desperate moves. There 

are very few families who want to see their child punished without 

any prospect of a light at the end of the tunnel. 

No family should feel that it has to relinquish custody of a child 

to obtain needed mental health services. Yet scores of parents 

across the Nation have surrendered their influence on key aspects 

of the children’s lives to get access to public mental health services 

for their kids. This is a difficult problem to address, to be sure, and 

there are a couple of bills that would help. One, Madam Chairman, 

is yours, the Keeping Families Together Act, and I would like to 

be included as a co-sponsor. I think it has been done, but if not, 

I certainly want to be there. 

Chairman COLLINS. We are pleased to have you. 

Senator LAUTENBERG. I want to help you work with this problem, 

see if we can find a solution jointly. That one would lay a strong 

foundation for needed reforms by promoting access to these services and reducing fragmentation in service delivery. 

Another is a bill that has overwhelming support in Congress, and 

that is the Senator Paul Wellstone Mental Health Equitable Treatment Act. This bill would build on a 1996 law prohibiting health 

plans that offer mental health coverage from setting lower annual 

and lifetime spending limits for mental illness treatment. In an 

April 2002 speech to mental health professionals in New Mexico 

President Bush said, the health insurance system must treat mental illness like any other ailment stating ‘‘that Americans deserve 

a health care system that treats their illnesses, their mental illnesses with the same urgency as a physical illness.’’ I agree with 

the President’s sentiment and I hope the administration, in the 

short time remaining in this session, becomes more involved in the 

issue. The President’s support would go a long way in getting these 

bills signed into law before we adjourn in the fall. 

I thank you, Madam Chairman, for doing this. 

Chairman COLLINS. Thank you. Senator Carper. 

OPENING STATEMENT OF SENATOR CARPER 

Senator CARPER. Thank you, Madam Chairman. I just came to 

see Henry Waxman. Henry, you are holding up well. I have known 

him for about 22 years. He looks today just like he did—either he 

5

is aging gracefully or he just got old quick. I am not sure which. 

It is great to see you, and appreciate your work on so many issues. 

Senator Collins and I are especially aware of the good work he 

is doing over in the House with Congressman McHugh on postal 

reform. We are mindful of that work and grateful for the opportunity to partner with you on that front. 

I want to add a comment or two with respect to the issue that 

is before us today. I am not going to speak to serious mental disorders but I do want to talk about some of the briefing materials 

that I read on the hearing today, talk about a lot of students who 

are in special ed and how they end up in prisons. I do not know 

if you remember a fellow named Barry McCaffrey. Barry McCaffrey 

was the Nation’s drug czar, retired general. He came to our State 

several years ago when I was governor, and he came to our State 

in order to put a spotlight on a program that we had put in place 

in all of our prisons called a Key and Crest program. Whenever 

people are within a year of leaving prison we would put them 

through an extensive program, last about half a year. We would 

follow up with them outside of prison. And we cut the rate of recidivism for people who completed the program from about 70 percent for most of our population down to about 40 percent, which is 

real progress. It is not zero, but it is a much-improved reduction 

in the number of people who come back to prison after they have 

been released. 

I remember a conversation that he and I had with a lot of inmates in a room just a little bit smaller than this one. We had really about an extra half an hour to kill on our tour of Gandry Hill 

Prison in Wilmington, Delaware. We had about 70 inmates in the 

room with us. I said to the inmates—Delaware is a small State and 

you literally know almost everybody, and I knew a bunch of them. 

I said, how did you guys end up here? And a lot of them were 

young, late teens, early 20’s. I said, how did you guys end up here? 

Just tell us your story. 

About three or four took the advantage to do that and they told 

a story that was frighteningly similar. I was born when my mom 

was young. I never knew my dad. I started school and other kids 

knew how to read, they knew their letters, they knew numbers. 

They could already do that when they got to kindergarten. I could 

not, and I started behind. They knew words that I did not. I started behind and just got further behind. And I finally learned when 

a teacher called on me, in an effort to not be embarrassed by how 

little I knew, just to be disruptive, and to make them wish they 

had not called on me. Eventually they put me out in the hall or 

maybe sent me down to the principal’s office. When I got older I 

found that if I was disruptive enough, rather than be embarrassed 

every day with just how little I knew, they would suspend me and 

maybe eventually expel me. 

And I got out on the streets and did not have any skills or any 

knowledge, could not read or write, and the way that I could enhance my self-esteem was to turn to drugs or alcohol. And since I 

didn’t have any skills to make a living, I turned to crime in order 

to get the money to buy the drugs or alcohol and make me feel better about myself. It was interesting, one after the other really told 

stories very much like that. 

6

The point I want to make is this, and I know I have used too 

much time, there are amazing things that we can do with very 

young people to make sure that when they walk into kindergarten 

at the age of five and first grade at the age of six, they are ready 

to roll. They are ready to be successful. 

In my State, we have just completed not long ago a longitudinal 

study where we took early age, we work with their parents to make 

sure that they had the skills that they needed to help prepare their 

kids for success, pre-K age three, age four, full day kindergarten 

for those kids, and then to use afterschool programs to work with 

those kids once they got in the first grade. We found at the end 

of the study period that we were studying these hundreds of kids, 

that we reduced by more than half the referrals to special ed. We 

found that those kids reached the third grade, that they were performing on par just about as well as other kids from normal, intact 

two-parent families where they had every opportunity. 

The last thing I would say is this, we had a debate—not really 

a debate, but a discussion on the Senate floor a couple of months 

ago when welfare reform came up, and the issue we were debating 

was the Snowe amendment on the adequacy of funding for child 

care, quality child care for those whose parents are going off of welfare and going to work. Having a colloquy with Senator Chris 

Dodd, and I made the point, if you have got kids who grow up in 

a family where somebody reads to them literally from the start, 

just works with them on their vocabulary and exposes them to all 

kinds of experiences, good experiences, and works on their intellect, 

those kids will walk into the first grade with a 25,000-word advantage in their vocabulary over kids who have not had that opportunity. 

And Chris Dodd said, no, you are wrong. It is 100,000 words. It 

is 100,000 words, the deficit that kids bring from a disadvantaged 

background where no one has been involved, no one has been preparing them. And we should not be surprised that when those kids 

get to school they fall behind, and they get in trouble. And when 

they get in trouble, they do not finish school. And when they do not 

finish school, they end up out on our streets and they commit 

crimes. A lot of them were in that prison that day, and some of 

them are probably still there. But we can do something about that. 

Last P.S., if I may, Madam Chairman. It is a great story about 

an accelerated reading program in our State that has been introduced in a couple of elementary schools, actually in kindergarten. 

They have been able to work with kids in kindergarten so that by 

the time they finish kindergarten they are reading at a first and 

second-grade level. These are kids from from 30, 40, 50 percent free 

and reduced price lunch schools, and these are schools where they 

have taken the kids from almost nobody reading at a first or second-grade level to as many as 80 percent of the kids reading at a 

first or second-grade level. Kids you would never expect that to 

happen. 

So I want to mention those things that happen in the real world 

every day. This is the real world too, but I wanted to share them. 

Thank you very much. 

Congressman Waxman, Hon. Henry Waxman, great to see you. 

Chairman COLLINS. Thank you. 

7

1The prepared statement of Mr. Waxman, with attachments, appears in the Appendix on page 

31. 

It is now my pleasure to welcome our leadoff witness, Representative Henry Waxman. He represents California’s 30th Congressional District. I understand that you first came to Congress in 

1974. That was the same year that I first came to Congress, but 

I was a lowly intern for then-Congressman Bill Cohen, whereas you 

came as a powerful congressman, so there was quite a difference. 

Since 1997, Representative Waxman has served as the ranking 

member of our companion committee in the House, the Government Reform Committee. He has established a special investigations division staff that has prepared many investigative reports, 

including the one that we are releasing today. As I mentioned in 

my opening statement, Representative Waxman has been a longtime leader on health care issues in the House of Representatives 

and I am very pleased that he is here today. 

After your statement, Congressman, I would invite you to come 

up and join us up here, because I know you will want to participate 

further in the hearing. So please proceed with your statement and 

again, thank you. 

