V. Conditions of Confinement: Mental HealthMental health problems are widespread among children in the juvenile justice system.422 In New York in 2004, of the children screened by OCFS for special needs when taken into custody, 52 percent were identified as having mental health needs.423 This official figure is not disaggregated by gender. Some research, and the experience of practitioners, suggests that incarcerated girls generally have more mental health needs than boys,424 and are also more likely than boys to be diagnosed with more than one mental health problem, often a mental health disorder together with a substance abuse disorder.425 According to a knowledgeable source:
Moreover, research outside New York suggests that a significant proportion of incarcerated adolescents suffer from post traumatic stress disorder (PTSD), and that girls are more likely than boys to develop PTSD when exposed to trauma.427 Whether or not they suffer from PTSD, a high proportion of incarcerated girls have experienced past trauma and abuse, which contribute to mental health problems. Seventy-seven percent of children admitted to OCFS custody in 2004 and screened by the agency were found to have substance abuse problems.428 Substance abuse needs to be addressed as part of an effective treatment regimen, and as experts point out, must also be recognized in many cases as an effort by children to self-medicate for untreated mental illness.429 As a knowledgeable source put it:
As described earlier in this section and in Girls’ Delinquency: Systemic Failures and Pathways to Incarceration, above, children entering the juvenile justice system, and many girls in particular, have serious mental health needs. As one source put it:
Lansing and Tryon face the difficult challenge of trying to help highly troubled girls acquire the skills and self-knowledge they need to be able to cope, and of accomplishing this with limited budgetary resources and consequent limitations in staff. Whether because of resource constraints, policy, or institutional culture, HRW/ACLU are concerned that the facilities may fail to give sufficient priority to the girls’ needs for mental health interventions by professional mental health staff, including individual therapy and medication, as well as for a full range of psycho-social and therapeutic programs to provide girls with improved life skills. We are also concerned that the culture in the facilities may be too wedded to a punitive orientation. We were told by one source, for example:
All OCFS facilities provide some form of mental health and substance abuse programming. At the Lansing and Tryon facilities, mental health services are provided by a combination of OCFS staff, staff of the state Office of Mental Health (OMH), and independent contractors. Pursuant to a memorandum of understanding between OCFS and OMH, “mobile mental health teams” of OMH staff work daily in certain OCFS facilities, including Lansing and Tryon.433 Mental health services include psychiatric services, as well as psychological counseling provided by psychologists and social workers. Official records for Lansing state that one psychiatrist visits the facility three days per month, and another visits Lansing’s mental health unit at about the same frequency.434 Tryon appears to have a similar system, but official records provided to HRW/ACLU by OCFS contained less information regarding the frequency of psychiatrists’ visit to the facility.435 Psychiatrists’ duties are described in agency documents as providing “treatment” to children needing psychiatric services.436 Agency records state that psychiatrists are available to children for “consult by phone,” and that Lansing has “telepsychiatry equipment” connecting the psychiatrists from various facilities to each other.437 According to an informed source, in practice, the psychiatrists’ role is almost entirely limited to prescribing and administering psychotropic medication and periodically monitoring the progress of medicated children.438 OCFS describes psychologists’ duties as diagnosing and treating residents with signs of “mental illness, poor adjustment, and/or emotional/learning problems,” as well as consulting with staff, referring girls to the mental health unit, assisting in release planning and outpatient referrals, and administration.439 According to an informed source, in practice, psychologists conduct diagnostic tests, refer children to other facilities, and determine special educational needs, among other things.440 Psychologists also provide therapy to children. Therapy involves working with children to understand what mental dynamics are occurring, patient education to help children understand their own condition, and symptom management, for example, if a child expresses a wish to harm herself.441 Social workers also provide therapy, but cannot conduct testing.442 OCFS administrators express pride in their achievements