TESTIMONY OF HON. HENRY WAXMAN,1 A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. WAXMAN. Thank you very much, Chairman Collins, for your 

leadership on this important issue, for holding this hearing, and for 

the extraordinary kindness you are showing me by inviting me to 

join you at the hearing. I think it is unusual to have a member of 

the House sit with the Senators, but on this issue we are not 

House members or Senate members, we are not Democrats or Republicans. We are people who care about an issue that we hope we 

can do something about. Senator Lautenberg and Senator Carper, 

thank you for your kind words. Senator Lautenberg about my 

work, Senator Carper, about the way I look. I will take whatever 

good comments I can get. But you two in your statements have expressed an extraordinary understanding of the loss to all of us in 

this country if we do not do all we can to help children realize their 

full potential. 

What we are discussing today is a small issue. There are huge 

issues of how to make sure that everyone has the opportunity to 

succeed to the full extent possible. But in this particular situation 

there is an issue that I think we need to pay attention. Too often 

there is little connection between issues Congress addresses and 

the real problems facing our Nation. When foreign sales corporations seek change in the tax laws, as they are currently doing, hundreds of lobbyists come out of the woodwork and campaign contributions flow like water, and the attention of legislators become 

riveted on arcane provisions that have little relevance for most 

Americans. 

But when there is a crisis in access to children’s mental health 

services, that same sense of urgency is lacking. The problem is real 

and affects millions of families, yet without corporate lobbyists in 

the hallways or the prospect of sizable campaign contributions, the 

needs of children with mental illness have received little attention. 

8

That is why your long term commitment to children’s mental 

health care is so rare and so extraordinary. The fact that all three 

of you are taking your time to be here shows your commitment to 

trying to understand the problem and trying to think through what 

we can do about it. 

The report we are releasing today is so important. I hope we can 

finally jolt Congress and the administration into action. Two years 

ago, at the request of Senator Jeff Bingaman and Representative 

Tom Udall, my staff investigated the fate of youth with mental illness in New Mexico who could not obtain care in their communities. What we found was deeply disturbing. One in seven youth 

in juvenile detention in New Mexico were there solely to wait for 

mental health services. Over 700 young people jailed simply because treatment was not available. 

It was apparent to you, Chairman Collins, and to me that these 

inexcusable conditions were likely to extend beyond New Mexico, so 

at our joint request we asked the staff to expand its investigation. 

We surveyed every juvenile detention facility in the United States. 

We heard back from more that 500 administrators in 49 States, a 

response rate of over 75 percent. The resulting report is the first 

ever national study of unnecessary incarceration of children suffering from mental illness and here are some of the key findings. 

Two-thirds of juvenile detention facilities in the United States 

lock up mentally ill youth because there is no place else for them 

to go. 

Every day, about 2,000 young people are incarcerated simply because community mental health services are unavailable. This represents about 7 percent of all youth in juvenile detention. 

In 33 States, juvenile detention centers hold young people with 

mental illness who have no charges against them of any kind. 

Over 160 detention centers report that youth held unnecessarily 

have attempted suicide. 

And children as young as 7 years of age are incarcerated because 

they do not have access to care. 

Many of the detention centers we surveyed responded with written pleas. A detention center in Louisiana wrote, ‘‘We appear to be 

warehousing young people with mental illnesses due to lack of 

mental health services.’’ A Washington State administrator said, 

‘‘We have had a number of juveniles who should no more be in our 

institution than I should be able to fly.’’

A Tennessee administrator implored, ‘‘The last place some of 

these kids need to be is in detention. . . . Those with depression 

are locked up alone to contemplate suicide. I guess you get the picture.’’

And we get the picture, too, and it is deplorable. 

The findings of this report indict how our society treats children 

suffering from mental illness in the United States of America in 

the 21st Century. 

The report recalls the 19th Century. It recalls Charles Dickens 

and what he wrote about how people were treated in London at 

that period of time; and in this country, when reformer Dorothea 

Dix traveled from jail to jail gathering stories of individuals suffering from mental illness who were abandoned and ignored. Her 

work led to the creation of the Nation’s first asylums. 

9

Since the mid-1800’s, psychiatry and associated professions have 

learned to diagnose and treat complicated mental illnesses. Hospitalization is now recognized as a treatment of last resort. It is 

well understood that many children with mental illness can recover 

and lead productive lives. 

Yet even as scientific knowledge has advanced, our social policy 

has faltered. We have seen the emptying of psychiatric institutions 

without the establishment of community services. We have seen 

the starvation of public budgets that support the basic needs of 

millions of Americans with mental illness. 

And today, the backbone of financing for children’s mental health 

services, the Medicaid program, is in grave danger. Proposals to 

turn a guarantee of care into block grants for States could seriously 

compromise what little is left of the safety net. 

The findings of this report call on us to reverse course. 

Congress must ensure that adequate mental health services are 

available to all who need them. We must reform a confusing and 

bewildering mental health care system so that it works for the benefit of children and their families. 

And we must insist upon accountability so that someone is held 

responsible each and every time a child is jailed to wait for mental 

health services. 

We must work together—not as Democrats or as Republicans, 

but as Americans who care about children and their families—to 

end this warehousing of young people who are in need of treatment. 

In closing, let me again thank you, Chairman Collins, for your 

leadership. I look forward to hearing the distinguished witnesses 

who will testify about these serious problems later this morning. 

I hope we can learn more about this problem, draw some attention to it, and then think together how not to just ignore this problem but be constructive on a serious matter. 

Thank you very much. 

Chairman COLLINS. Thank you for your excellent testimony. I 

would invite you to come join us. To avoid giving my Republican 

colleagues a heart attack, I would suggest you sit on the Democratic side. [Laughter.] 

But we would welcome you to come join us for the second witness 

panel. 

I do want to salute you again for your excellent survey. It really 

was not only comprehensive—and I was pleased to join in supporting it—but it gave us for the first time a picture of just how 

widespread and serious this problem is. As you stated in your testimony, the fact that we have 2,000 children on any given night incarcerated who have done nothing wrong but are just simply ill 

ought to be a call to action for all of us. So thank you for your good 

work, and please do come join us. 

Mr. WAXMAN. Thank you very much. 

Chairman COLLINS. The Committee will now hear from representatives of the juvenile justice and mental health systems as 

well as from advocates for young people with mental disorders and 

their families. 

First, I am pleased to welcome Carol Carothers, who is the Executive Director of the National Alliance for the Mentally Ill in the 

10

1The prepared statement of Ms. Carothers appears in the Appendix on page 57. 

State of Maine. She is also, I am very proud to say, the recipient 

of this year’s highly prestigious Robert Wood Johnson Community 

Health Leadership Program Award for her efforts to prevent inappropriate incarceration and her advocacy for improving treatment 

for people with mental illness who have become involved with police and correctional institutions in Maine. 

I will tell you, for the benefit of those of you who do not live in 

Maine, that Carol is known throughout the State for her tremendous advocacy on behalf of people who are suffering from mental 

illness. She is a hero with local law enforcement and sheriffs who 

too often find that people with mental illness are in their jails and 

prisons. And we are very pleased to have her here today. 

The Committee is also very proud to welcome back Tammy Seltzer, the senior staff attorney for the Judge David L. Bazelon Center 

for Mental Health Law, which is a leading national legal advocacy 

organization for adults and children with mental disabilities. We 

worked with the center in our previous hearings last year, and we 

are very pleased to welcome Ms. Seltzer back. 

Next I would like to introduce Leonard Dixon, who is the Executive Director of the Wayne County Juvenile Detention Facility in 

Detroit, Michigan. Mr. Dixon is also the President of the National 

Juvenile Detention Association and will be testifying on behalf of 

that association, as well as the American Correctional Association, 

and we are very pleased to have you here as well. 

The Committee is also pleased to welcome the Hon. Ernestine S. 

Gray. Judge Gray has served in the Orleans—that may be a Maine 

pronunciation—Parish Juvenile Court in Louisiana as a judge for 

more than 19 years, and she has received national recognition for 

her work on behalf of children and their families. Welcome to you. 

And last, but certainly not least, we will hear from Dr. Ken Martinez, the Director of Children’s Behavioral Health for the Department of Children, Youth and Families in New Mexico. Dr. Martinez 

will tell us about some of the very innovative programs that have 

been initiated to address this problem in New Mexico, and we are 

very pleased that you could be with us as well so that we can see 

what can be done in a very practical way. 

As you can see, we have assembled a very distinguished panel 

of witnesses. I am very pleased you could all be with us, and we 

are going to start with Ms. Carothers. Thank you. 