in providing mental health care to incarcerated girls. They point, for example, to the designated mental health units at each of the Lansing and Tryon facilities as evidence of their efforts.443 Each of the two facilities has a unit to house children identified as having the most severe mental health needs, called the “mental health unit.”444 These mental health units are small, holding about 12 children rather than the 20-25 held in the “generic,” or non-mental health units.445 An OMH “mobile mental health team” is assigned to each mental health unit and provides intensive mental health treatment services on a daily basis.446 According to OCFS documents, Lansing’s mental health unit employs one psychologist, two psychiatric social workers, and a “treatment team leader.”447 Tryon’s mental health unit is staffed by a psychologist and two social workers.448 The establishment of the dedicated mental health units was unquestionably a step forward, especially since professional OMH psychiatrists, psychologists and social workers are now placed in the units to give care to the children housed there.449 Nevertheless, the size of such specialized units is a concern. Grievance logs contain complaints by girls of not being allowed into such units despite believing that they require specialized care.450 OCFS documents provided to HRW/ACLU provide much less detail about substance abuse treatment than they do about mental health treatment. They indicate that, at Lansing, group sessions are held once per week by an outside contractor for girls “with the most severe abuse problems.”451 A staff schedule for Tryon indicates that a drug abuse counselor is available four full days per week.452 Some interviewed girls told HRW/ACLU that they did not have substance abuse problems and therefore did not receive treatment. Others described group meetings in which addiction and other issues were discussed. For example, Bless L., who was 14 when she was incarcerated in the Lansing facility, said:
Screening and assessment are important first steps in the provision of mental health care. HRW/ACLU have been told by informed sources that girls entering Tryon Reception Center are screened by a mental health worker who administers psychometric “scales” for depression, IQ, and other values. These scores are combined with information about the girls’ history, including for example, past mental illness and substance abuse, and the girl is assigned a score between one and four. A high score alerts the facility to which the girl is ultimately assigned that she requires a more detailed assessment.454 The usefulness of this preliminary assessment is undermined by the absence of specific facilities that could provide treatment tailored to girls’ specific mental health problems and needs. A knowledgeable source describes this problem as follows:
Once girls arrive at Lansing or Tryon, a more in-depth assessment may be performed. OCFS’s facility operational guidelines for Tryon Girls Center require that children placed there “receive a brief mental health screening by medical staff at admission via the Admission Screening Interview.”456 If significant problems such as “bizarre thought” or “suicidal intent” are observed during the screening, the facility administrator is to be notified “for further action.”457 If a girl receives a high “mental health screen score,” a “mental health assessment” is performed. 458 Whatever the screening and testing indicate, the mental health services at Lansing and Tryon remain limited because of a shortage of qualified staff.459 The need for professional mental health services exceeds the beds in the mental health units. The extent of the need is indicated by the fact that over the last two years, an average of 53 percent of girls held at Lansing, and 64 percent of those held at Tryon were administered psychiatric medication.460 Yet at Lansing, the approximately seventy girls who are not in the mental health unit receive psychological services from only one psychiatrist,one full-time psychologist, and two part-time social workers.461 At Tryon, one psychiatrist, three psychologists and a single psychiatric social worker staff the non-mental health units.462 OCFS administrators themselves acknowledge that more care is needed, citing budgetaryconstraints as the cause of deficiencies.463 As explained to HRW/ACLU:
Another interviewee agreed, stating, “There aren’t enough mental health providers, it’s limited for the number of children.”465 At least some girls have also complained about not having access to mental health care when they feel they need it. In Lansing, over the course of one year, over twenty grievances were filed by girls saying such things as “has not been counseled, told someone would be available to talk to her,”466 and “really needs to talk.”467 Other complaints state: “put in 2 sheets to contact social worker, no response,”468 and “she feels she is about to blow/go crazy. Needs to talk to someone about her issues.”469 One grievance reads: “not on meds, needs to talk to someone about issues going on in her head.”470 According to Devon A., who is now 17 years old, access to mental health professionals is limited:
Much of the “counseling” children receive at Tryon and Lansing is not provided by mental health professionals but by line staff who supervise the children day to day as well as lead various group sessions addressing life skills, anger management, and victim awareness.472 The counseling provided by line staff is a part of what OCFS calls its “behavior modification program,” an effort to help change children’s behavior through positive and negative reinforcement taking the form of rewards and punishments.473 Professionally trained mental health staff also lead group sessions as well as provide individual therapy. We do not have data from OCFS regarding how many girls receive individual therapy, how long the sessions are, and the length of time girls remain in therapy. Based on the limited information we have, however, we are concerned that the girls mental health needs are shortchanged because of inadequate staffing. Some girls find such programs helpful. For example, according to an OCFS administrator, girls in OCFS facilities are offered a program called “Adelante.”474 Adelante was developed at Lansing by facilities staff and addresses trauma from sexual abuse.475 Devon A., who had been raped prior to her incarceration, did not describe participating in the Adelante program, but said she spoke with a “rape coordinator” at Tryon about having been raped, and that the conversations helped her to “become a survivor rather than a victim.”476 Yet, like the counseling performed by unit staff, these sessions do not constitute professional mental health interventions or therapy but are intended instead to offer support to the girls and to help them learn to modify concrete behaviors such as the expression of anger.477 An expert explained:
Not surprisingly, line staff vary in their commitment to and ability to provide effective group sessions and individual support to the girls. Many direct service staff are inadequately prepared to help girls with their mental health needs. By incarcerating girls in facilities far from the girls’ communities and families, the state effectively supplants the girls’ individual social networks with facilities staff. 480 It is therefore unsurprising that the relationship between girls and the line staff who supervise them daily in their living quarters is a major determinant of how girls view their experience of incarceration. This close interaction, in combination with the relatively infrequent contact girls have with an overextended mental health staff, mean that the work of mental health professionals can be significantly enhanced or undermined by line staff. The importance of a highly qualified staff in promoting rehabilitation and providing positive role models is reflected in detailed international guidelines regarding staff selection, qualifications, remuneration, and training.481 Juvenile justice services, moreover, are to be conducted, “with a view to improving and sustaining the competence of personnel involved in the services, including their methods, approaches and attitudes.”482 Experts in juvenile development concur that to offer girls the possibility of changing self-destructive behavior, the facilities staff with whom girls interact day to day must be exceptionally skilled, nurturing, respectful, and non-judgmental.483 Yet nationwide, facilities staff often lack both the high level qualifications and the nurturing attitude necessary to promote troubled children’s development and mental health. New York may be no exception. Informed sources have stated to HRW/ACLU that direct care staff in OCFS facilities frequently lack sufficient knowledge of mental health issues to handle the complex demands posed by girls with mental health problems, and, depending on the facility, are insufficiently supervised.484 As a service provider in a non-secure girls’ OCFS facility put it:
That staff members, while generally well intentioned, are in many instances unqualified and insufficiently trained to maintain the difficult balance between compassion and professionalism necessary to work with girls with mental health problems is reflected in girls’ reports of their interactions with staff. While some girls said that certain staff members listened to them and provided helpful advice about problems in the girls’ lives, many girls complained of disrespectful or unfair treatment and of being singled out by certain staff. OCFS grievance records are replete with allegations of staff venting aggression on girls, neglecting their job duties, targeting certain girls, and favoring others.486 According to girls’ complaints, targeting takes the form of addressing them rudely, limiting