TESTIMONY OF CAROL CAROTHERS,1 EXECUTIVE DIRECTOR, 

NATIONAL ALLIANCE FOR THE MENTALLY ILL OF MAINE 

Ms. CAROTHERS. Thank you, Chairman Collins and Members of 

the Governmental Affairs Committee. I am Carol Carothers, the 

Executive Director of NAMI Maine, which is the Maine State chapter of NAMI—the National Alliance for the Mentally Ill. Thank you 

for the opportunity to testify. 

I can tell you that the findings contained in today’s report are 

accurate. Youth with mental illnesses are held in juvenile detention 

because they cannot access treatment. We would not dream of placing a child with cancer, for example, in juvenile detention to await 

11

treatment. It is outrageous that we do this to children with mental 

illness, and there are four points I would like to make today. 

One, children and families are suffering unthinkable consequences from this crisis. My first involvement with this issue was 

the death by hanging of an 18-year-old whose mental illness and 

substance use disorder had been untreated for years. He died in 

Maine’s most restrictive prison—the super-max—because he was 

suicidal and no hospital bed could be found. 

More recently, Maine settled a lawsuit on behalf of a child committed to the youth center at age 13. He was suffering from depression and suicidal ideation, held in isolation for 152 of his first 240 

days. Each of five future admissions also resulted in long periods 

of isolation, behavior deterioration, depression, aggression, and 

eventually self-mutilation. 

Just last week, I spoke to two moms. Both tried unsuccessfully 

for years to secure school-based services for their mentally ill sons. 

The schools sent them home or suspended them for not following 

school rules. The moms nearly lost their jobs. The other children 

begged to have their brothers kicked out. Eventually, the courts, 

with few resources, incarcerated them. Once incarcerated, the boys 

lived with more accomplished juveniles. One mom said, ‘‘If I could 

ask anything, I would ask, ‘What money did you save by denying 

my son mental health treatment and services? ’ ’’ The second mom 

said, ‘‘My son learned to cut himself in there.’’

Two, juvenile detention centers are the worst possible environment for children with mental illnesses. Many of the techniques 

used in correctional settings, like prolonged isolation and restraint, 

actually lead to increased, not decreased, acting out and self-harm, 

particularly among youth with mental illnesses. When children are 

detained in juvenile centers in Maine, they are housed in a single 

unit where 10-year-olds can be housed with 20-year-olds. Providing 

for their individual needs is extremely difficult. Staff can spend 

most of their time protecting the vulnerable kids from the predatory kids, especially when a unit designed for 30 houses 43. Correctional settings are slow to respond to kids with undiagnosed disabilities, leading to deterioration in mental status, increased violations of rules, and increased discipline. The unfortunate reality is 

the more experiences youth with mental illness have in juvenile detention, the more likely they will descend deeper and deeper into 

the criminal justice system. 

Three, Maine, like most States, lacks adequate home and community-based services. Most States lack adequate home and community-based mental health services. Maine spends 60 percent of 

its scarce dollars on institutional services, despite the fact that 

home and community-based services cost less and produce better 

outcomes. It costs between $50,000 to $80,000 a year for detention 

and about $30,000 to provide intensive in-home services for a family for 1 year. 

Too many youth housed in juvenile detention centers graduate to 

the adult correctional system. The United States has the largest 

number of incarcerated citizens in the world, and we open four new 

correctional institutions every month. We must not become a Nation that spends more to incarcerate children than to educate or 

provide treatment for them. Money cut from mental health and 

12

1The prepared statement of Ms. Seltzer appears in the Appendix on page 63. 

substance abuse services is shifted to corrections budgets, a waste 

of taxpayer money and an inhumane and counterproductive way to 

treat children and adults with mental illnesses. 

Four, what can be done to help end this crisis? Enact the Keeping Families Together Act, which would help end the tragedy of 

custody relinquishment. 

Enact legislation to help improve access to essential evidencebased, community-based services for youth with mental illness and 

their families. 

Enact the Mentally Ill Offender Treatment and Crime Reduction 

Act which would authorize funding to help States reduce the high 

percentage of youth and adults with mental illnesses locked up in 

jails and prisons. 

Enact the Senator Paul Wellstone Mental Health Equitable 

Treatment Act, which will assure access to treatment. 

And enact the Family Opportunity Act to allow families with 

children with serious disabilities to buy into the Medicaid program. 

In closing, I would like to thank Senator Collins and Representative Waxman for their leadership in requesting this report. I would 

also like to share with the Committee that in preparing my remarks for this hearing, I spoke with families, inmates, and advocates, asking: What is the most important thing that I should say? 

The answer they all agreed upon was: Make sure they understand 

the urgency of this issue. Thank you. 

Chairman COLLINS. Thank you. Ms. Seltzer. 

TESTIMONY OF TAMMY SELTZER,1 STAFF ATTORNEY, JUDGE 

DAVID L. BAZELON CENTER FOR MENTAL HEALTH LAW 

Ms. SELTZER. Good morning, Chairman Collins, Senator Lautenberg, and Congressman Waxman. Thank you for the opportunity to 

speak. 

On any given night, nearly 2,000 children and youth—some as 

young as 7 years old—languish in juvenile detention facilities 

around the country solely because they need mental health services. 

Until now, public policy circles have largely ignored this issue, 

but thanks to Chairman Collins and Congressman Waxman, we 

now know how widespread this tragedy is. 

I am not going to highlight any of the findings of the report, just 

to say that they are consistent with what we have been hearing 

from families and advocates around the country. Although the 

issue of victimization was not addressed in the report, I think it 

is important to note that these incarcerated youth are also more 

likely to be victims of violence in these detention centers because 

they are perceived as more vulnerable. 

My testimony today will address the causes of this tragedy, describe the kinds of services and supports that children need to 

avoid ending up in juvenile detention centers, and outline steps 

that the Federal Government can take to make a difference for 

these children and their families. 

According to the detention center administrators, these children 

they identified for the survey should not be in their facilities and 

13

would not be there if appropriate community mental health services were available. 

Children with mental disorders are funneled into the juvenile 

justice system through a variety of ways. Number one is the lack 

of access. In most communities, the public mental health system is 

open from 9 to 5, when most children are in school. The police department, on the other hand, is open 24 hours a day. I think that 

fact right there explains why so many children are ending up in 

detention facilities. 

But there is also a lack of accountability and a bias toward law 

enforcement solutions. The agencies responsible for supporting parents and treating their children pass the buck by telling parents 

that they should call the police for help. In one case, a mental 

health crisis line designed to aid parents in just these situations 

called the police rather than sending out a mental health crisis 

team. 

There is also a lack of comprehensive private and public insurance for mental health problems, as was mentioned earlier, and a 

lack of coordination. The public agencies that serve children are so 

uncoordinated that children can end up with several diagnoses, and 

each agency ends up referring the child to another agency for services that do not even exist. 

While model programs are far too rare, effective alternatives to 

incarceration do exist. One such program, Wraparound Milwaukee, 

works closely with parents to provide services tailored to the needs 

of each child so children can stay out of crisis and out of the juvenile justice system. The program is reducing costs and—more important—reducing the number of children who end up in juvenile 

detention centers. 

Fortunately, we know the principles that make programs like 

Wraparound Milwaukee successful. Children and their families 

must have ready access to mental health services and supports. 

This access has to be based on real kid time and not bankers’ 

hours. Services and supports must be designed to enable children 

to succeed and not just avoid detention, and child-serving agencies 

need to work together and be held accountable. And the Federal 

Government can play a key role in addressing this problem, both 

through Federal agency actions and through specific legislation. 

According to today’s report, the General Accounting Office recommended that the Department of Justice ‘‘track the inappropriate 

detention of mentally ill across the country.’’ Given the seriousness 

of this situation, we urge lawmakers to require the Department of 

Justice to reconsider GAO’s request and also encourage the Department to enforce the law. 

But simply closing the door to juvenile justice is not a panacea. 

For example, the report notes that many children are languishing 

in these detention centers because there is a lack of specialized foster care placements. Obviously, children should be kept at home 

whenever possible, and necessary services should be brought to 

them there. But when that is not possible, therapeutic foster care 

has proven effective. 

States can use Medicaid to help pay for the services that are provided with therapeutic foster care, but far too few States take advantage of this because they are confused about Medicaid law. 

14

1The prepared statement of Mr. Dixon appears in the Appendix on page 76. 