girls’ access to the bathroom, holding a grudge against girls for a past conflict, allowing girls to fight with each other, and even playing tricks on targeted girls.487 Some girls felt that staff took their anger out on the girls. For example, girls at Tryon reported that playing kickball during physical education isn’t fun because the staff members play and hit the girls hard with the ball.488 In their grievances, girls frequently describe staff as “rude,” “nasty,” and having an “attitude.” Additionally, girls sometimes felt neglected by staff. Conversely, girls also complained that staff were sometimes too familiar with them, or showed favoritism toward some girls. According to the girls’ complaints, this favoritism takes the form of allowing some girls to physically touch staff in contravention of the rules, the giving of extra food, or allowing extra time for phone calls or showers. Devon A. complained that facilities staff “personalized” with girls. When asked what she meant, she replied:
Devon A.’s account is corroborated by facilities grievance logs in which girls complain that staff members at the Lansing and Tryon facilities tell girls that they are “attention seeking,” “too emotional, cries too much,” a “cry baby,” or “acting like a baby.”490 In fact, such attention seeking behavior may arise from a history of victimization.491 Girls complain that their direct care staff mentors or counselors ignore them, put words in their mouths, or avoid speaking to them for weeks at a time.492 One girl at Tryon complained that she was told by her counselor that the counselor “washes her hands of her.”493 A possible remedy to this is increased staff training on mental health issues.494 In addition to depriving girls with mental health problems of the nurturance they need daily, insufficient knowledge among line staff of girls’ mental health concerns can have additional consequences. As described in Violations of Privacy, above, poorly trained and supervised line staff may inadvertently or purposefully disseminate intensely personal information concerning girls’ health and histories.495 Staff may also interfere with treatment, for example, by failing to dispense psychotropic medications at the appropriate times,496 or by disregarding recommendations made by mental health professionals.497 Staff insufficiently trained in mental health provision may also complicate the provision of mental health services upon a girl’s release. According to facilities policies, psychological and regular staff are to “coordinate their efforts with the after care worker in securing appropriate services in the community” when children are released from the facility.498 The development and execution of an aftercare plan for mental health care is crucial because after a stay often lasting for a period of months, psychological treatment is usually incomplete and must be continued. Yet HRW/ACLU was told that the coordination can be problematic, with the regular OCFS staff counselor making recommendations at odds with those of mental health providers, and with lax implementation by some OCFS aftercare workers.499 In some cases, administrative confusion prevents Medicaid benefits from being reactivated for girls leaving facilities, blocking girls from obtaining prescribed psychiatric medication.500
Punishment for self-harm is also a concern. Confinement in a prison-like environment can aggravate mental health problems and increase the likelihood of self-mutilation and even suicide for some people.501 When HRW/ACLU requested data from OCFS regarding the frequency of suicide attempts and self-harm among incarcerated girls, OCFS initially denied the request, and later stated in response to an administrative appeal that it “does not maintain cumulative statistical data regarding . . . suicide or self-harm.”502 HRW/ACLU are perplexed by OCFS’s failure to maintain such statistics. There is no question that girls in these facilities have engaged in suicide attempts and self-mutilation. 503 The monthly reports for Lansing and Tryon reveal numerous instances. 504 For example, a Tryon monthly report stated:
An earlier report gives a similar account:
As for self-harm, when asked whether she had cut herself while at Tryon, Felicia H. stated:
When Alicia K. was asked whether she had ever witnessed it at Tryon she replied:
Children can harm themselves for psychiatric reasons or to gain attention or both.510 Within as without institutional settings, self-cutting is more prevalent among adolescent girls than other groups, and is usually diagnosed as a symptom of an anxiety disorder or borderline character disorder, and in some cases may be traced to psychiatric medications such as Prozac or certain other antidepressants.511 As explained by Terry Kupers, M.D., M.S.P.:
Staff must respond when they see a child trying to injure themselves, but the nature of the response should be calibrated to the situation.