CMS, the Center for Medicare and Medicaid Services, could clear 

up these misunderstandings by issuing a memo to State Medicaid 

directors. 

In 1997, the Individuals with Disabilities Education Act was reauthorized to explicitly require schools to respond proactively to 

problem behavior of students when it affects their learning or the 

learning of others. But too few schools have embraced these positive behavioral supports. Instead, they rely on zero tolerance policies, suspensions, and expulsions, and, increasingly calling the police—tactics that do nothing to improve student behavior and only 

increase the likelihood they are going to end up in the juvenile justice system. The Department of Justice must do more to enforce 

IDEA. 

In terms of specific legislation, the Family Opportunity Act, as 

Ms. Carothers mentioned, is something that would enable more 

families to have access to Medicaid. And the Keeping Families Together Act, which Chairman Collins has introduced, along with others, is a very important specific piece of legislation that would help 

reduce the number of children with mental or emotional disorders 

by supporting States’ efforts to develop coordinated systems of care. 

When I last appeared before this Committee last year to talk 

about custody relinquishment, I discussed the GAO study that 

Chairman Collins mentioned. And as someone working in mental 

health for 8 years, what was shocking to me was not the number 

of children that families were giving up, because I think that 

12,700 number is actually an underestimate. But what was the 

most shocking is where those children were ending up. Two-thirds 

were ending up in the juvenile justice system, not child welfare. 

I want to commend Senator Collins and Congressman Waxman 

for commissioning this important report, and hopefully by providing this kind of information, we can address the problems so 

that parents do not have to face this tragedy. These children languishing in juvenile detention centers are being thrown away like 

yesterday’s garbage, but they are tomorrow’s adults. And as Congressman Waxman said, if we are denying them their potential, 

that would be the greatest tragedy of all. Thank you. 

Chairman COLLINS. Thank you. Mr. Dixon. 

TESTIMONY OF LEONARD DIXON,1 PRESIDENT, NATIONAL JUVENILE DETENTION ASSOCIAITON, AND EXECUTIVE DIRECTOR, WAYNE COUNTY JUVENILE DETENTION FACILITY, DETROIT, MICHIGAN 

Mr. DIXON. Good morning. Thank you for the opportunity to testify before you today, and I would like to ask that my full written 

testimony be entered into the record. 

Chairman COLLINS. Without objection. 

Mr. DIXON. I am Leonard Dixon, President of the National Juvenile Detention Association and the Executive Director of the Wayne 

County Juvenile Detention Facility in Detroit, Michigan. I wish to 

thank Chairman Collins, Senator Lieberman, and Representative 

Waxman for their leadership on this issue and for inviting me here 

today to discuss with you my views on the report submitted by the 

15

Government Reform Committee on incarcerating mentally ill youth 

awaiting community placement in the United States. 

The report serves to highlight the seriousness of one of the most 

difficult issues facing all juvenile detention centers across the Nation, and its impact on the daily operations of these facilities across 

the country cannot be underestimated. 

In Wayne County last year, there were 4,152 youth between the 

ages of 10 and 17 that were identified in our facility, that came 

into our facility. Of that, 2,331 of those youth, 56 percent, needed 

and received mental health services. There are several factors within the field of juvenile justice that constitute a reasonable argument to ensure that the inappropriate placement of youth with 

mental health issues in detention ends. The most compelling argument is that detention for youth is generally short term and does 

not include nor guarantee the provisions of any type of formalized 

treatment to address identified disabilities, including mental illness. Youth with mental health issues require support and management services that often exceed the level of training provided in 

detention facilities. 

A second reason for ensuring that youth with mental illnesses 

are not detained in juvenile detention facilities is that they are 

more difficult to manage, more explosive, more easily agitated, require more intensive supervision, and create more strain on direct 

care staff than other youth within the juvenile facility. Management of youth with mental health issues results in a higher number of injuries to both staff and youth, the destruction of property 

with building repairs. Most juvenile facilities do not have the luxury of separating youth with mental health issues from the general 

population. This creates an atmosphere of conflict and unrest for 

everyone, and the potential for crisis can be very high. 

I would like to give you a couple of stories. The first involves an 

11-year-old female youth. At the age of 8, she was hospitalized in 

a psychiatric facility for the first time because of aggressive behavior towards her mother. Before entering the juvenile justice system, 

she had two more inpatient psychiatric hospitalizations. She still 

began to develop anxiety about school and in the fifth grade refused to go to school. Because of her mental health history, she 

came into our facility. At that time, it was very apparent to the 

mental health team that her difficulties were related to her relationship with her mother and would be best addressed by family 

therapy. 

The youth was returned to our facility in less than 5 weeks because her mother told the court that her daughter was refusing to 

follow directions. She remained in detention for an additional 3 

months as she awaited placement for community services. 

The second case is a clear example of the failing of our Nation’s 

foster care system. It involves a 15-year-old male who entered the 

foster care system when he was 9 because of abuse and neglect. 

The youth had never returned home since that time. He has been 

in and out of our facility at least eight times. He has had stints 

in short-term psychiatric hospitals and has been in many residential facilities. 

During his last stay at our facility at Christmas, he was very depressed and began to engage in self-mutilating behavior. As a reVerDate 0ct 09 2002 08:57 Nov 22, 2004 Jkt 095193 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 C:\DOCS\95193.TXT SAFFAIRS PsN: PHOGAN
16

sult, he was placed on constant watch. He told the detention staff 

that he had swallowed a piece of glass and was sent to the emergency room. From there he was transferred to a psychiatric hospital for treatment of his depression. After 3 days, he pulled the 

fire alarm at the hospital and escaped. 

He had planned all along to go back to his old neighborhood and 

look for his family. He managed to elude the authorities for several 

months. He found some relatives. Upon his return, he was disillusioned about his family and sadly reported that he felt unconnected 

to them. 

The need for collaboration with mental health agencies in the 

community is often very difficult but extremely important in terms 

of taking care of these youth. The most critical reason for the gap 

in networking on behalf of youth is the lack of coordinated communication between mental health and juvenile justice systems. The 

correction community has long been sympathetic to the need of juvenile offenders with special needs. In 2001, the National Juvenile 

Detention Association adopted the following position statement—

which I will not read for the lack of time. 

Despite our efforts to ensure that those in need of mental health 

services do not end up in our custody, parents are often forced to 

choose the confinement of their children with mental health issues 

in a detention center as a two-pronged solution to the crisis. 

In closing, I have nine areas that will be in the record, but one 

I would like to cite particularly: The issue of Medicaid funding. 

What happens in our country is that when a youth is brought into 

a public detention facility, the Medicaid funding is usually cut off, 

which means that the money is not following the kid, the kid is following the money. And with that, it has become—other funding 

sources identified for youth services must follow the youth and not 

become available only when the youth enters the system as designated levels of care. Special emphasis must be placed on mental 

health parity with medical services for our most vulnerable resource. And I would say what my father would say a long time ago: 

You cannot cripple a person and then criticize the way that they 

walk. When we place kids in institutions without having the proper 

services, the proper appropriate services for them, then we are asking the facilities to perform at a level that they are not capable of 

doing. And most detention centers in the country do not have mental health services, so you are placing kids with those problems in 

with kids who are purely delinquent kids, and we are asking for 

a good result. That will never happen. 

So I would like to thank you again, and the bills that are currently before Congress are two bipartisan proposal that merit consideration and swift approval, which would help to fill the gap between treatment and detention: The Keeping Families Together 

Act, introduced by Senator Collins and others, and the Mentally Ill 

Offender Treatment and Crime Reduction Act. 

Thank you very much. 

Chairman COLLINS. Thank you, Mr. Dixon. Judge Gray. 

17

1The prepared statement of Judge Gray appears in the Appendix on page 87. 

TESTIMONY OF HON. ERNESTINE S. GRAY,1 CHIEF JUDGE, ORLEANS PARISH JUVENILE COURT, NEW ORLEANS, LOUISIANA 

Judge GRAY. Good morning, and thank you for the invitation to 

participate in this hearing. I am a juvenile court judge from New 

Orleans, Louisiana, having been on the bench for over 19 years, 

and my 19 years on the bench has given me a wealth of knowledge 

and experience dealing with the juvenile justice issues. I have 

served on many boards and commissions regarding juvenile justice 

issues. I have served as a member and past president of the National Council of Juvenile and Family Court Judges. I want to 

thank you for your efforts in this area and your attention to this 

important issue, and I would like to say that this is long overdue. 