Girls in OCFS custody who attempt suicide or are otherwise believed to be a suicide risk are put on suicide watch, where they are constantly watched by staff and monitored by a psychologist.514 Girls may also receive more counseling than usual.515 Girls who have engaged in lesser forms of self-harm, such as scarring themselves, may be put on “personal safety watch,” in which staff must check up on the girl every 15 minutes. But in at least some cases, self-harm receives punishment as well as treatment. For example, a grievance report from Tryon, reads:
That girls are punished for mutilating themselves is also confirmed by Alicia K’s experience:
International standards prescribe complete mental health assessments of incarcerated children as soon as possible after they are admitted to a facility, and provide details as to the kinds of reports and individualized treatment plans that should be generated for each child.518 Children found to be suffering from mental illness should “be treated in a specialized institution under independent medical management.”519 New York case law recognizes a right under the United States Constitution to adequate rehabilitative treatment for all incarcerated children.520 In addition, under international norms, juvenile facilities should offer treatment for drug abuse administered by qualified personnel and tailored to the age, sex, and other characteristics of the children served.521 Delinquency court judges, moreover, place girls in facilities with the expectation that they will receive particular mental health care services, and often enter an explicit order to that effect.522 By incarcerating mentally ill children in prison-like facilities such as Lansing and Tryon, New York State is failing to meet the international standard requiring mentally ill children to be treated in specialized medical institutions. In addition, in those instances in which New York fails to provide adequate mental health care for children with mental health problems, the state is violating its duty under U.S. constitutional law to provide adequate rehabilitative services to all children. General Health ConcernsUnder international guidelines, every incarcerated child is entitled to receive adequate medical care.523 The provision of care is especially important for a population of children who often lack adequate health care prior to their incarceration, a situation provoking complaints from public health experts that because aspects of the larger health care and welfare systems do not function effectively, the juvenile justice system has become a major provider of health care to indigent children.524 Although not all children admitted to OCFS custody are screened for health, mental health, substance abuse, and other needs,525 girls do receive a health screening when they enter Tryon Reception Center.526 The girls that HRW/ACLU spoke to did not know or did not remember specifically what they had been tested for besides sexually transmitted infections, and did not appear to have received detailed information or counseling regarding the outcome of the screening.527 Most girls expressed satisfaction with the health care they received for routine problems such as colds and menstrual pain. That girls’ physical health needs are met is corroborated by other sources whom HRW/ACLU interviewed.528 Girls who need medical care while held in the facilities are required to fill out a form, called a “sick call,” requesting a visit to medical staff.529 An on-site nurse must evaluate the girl’s needs, treat her if possible, and refer her to an outside provider if necessary. According to residents of Tryon, there is no physician, eye doctor, or dentist on-site, but they do visit the facility regularly.530 Some girls reported problems with various aspects of the provision of health care at the facilities. In their grievances, girls complain that their requests for medical care are ignored, even after they submit multiple sick call forms regarding the same medical complaint. Other girls complain that they had to wait for days, weeks, or even months before they receive care.531 Yet others complain that the on-site nurse is only available until 6 p.m., rather than 24 hours a day, or that on-site staff is reluctant to refer girls’ problems for specialist care, even when the problem cannot be treated effectively at the facility.532 422 See generally “Healing Girls in the Juvenile Justice System: The Challenge to Our Community,” Proceedings of the July 2003 conference of the Health and Medicine Policy Research Group. Similarly, in a 2002 report, researchers documented the high rates of psychiatric disorders in youth in juvenile detention throughout the country, Linda Teplin et al., “Psychiatric Disorders in Youth in Juvenile Detention,” Archives of General Psychiatry, 59 (2002), pp. 1133-1143. 