No one can doubt that there is a serious issue as it relates to the 

mental health of our children, and an equally serious issue with 

the way we provide treatment, when and if treatment is provided. 

All of my experience over the past 19 years is consistent with the 

findings of the report being released today. All too often, children 

charged with delinquent behavior are identified early on as needing 

mental health services. However, because those services are not 

available, the children are sent back to their families with no supports until there is another violation. Many times it is only after 

several brushes with the law, each time a little bit more serious, 

before everyone is fed up and then the solution is to incarcerate the 

children for a reason, and the reason being so that they can get 

mental health services that they need. 

Judges I can tell you, are frustrated on a daily basis by having 

to be put in a position of knowing that the only reason really we 

are incarcerating children is so that they can get mental health 

services. I am a judge who believes very much in due process and 

procedural rights, and I have been known on the bench to say 

daily, ‘‘This is not right. We should not incarcerate children just because they are ill.’’ And many times I have found in cases that we 

seem to be just making up violations so that we can get them into 

the system and get them services. And you have already heard 

from Mr. Dixon that those services that they need are generally not 

provided because those facilities are not equipped to provide the 

mental health treatment that the children need. 

Judges are faced with families many times a day who are saying, 

‘‘We cannot do it any longer. We are unable. We do not know what 

else to do. And so I want you to take them. I am not taking them 

home. I refuse to take them home because I am afraid of them, I 

am afraid of what they might do to me, what they might do to 

themselves, or what they might do to someone else.’’ And so they 

bring them to court many times, and they leave them on the doorsteps of the court, and the judges are then faced with what to do 

with these children. 

These issues cut across both delinquency and dependency cases, 

and it is not a surprise that many children who are abused and neglected many times end up in the juvenile delinquency side. It is 

unfortunate that there is a high correlation between the children 

who are in our dependency caseload and those who are also in our 

18

delinquency caseload. Children who have been abused and neglected many times end up incarcerated, again, because we are not 

able to provide the services that they need. They have bombed out 

of their foster home placements. The caretakers are saying, ‘‘We 

can no longer provide the services that they need in the home, and 

so you need to find another placement for them.’’ And many times, 

the only placement we can find, especially on short notice, is a 

placement that is in a detention facility. 

Status offenders, children who are runaways, who are truant, 

who are ungovernable and unruly, many with mental health issues, 

are detained or locked up ‘‘for their own good’’—because that is the 

only way that judges think they can keep them safe. 

I have looked at many of the bills that are pending and that have 

been introduced to address this issue. My concern is, for example, 

on S. 1704, it sets up a competitive grant process. I long for the 

day—I do not mean this to be disrespectful. I think that it is good. 

But I long for the day when children will be able to receive services 

that they need in their State, regardless of whether or not a State 

agency is able to write a competitive grant. We are concerned about 

the families relinquishing their children to get services. Are we also 

setting up a situation in which they will have to move to another 

State to get services? In this country, I do not believe that is appropriate. It is inconsistent with what we say about children being our 

greatest natural resource. Children deserve the services that they 

need no matter what State they are in purely because they are in 

this country and are part of our citizenry. 

One of the problems that I see that I do not believe is addressed, 

I think that there is a lack of specialists—psychiatrists and psychologists with the special training to deal with young people. And 

one of the things I would hope that we might be able to do is sit 

down with some of the medical schools and universities and try to 

figure out if there is a way that we can develop a larger pool of 

people who are specially trained to deal with children—child psychiatrists and psychologists. And I believe that we can do that, perhaps looking at what was done in the area of legal aid when there 

was a lack of attorneys in the South. There were programs that 

were developed that would recruit and then help those persons pay 

back their school loans, any number of things so that we would be 

able to recruit the kinds of people that we need. So I would urge 

working with medical schools and universities to address that 

issue. 

There are a couple of recommendations that I would like to 

make, and I think we all know what is needed, but I would just 

say them for the record so that we can be clear: 

Twenty-four hour availability of services. 

Standardized screening and assessment. It seems to me it makes 

no sense to have one screening for juvenile justice and one screening for mental health when we know the children are all the same. 

So let’s get together and decide what is the best assessment tool 

that we all can use that will provide the information that we need 

in order to be able to effectively treat the young people who are appearing in our systems. 

Better communication and coordination interagency and intersystem. This means developing the capacity and ability to share inVerDate 0ct 09 2002 08:57 Nov 22, 2004 Jkt 095193 PO 00000 Frm 00022 Fmt 6633 Sfmt 6633 C:\DOCS\95193.TXT SAFFAIRS PsN: PHOGAN
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1The prepared statement of Dr. Martinzes appears in the Appendix on page 89. 

formation across systems about the children that we are working 

with. 

Community-based programs. It has already been talked about. 

Integrated treatment across all systems, that is, child welfare, juvenile justice, mental health, special education, and substance 

abuse. 

More research on the prevalence of mental health disorders 

among youth. And it has already been suggested and I would second that: We are urging the Department of Justice to track the inappropriate detention of youth with mental illnesses across this 

country. 

No matter how hard we try, we may not be able to treat all children outside of detention. Nonetheless, children who are rightfully 

detained, these children need treatment for their mental illness, 

mental disorders, and you have already heard that in the juvenile 

detention centers that is not appropriate. And so we need to work 

on the treatment that we are providing for those children who are 

legitimately detained. 

In order to effectively serve this population, the juvenile justice 

system and the mental health system must work together to develop programs and services for these children. These services need 

to be appropriate for the child’s age, gender, and culture, individualized and family-focused. 

I would also urge—I would be remiss if I did not urge you to look 

closely at what happens to youth of color in the juvenile justice system. They are overrepresented in the juvenile justice system and 

many times underserved by the mental health system. So as you 

are looking at this issue, I would encourage you to pay some attention to that as well. 

I thank you again for the opportunity to be here this morning 

and look forward to having a discussion with you during the question-and-answer period. I would tell you that the juvenile judges 

from around the Nation are profoundly interested in this work, and 

we are willing to work with you to find solutions that improve the 

lives of these children and families. Our detention facilities should 

not be used as substitute mental hospitals. Thank you. 

Chairman COLLINS. Thank you, Judge. Dr. Martinez. 

TESTIMONY OF KENNETH J. MARTINEZ, PSY.D.,1 DIRECTOR, 

CHILDREN’S BEHAVIORAL HEALTH, DEPARTMENT OF CHILDREN, YOUTH AND FAMILIES, STATE OF NEW MEXICO 

Dr. MARTINEZ. Thank you, Senator Collins, for the opportunity to 

be here today, and thank you to Senators Durbin and Lautenberg, 

and Congressman Waxman also. 

I would like to share with you some approaches that we have in 

dealing with juvenile justice clients in our system in New Mexico, 

but first I am going to make some key points about the national 

scene. 

First, the prevalence of mental health disorders among youth in 

the juvenile justice system is two to three times higher than among 

youth in the general population. Anywhere from 70 to 100 percent 

20

of youth in the juvenile justice system have a diagnosable mental 

health disorder. 

Second point: The mental health and substance abuse needs of 

the juvenile justice population have been neglected. There is a 

growing concern over the criminalization of mental illness among 

our juvenile population. The juvenile justice system as well as the 

child welfare system are becoming the systems of last resort. 

And the third point: There are new and effective tools and services that are demonstrating real promise for youth in the juvenile 

justice system. We now have screening and assessment tools that 

have been specifically designed for youth in the juvenile justice system that have proven to reduce long-term rates of re-arrest, improve family functioning and school performance, and decrease substance abuse and psychiatric symptoms. 

Now I would like to take the opportunity to comment on Representative Waxman and Senator Collins’ report. 

First, I want to thank Representative Waxman, Representative 

Udall, and Senator Bingaman for choosing New Mexico to highlight 

the problems that are occurring around the country. We were the 

first to be highlighted, and that has really helped us move forward 

in taking the next steps to remedy the situation. So thank you, 

Congressman Waxman. 

As was implied in the report, juvenile detention centers—and, I 

might add, State correctional facilities—have become the de facto 

psychiatric hospitals and residential treatment centers for mentally 

ill youth. These youth require appropriate clinical services, professional clinical staffing, and evidence-based programs. 

Second, detention, especially unnecessary detention, for children 

and youth with mental health needs who are not properly screened, 

evaluated, and treated causes harm to these children and youth. 