423 OCFS, “2004 Annual Report.” This figure may be low, as OCFS does not necessarily perform screening on every child it takes into custody. 424 See Bonita M. Veysey, “Adolescent Girls with Mental Health Disorders Involved with the Juvenile Justice System,” Research and Program Brief, National Center for Mental Health and Juvenile Justice (July 2003) (summarizing existing research on mental health disorders among incarcerated girls). A 2005 study of children in Florida detention facilities found that 36 percent of girls, compared with only 10 percent of boys, reported having “five or more emotional issues in the previous two months,” and a larger proportion of girls reported taking medication for an emotional condition. Vanessa Patino and Barry Krisberg, “Reforming Juvenile Detention in Florida,” National Center on Crime and Delinquency, August 2005, 15. 425 See Veysey, “Adolescent Girls with Mental Health Disorders Involved with the Juvenile Justice System.” For information specific to New York, see “Arrested Development: Substance Abuse and Mental Illness Among Juveniles Detained in New York City,” Vera Institute of Justice (December 2000). According to other authorities, although girls in the general population have a higher prevalence than boys of certain disorders, such as depression, the rates of some conditions such as PTSD, schizophrenia and bipolar disorder are approximately the same in boys and girls. In addition, boys may act out their conflicts aggressively, resulting in a higher prevalence of antisocial personality and conduct disorders in the male population. Email message from Terry Kupers, M.D., M.S.P., to HRW/ACLU, June 22, 2006. 426 HRW/ACLU telephone interview (name withheld), August 2006. 427 Marianne Hennessey, et al., “Trauma Among Girls in the Juvenile Justice System,” National Child Traumatic Stress Network, Juvenile Justice Working Group (2004); Steiner, H., I. Garcia and Z. Matthews. “Posttraumatic Stress Disorder in Incarcerated Juvenile Delinquents,” Journal of the Academy of Child and Adolescent Psychiatry, 36(3)(1997) (concerning children confined by the California Youth Authority), 357-365. 428 OCFS, “2004 Annual Report.” 429 HRW/ACLU telephone interview with Legal Aid Society attorney, September 28, 2005. HRW/ACLU telephone interview (name withheld), August 2006. 430 HRW/ACLU telephone interview (name withheld), August 2006. 431 HRW/ACLU telephone interview (name withheld), August 2006. 432 HRW/ACLU telephone interview (name withheld), August 2006. 433 “Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System: Program Description, Mobile Mental Health Teams, New York State,” National Center for Mental Health and Juvenile Justice, (Draft January 2006), http://www.ncmhjj.com/Blueprint/programs/MobileMentalHealths.html (retrieved August 4, 2006). 434 Office of Children and Family Services, “OCFS Mental Health Staff Roster,” document dated March 29, 2006, obtained by HRW/ACLU under the New York Freedom of Information Law. The psychiatrist for the facility as a whole is scheduled to visit “three Wednesdays per month.” The mental health unit’s psychiatrist is scheduled for “Mon., 6pm,” and is listed as a 0.1 full time equivalent, as is the psychiatrist for the facility as a whole. 435 Ibid. Under the heading “schedule,” the words “Patriot Contract” appear for one psychiatrist and “Thurs/Fri – fluctuates with Boys MHU” appears for the other. 436 Ibid; Office of Children and Family Services, “Facility Operational Guidelines: Tryon Girls Center,” document dated December 20, 2005, obtained by HRW/ACLU under the New York Freedom of Information Law. 437 Office of Children and Family Services, “1. Mental Health Services offered at Lansing Residential Center,” undated document obtained by HRW/ACLU under the New York Freedom of Information Law. 438 HRW/ACLU telephone interview (name withheld), August 2006. 439 Office of Children and Family Services, “1. Mental Health Services offered at Lansing Residential Center,” undated document. 440 HRW/ACLU telephone interview (name withheld), August 2006. 441 Ibid. 442 Ibid. 443 Inez Nievez in HRW/ACLU meeting with OCFS senior administrators, Albany, New York, April 18, 2006. 444 “Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System: Program Description, Mobile Mental Health Teams, New York State,” National Center for Mental Health and Juvenile Justice, (Draft January 2006), http://www.ncmhjj.com/Blueprint/programs/MobileMentalHealths.html (retrieved August 4, 2006). 445 Ibid. 446 Ibid. 447 Office of Children and Family Services, “OCFS Mental Health Staff Roster,” document dated March 29, 2006. One psychologist position is vacant. 