Undiagnosed and untreated mental health disorders are exacerbated by the conditions of confinement. 

Third, youth who are detained for the sole reason of awaiting 

treatment in the community are predictably going to have a deterioration of functioning and an increase in symptoms, such as suicidal ideation and attempts, and those are the only likely outcomes 

that will occur while they await transfer. Consequently, their 

course of treatment may be lengthened when they eventually receive it. 

And, fourth, community-based services are needed and yet are 

not plentiful to meet the need. Culturally competent treatment that 

involves the family is a necessary prerequisite to success. 

The following describes some of the work that we are working on 

in New Mexico, and we admit that we still have a long way to go. 

From 1991 to 1999, the Bernalillo County Juvenile Detention 

Center, which is where Albuquerque is located, housed 130 to 140 

clients ages 8 to 18, with an average length of stay of 33 days each. 

Through collaboration and ongoing support of the Annie E. Casey 

Foundation, and utilizing best practices from other States, the 

Bernalillo County Juvenile Detention Center managed to accomplish many things. It now has an average daily census of 65, down 

from 140; with an average length of stay of 9 days, down from 33 

days, including for the most serious youthful offenders; a recidivism rate of 13 percent, down from 46 percent; and the cost for seVerDate 0ct 09 2002 08:57 Nov 22, 2004 Jkt 095193 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 C:\DOCS\95193.TXT SAFFAIRS PsN: PHOGAN
21

cure detention a day was $96, and now the cost of the community 

custody program is $19. Still, we have 73 percent of currently detained clients having at least one mental health diagnosis in those 

clients that are in detention. 

Now, how was all this accomplished? The Children, Youth and 

Families Department, the department that I work for—which is responsible for children’s behavioral health, juvenile justice, and 

child welfare—along with the Human Services Department—which 

is the Medicaid State agency—the Department of Health—which, 

among other things—the Bernalillo County, the University of New 

Mexico Health Sciences Center, the three Medicaid managed care 

organizations, and children’s court judges all collaborated, culminating in the Children, Youth and Families Department licensing 

the Bernalillo County Juvenile Detention Center as a ‘‘Children’s 

Community Mental Health Center,’’ which allowed for Medicaid 

billing of all medical and behavioral health services provided to 

non-adjudicated youth. The University of New Mexico also contracted child psychiatric staff and other providers to staff the center. Since it opened in 2002, the Children’s Community Mental 

Health Center, on the campus of the Bernalillo County Juvenile 

Detention Center, has seen 1,200 children. 

The detention center has a relationship with a local adolescent 

shelter care provider to be a reception/assessment center in lieu of 

detention for minor offenses that are frequently mental health or 

substance abuse related. Police take juveniles that are picked up 

to the reception/assessment center for mental health/substance 

abuse screenings and evaluations and treatment. 

We have four social workers in the Albuquerque Police substation and the sheriff substations to work with youth and their 

families at the time that they are picked up to avoid unnecessary 

detention. 

The Bernalillo County Juvenile Detention Center operates a 

Youth Reporting Center on its campus that is open 7 days a week 

from 8 a.m. to 8 p.m., offering academics, recreation, workshops, 

and other similar activities. 

The detention center has a community custody program to supervise youth at job sites and at schools. 

In addition to the county initiative, the Children, Youth and 

Families Department’s Juvenile Justice Services has worked closely 

with the New Mexico Juvenile Parole Board to parole technical violators and low-risk clients with low to high needs, who can then be 

referred to community programs. 

Our Department has reduced its statewide correctional facility 

census from 625 to 270, as of this week, a decrease of 55 percent. 

Consequently, we closed our 96-bed maximum security correctional 

facility last week, July 1 of this year. These reforms are a result 

of many factors, including juvenile detention reform, juvenile drug 

courts, re-education of juvenile probation and parole officers, law 

enforcement, juvenile court judges and attorneys. 

Additionally, our department has redeployed 41 positions that 

used to be employed in the maximum security facility to ‘‘front-end’’ 

services in communities, including to provide client supervision; regional coordinators to identify and develop programs in rural and 

urban communities; and to become functional family therapists and 

22

multi-systemic family therapists in the community. The Annie E. 

Casey Foundation is assisting New Mexico to replicate this model 

in seven other communities. 

Conclusions: The solutions are not simple. They involve crosssystem solutions. There is an obvious blurring of roles and responsibilities of child-serving systems, and that is a good thing because 

no longer is a child or youth exclusively a child welfare client or 

exclusively a juvenile justice client or a mental health client. They 

are the same child or youth in more than one system. They are all 

our children and youth regardless of the system door they enter. 

We in the New Mexico juvenile justice, mental health, and child 

welfare systems applaud you, Senator Collins, and your colleagues 

for introducing Keeping Families Together Act. It not only will provide funding for interagency systems of care for children and adolescents, but it acknowledges the cross-system complexity in defining the problem and in defining the solution. For too long, our 

child-serving systems have not worked together and, therefore, 

have missed opportunities to collaborate, share resources such as 

joint planning, program development, and human and financial resources. We have failed to function either as one child-serving system or as a coordinated and collaborating set of jointly responsible 

and responsive child-serving systems. Keeping Families Together 

Act would be one major step forward in promoting the cross-system 

collaboration, and it certainly complements the New Freedom Commission Report on Mental Health that also advocates for more and 

effective cross-system collaboration. 

There is much more that needs to happen, and we as policymakers need to recognize that meeting the behavioral health needs 

of our juvenile justice population in detention is critical. 

Many of the youth detained are in for relatively minor offenses. 

Diversion programs need to be developed, and we need to advocate 

for and fund more community-based options that will provide mental health and substance abuse treatment to these youth in their 

own communities and give judges, such as Judge Gray, options 

other than incarceration. The research suggests that this is the 

most effective approach. 

While we are doing a better job at screening and assessment, we 

need to advocate for and fund universal screening for all youth entering detention and provide evaluations and treatment when necessary in appropriate community-based settings. 

And, finally, community re-entry programs for youth transitioning out of detention and correctional placements need to be 

strengthened to maximize success and reduce recidivism in both 

the detention system and restrictive mental health settings. 

Thank you for your concern over this issue. Our collective goal 

is to improve conditions for our youth and provide the needed services and supports to them and their families. 

Thank you, Senator. 

Chairman COLLINS. Thank you. That testimony was very encouraging, and I look forward to questioning you, as I know the panel 

does. 

I am going to begin with Ms. Carothers with a question. I know 

that you have done a great deal of work with Maine’s inmate population with a focus on adult inmates who are living with mental illVerDate 0ct 09 2002 08:57 Nov 22, 2004 Jkt 095193 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 C:\DOCS\95193.TXT SAFFAIRS PsN: PHOGAN
23

ness. Could you give us some idea of how many of those adult inmates were also involved in the juvenile justice system? 

Ms. CAROTHERS. Most of the inmates that I have worked with 

were involved in the juvenile system. I interviewed 40 inmates in 

Thomaston Prison a couple years ago, and they all told the same 

story, which is poverty, foster care, a youth center, Wyndham, 

which is the first step, and then the higher prison, Thomaston. I 

think the recidivism is enormous, and I think it starts in juvenile, 

absolutely. 

Chairman COLLINS. I am struck by Dr. Martinez’s statistic that 

most youth in the juvenile justice system have diagnosable mental 

disorders. In fact, it may be as high as 70 to 100 percent, which 

is huge. Does that suggest to you, Ms. Carothers, that if we were 

to invest in mental health services for youth, we would greatly reduce the adult population in prisons? 

Ms. CAROTHERS. Prevention is everything, and so if you can catch 

kids early, you would absolutely make a difference in the whole 

system, the numbers in the adult system and the numbers in the 

juvenile system, start earlier. 

Chairman COLLINS. Judge Gray, could you give us an idea based 

on your 19 years on the bench of how many of the youth who come 

before you either have problems with mental illness or substance 

abuse? What percentage would you guess? 

Judge GRAY. I would guess clearly 70 to 85 percent of the kids 

who come before the court have a mental health issue and/or a substance abuse issue, because we do have co-occurring disorders, and 

so you have some children with both. But 70 to 85 percent of them 

have one or the other. 

Chairman COLLINS. Dr. Martinez, this suggests to me that an investment in community-based mental health care for juveniles can 

save not only a great deal of human suffering for these individuals 

and their families and communities, but also save a great deal of 

money as well in the long run. Was it difficult to convince the legislature in your State to make the up-front investment in mental 

health services that you are already starting to recoup? How did 

you convince policymakers in your State to make that up-front investment when they have to wait a bit for the savings to be realized? Even though it sounds like you have been able to realize savings as well as considerable public policy improvements rather 

quickly. 

Dr. MARTINEZ. Well, the investment is economic, certainly, but 

most importantly, it is an investment in our youth so that they do 

not become inmates of correctional facilities as adults. 

We are still having our struggles in convincing everyone, yet our 

efforts really are a bipartisan effort within our State legislature, 

led by our governor, to really make improvements in prevention 

and early intervention. We have spent many dollars in high-end 

services, as we call them, in correctional facilities. Redeploying 

those 41 full-time employees and putting them in communities is 

going to be an argument that hopefully will convince the rest of our 

legislators that this is a worthwhile effort. 

It is a long-term investment. It is very hard to convince people 

without data that, for the short term, prevention is worth the effort. And yet everything indicates to us that it is the only investVerDate 0ct 09 2002 08:57 Nov 22, 2004 Jkt 095193 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 C:\DOCS\95193.TXT SAFFAIRS PsN: PHOGAN
24

ment that is going to help us save our children and save money as 

well. 

Chairman COLLINS. Mr. Dixon, I was impressed in your testimony when you said that 56 percent of the people coming to your 

facility actually received mental health services. It seems to me 

that you are more advanced than many facilities if you are doing 

that kind of screening up front to identify people who need mental 

health services. 

Is your experience typical? Or do you think that it is unusual to 

have a system that does that kind of screening and provides these 

kinds of services? 

Mr. DIXON. Madam Chairman, it is almost laughable that we do 

not have this going on in most facilities in the country. We are very 

unique, in Michigan. And, I will say this: One of the reasons why 

that occurred and the reason why I am in Michigan is because we 

were being investigated by the Department of Justice. And it is a 

shame that what is starting to happen in this country is that no 

one wants to fix anything until the Department of Justice comes 

in and says that you have all of these problems. And we keep saying fix the problem up front, then you do not have to pay for it, 

because you spend a lot of money when you get into lawsuits, into 

litigation, and all those kinds of things. 

And so we have been stressing with folks around the country to 

fix your problems prior to someone coming in to tell you that they 

need to be fixed. 

Chairman COLLINS. Ms. Seltzer, I was very pleased that you 

gave us some specific actions that we can take, and we would like 

to work with you in encouraging CMS to issue the memo on therapeutic foster care that you mentioned. 

My time has expired so I need to wrap up quickly. But could you 

tell us a little more about the Wraparound Milwaukee program 

that you indicated as being a promising approach? 

Ms. SELTZER. Certainly. Wraparound Milwaukee has been 

around for a number of years, and it targets children who are in 

the juvenile justice system. At least initially that is what it did, 

and now it has expanded to focus on children who are at risk of 

entering the juvenile detention system. 

It works very intensely with schools and the mental health system and child welfare system to provide services to children in 

their homes where they live so that they are able to not only avoid 

juvenile detention but to be successful in school and in their communities and to be able to live with their families. 

Chairman COLLINS. Thank you. Congressman Waxman. 

Mr. WAXMAN. Thank you very much. 

When we were trying to find out about this problem of unnecessary detention of children because they could not get access to mental health services, we wrote to the juvenile detention facilities, and 

we got a real strong response, not just giving us the information 

but anger and frustration by many of the administrators of these 

facilities that they were being used as warehouses. 

Mr. Dixon, is it true that they cannot turn anybody away? And 

is it your sense that other agencies and insurers are just saying no 

more and that is why they are ending up in your facilities? 

25

Mr. DIXON. Yes, that is correct, Congressman. One of the things 

that we keep saying is that detention has become not only the 

dumping ground, but it is the emergency room of whatever goes on 

in the systems, because no one can handle—no one wants to handle 

the kid. I was struck by an article last week in the Miami Herald

where three girls who were in a mental health facility tried to escape, and they placed them in a detention facility for 21 days because they were trying to escape from a mental health facility. 

Well, to me, that is backwards. 

And so, yes, it has become almost unbearable because we are 

talking about money here, and we are having staff who are injured 

because they are not trained to deal with kids who have these 

kinds of problems. And if you are going to do it, then you are going 

to have to put in training and all those things in the institutions, 

and that is not happening. 

And so we have been very fortunate in Michigan, but it is a 

major issue for every detention facility in this country. 

Mr. WAXMAN. Thank you very much. 

Ms. Carothers, I wanted to ask you: Some people might say the 

best way to solve this issue or to deal with it is to get services in 

the detention centers. Is that going to be a good way to make sure 

that children have access to what they need? 

Ms. CAROTHERS. You need services in the detention centers for 

those kids who you cannot keep out. But what you really need is 

diversion, and diversion is just a word unless you have something 

to divert people to, which means services. So you actually have to 

have diversion, and you cannot have diversion unless you have a 

lot of mental health services in the community. And those need to 

be evidence-based blueprint services where folks have the understanding to treat people with dual disorders and who have criminal 

justice involvement. Oftentimes our mental health centers do not 

have that expertise. 

Mr. WAXMAN. In other words, a lot of kids just should not be in 

the detention center at all. They should be getting care elsewhere, 

either in the community mental health centers or hospitalization or 

child welfare agencies of one sort or another. Is that the——

Ms. CAROTHERS. I do not think they would be in the criminal justice system if the safety net service system was there. 

Mr. WAXMAN. And, of course, they are not, for many of them, 

even involved in any kind of criminal activity. On that point, somebody said ‘‘criminalization’’ of mental health is what is going on. 

Mr. Martinez, I am pleased to hear what you had to say about 

the fact that when Senator Bingaman and Congressman Udall 

asked us to do this evaluation, we started in New Mexico, and it 

seems to have led to a number of reforms in your State to try to 

actually come up with some ways to deal with this problem. You 

went through some of the points, but I was interested, particularly 

because I have a background in this area, how you use the Medicaid funding to accelerate the transition from juvenile detention to 

mental health, and community mental health services. Were you 

able to figure out some way to draw more Federal dollars so that 

these services would be available under Medicaid? So many of 

these children are going to be eligible for Medicaid, if not all of 

them, because of the institutionalization. 

26

Dr. MARTINEZ. Well, what we have done is for non-adjudicated 

youth, we have accessed Medicaid services because that is certainly 

allowable. So for those kids that have been diverted from detention 

and can be served in the Children’s Community Mental Health 

Center or who are released from detention who are Medicaid-eligible by income, we certainly can serve them in the Children’s Community Mental Health Center. So we are not drawing down any 

more or different kind of funding for Medicaid, but certainly we utilize it quickly. And with presumptive eligibility, which is allowed 

under Title 21, the State Children’s Health Insurance Program, we 

are able to make children presumptively eligible upon release from 

detention or at the Children’s Community Mental Health Center 

itself. 

Mr. WAXMAN. So you are using the system the way it was intended, to make sure that children get preventive services through 

Medicaid, but preventive health services, in this case mental health 

services, to deal with the problem before they have to be put into 

some kind of detention center incarceration. 

Dr. MARTINEZ. That is correct, Congressman. 

Mr. WAXMAN. Any other strategies you have employed for preventive purposes? 

Dr. MARTINEZ. Well, again, we have our social workers in the police substations and the sheriff substations in order to divert kids 

when they are picked up in the middle of the night, or whenever 

they are picked up. This is to avoid incarceration by working with 

the family at the very moment that the crisis is happening because 

crises do not wait for 8 to 5, and families are in need 24/7, as we 

have heard. So we do not want our detention centers to be the 

emergency rooms anymore. So that is one strategy. 

We have worked with our judges and with our probation and parole officers to ask them what they feel they need. And certainly 

as the judge was saying here, they need options that do not require 

detention, and those are the community-based services to refer children and the families to. Those community-based services need to 

be evidence-based, meaning they should work because they have 

been proven to work in other settings. 

Mr. WAXMAN. Chairman Collins, this has been an excellent 

panel, and I want to thank all of them for their testimony. 

Chairman COLLINS. Thank you. Senator Durbin. 

OPENING STATEMENT OF SENATOR DURBIN 

Senator DURBIN. Thank you, Madam Chairman. And let me say, 

there are few committees and few chairmen who would take the 

time to hold this hearing. It is really unfortunate. But this is an 

exception, and under your leadership, in this Committee, together 

with our friend Congressman Waxman, we are talking about a subject which a lot more people should be talking about in the Senate 

and in the House and across the United States. 

If the topic had been that we have discovered through investigation that children were starving at these facilities, subjected to 

physical abuse, were not properly clothed, were freezing in the winter, I think we would have a bank of cameras against that wall, 

and it would be on the front page of most papers tomorrow. But 

27

because the underlying issue is mental illness, it is not likely. 

Why? 

Well, I think, frankly, because we as a society view this as a 

curse or a crime, not an illness. We just have not grown up to accept the reality that it is an illness that can be treated. 

And, of course, the Senate has not done much on its own. When 

Senator Wellstone died, we said one thing we are going to do when 

we get back is deal with mental health parity, you can bet, in the 

name and honor of Paul Wellstone. Almost 2 years have passed 

and nothing has happened. That is a sad commentary on the body 

that we serve in. We should do more. Senator Domenici has been 

a leader in this area. Senator Wellstone was. There is a lot more 

that we can do. 

I am struck by a lot of things at this hearing. A lot has been covered so well by the Chairman and Congressman Waxman. But a 

couple things do stand out here. Why do we have such an increased 

incidence of mental illness? Some of the statistics among African 

Americans suggest mental or emotional disabilities are up 77 percent in the last 30 years or so. Why? Why are we running into 

more of this? Is it because we now know what to look for? It has 

always been there, we did not know what to do with it before, now 

we can diagnose it and now we can suggest treatment? But is there 

something going on in America that has led to this dramatic increase in mental illness, particularly among young people? Is this 

the beginning of a trend that is even going to be worse in years 

to come? 

Would anybody like to suggest an answer? 

Judge GRAY. Well, I think I will be brave. I think there are a 

couple of things, Senator. You touched on one. I think that now, 

more than in years past, people are willing maybe to speak up and 

to say we are having a problem in this area. Many years ago, it 

was a shame, it was a curse, and so people tried to keep it hidden. 

I think now people are at a point where they just cannot provide 

for themselves without going somewhere else to get help. 

I do think that, unfortunately, in this country many of our young 

people are disillusioned about what their futures are in this country. And if you talk about the African American community, they 

are out of work; they do not see a future; they do not have a hope 

for a future. And so many of our young people have turned to 

drugs, and that is a real problem. And, actually, I am not just 

going to say African American because I think what we see is that 

drug usage is high among white kids as well. But, unfortunately 

for African American children, I do not believe that they see a way, 

that they see a future, and so they are very disillusioned. They are 

growing up in families where many of their parents are incarcerated, have been incarcerated, are also on drugs. And they are being 

pushed out of the school systems. You heard about children who 

are being expelled and suspended. These are the children who are 

being pushed out of the school systems. And so they go home at 

night without a hope for tomorrow that things are going to be better. I think that is one of the reasons we are seeing more of these 

kinds of problems prevalent among our young people. 

Senator DURBIN. Mr. Dixon, I liked your father’s quote. [Laughter.] 

28

Mr. DIXON. Oh, he was smart. 

Senator DURBIN. If I wrote it down correctly, ‘‘You cannot cripple 

a child and then criticize the way he walks.’’

Mr. DIXON. Right. 

Senator DURBIN. And I think that is part of the problem that 

Judge Gray is pointing to. If we do not get to some of the root 

causes of this despair and family break-up and dysfunctional situation, then we are going to continue to treat imperfectly the results. 

Ms. Carothers, you talked about what happens once these young 

people reach the age of 18. Has anybody done a study to figure out 

what happens to them once they have been pushed around in the 

system through foster care and detention facilities and now, bingo, 

they are adults out on their own? Where do they go? 

Ms. CAROTHERS. I have not seen a study. Anecdotally, through 

my work with adults, I can tell you that recidivism is enormous 

and is highly likely if you are in the juvenile criminal justice system for you to be in the adult criminal justice system. And, the 

numbers of people we have in the adult system speak to that. We 

have more people incarcerated than any other country anywhere. 

But I have not seen any—I could look and send you some recidivism studies if you would like. 

Senator DURBIN. I have sat in some of these facilities, some of 

the better ones. They are despairing that, at age 18, it is as if they 

have to walk away in my State from a lot of the services and a lot 

of the help that they could offer to a person just because that age 

has been reached. 

Let me just add, we are about to consider a gang violence bill on 

the floor of the Senate, and no one supports gang activity and the 

criminal violence and the terrible thing that is happening. But one 

of the things that this bill does is shift the burden of whether the 

accused gang member under the age of 18 is going to be treated 

and prosecuted as an adult or child. Currently, it is up to the State 

to argue that this person should be treated as an adult even 

though they are under the age of 18. The bill flips the responsibility. Now it is up to the young person and his attorney to argue 

they should be treated as children in the system; otherwise, they 

will be treated as adults. That is a dramatic change, and it kind 

of goes to the same argument here when it comes to young people, 

this mindless ‘‘you do the crime, you do the time.’’ We get into this 

sloganeering here and forget that those are real human beings 

standing in front of us, some of whom have been victims of the system of our own creation. Thank you, Madam Chairman. 

Judge GRAY. Senator, I would say, if I could, in response to your 

question about the studies, in particular for children who are aging 

out of foster care, there is quite a bit of information out there about 

those children who are transitioning out of the foster care system 

upon their 18th birthday and what life looks like for them. And I 

would be happy as well to send you some of that material. But 

what it shows is that those children that we saw are now independent at 18 or in some States 21, they lack the ability to get 

jobs; they are in the homeless population; they are in the mental 

health institutions because many of them do have mental health 

issues that are not being treated. They do not graduate from high 

school. They are not getting their GEDs, and, therefore, they are 

29

not going on to higher education. Their lives are really not looking 

very positive when they age out of foster care, and so that is a real 

concern for those of us in the juvenile area who are dealing with 

that population of kids every day, trying to figure out what are the 

safety nets we can put in place for them so that they have a chance 

to make it in this society when they are no longer cared for by the 

State child welfare agencies. 

Dr. MARTINEZ. Senator Collins, may I respond to Senator Durbin? 

Chairman COLLINS. Absolutely. 

Dr. MARTINEZ. With regards to your first question about the 

prevalence or incidence of mental illness among our youth, in our 

child welfare system we have an overrepresentation of children of 

color. In our juvenile justice system, we have an overrepresentation 

of children of color. In our mental health system, we have an 

underrepresentation of children of color. So when we see the number of children of color being identified as having mental illness 

going up, in some ways that is a good thing in that we are now 

screening and assessing and identifying those children better than 

we ever have before. Once they are identified, hopefully we exercise 

that professional and ethical responsibility to treat those children. 

And I think that is a good thing. 

I do not necessarily think that there is a higher incidence as 

there are more children being identified. And, of course, there are 

many societal factors that play into this, whether it be poverty, 

poor education, and other societal issues. But we are encouraged to 

see more numbers of children of color being identified so that we 

can do something about it. 

Chairman COLLINS. Thank you, Senator Durbin. 

I want to thank all of our witnesses today. You really enhanced 

our understanding of the consequences of the tattered safety net 

that we have for caring for children with mental illness. I want to 

thank in particular Congressman Waxman for his participation. It 

has been a great honor to work jointly with you on this. And I really hope that this bipartisan, bicameral approach can make a difference, because what is going on now is absolutely unacceptable. 

That we are incarcerating children who are ill, who are suffering 

from mental illness, rather than treating them because there is no 

place for them to go is a tragedy, and it just called out for our action. And we need a comprehensive approach. We need to pass the 

Keeping Families Together Act, the Family Opportunity Act, a bill 

that I have cosponsored with Senator Bingaman to increase the 

number of mental health professionals for children. But I am sure 

I can speak for my colleagues in saying that we are really committed, and I want to thank them for their participation today. 

Thank you so much for sharing your extraordinary expertise and 

your caring with the Committee. 

The hearing record will remain open for 15 days for additional 

statements and questions. And, finally, I would like to thank Priscilla Hanley of my staff and also Dr. Josh Sharfstein of Congressman Waxman’s staff for their hard work. We could not have done 

it without them. 

So thank you, and this hearing is now adjourned. 

[Whereupon, at 11:40 a.m., the Committee was adjourned.] 

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