448 Ibid. 449 Nevertheless, facilities reports suggests that serious problems may also exist within the mental health units. In one month, for example, 15 of the 28 uses of physical force against girls in Tryon’s non-secure portion occurred in the mental health unit. Tryon Monthly Report, December 2002, p.2. 450 See, for example, Lansing Grievance #7291 (11/05). 451 Office of Children and Family Services, “1. Mental Health Services offered at Lansing Residential Center,” undated document. The sessions are conducted by an “OASIS provider from Tompkins County Council on Alcoholism.” See, for example, Lansing Monthly Report, March 2005 – December 2005. This and subsequent citations refer to monthly reports generated by the director of each OCFS facility and submitted to the OCFS central office. The reports were obtained by HRW/ACLU through requests made under the New York Freedom of Information Law. 452 Office of Children and Family Services, “Tryon Girls: Week#1, Week#2,” untitled, undated document obtained by HRW/ACLU under the New York Freedom of Information Law. 453 HRW/ACLU interview with Bless L., New York, New York, March 22, 2006. 454 The bulk of this description was provided by individuals interviewed by HRW/ACLU who requested that their names be withheld due to concern for negative repercussions for taking part in the research. In response to HRW/ACLU’s request for records “describing in detail the mental health services offered” by Tryon Reception Center, OCFS produced only a brief, general description of the center stating that “Youth receive thorough assessments – e.g. medical, educational, psychological and mental health – during the fourteen (14) day stay.” Office of Children and Family Services, “Girls Reception Center at Tryon,” document dated December 2003. 455 HRW/ACLU telephone interview with (name withheld), August 2006. 456 Office of Children and Family Services, “Facility Operational Guidelines: Tryon Girls Center – Mental Health Services,” document dated December 20, 2005. 457 Ibid. 458 Ibid. The “psychological assessment” is described in this way: “While assessing cognitive, affective and behavioral domains, they are used to measure intellectual functioning, academic achievement, socio-emotional functioning, visual motor, auditory perception, learning disabilities, minimal brain dysfunction, personality, and neurological dysfunction.” 459 Shortages of direct service staff can also affect mental health service provision. See Tryon Monthly Report, May 2005, p. 14 (“Some non-OCFS clinical staff []are continuing to have difficulties having youth transported to their office for treatment due to lack of OCFS staff to do transport”). 460 Calculated from monthly reports for each facility obtained by HRW/ACLU via requests made under the New York Freedom of Information Law. Tryon’s monthly reports provide no figures for 8 of the months in question. 461 Office of Children and Family Services, “OCFS Mental Health Staff Roster,” document dated March 29, 2006. Social workers, rather than psychologists, are generally used to fill out the counseling staff because they are cheaper to employ than psychologists. When properly trained, social workers can in some ways provide therapy as effectively as psychologists. 462 Ibid. 463 HRW/ACLU meeting with OCFS senior administrators, Albany, New York, April 18, 2006. 464 HRW/ACLU telephone interview (name withheld), August 2006. 465 HRW/ACLU telephone interview (name withheld), June 2006. 466 Lansing Grievance #6759 (6/05). This and subsequent citations refer to grievance logs maintained by the facilities and obtained by HRW/ACLU through a request under the New York Freedom of Information Law. The logs contain abbreviated summaries of grievances filed by incarcerated girls. The citations herein contain the unique number assigned to each grievance and the month and year in which the grievance was submitted. 467 Lansing Grievance #6539 (4/05). 468 Lansing Grievance #7309 (11/05). 469 Tryon Grievance #9276 (6/05). 470 Lansing Grievance #5713 (10/04). 471 HRW/ACLU interview with Devon A., Albany, New York, February 28, 2006. 472 Facilities Monthly Reports, passim. 473 Legal Aid Society site visit. 474 Inez Nievez in HRW/ACLU meeting with OCFS senior administrators, Albany, New York, April 18, 2006. 475The Adelante program is not always provided. See, for example, Lansing Monthly Report, March 2005 (“Would like to see Adelente provided again as a group curriculum.”). 476 HRW/ACLU interview with Devon A., Albany, New York, February 28, 2006. On the other hand, Ebony V., who was incarcerated on a prostitution charge at the age of 16 and sexually abused within the facility, explained that she received no sex abuse or trauma counseling at all. HRW/ACLU interview with Ebony V., New York, New York, March 16, 2006. Ebony V.’s experience of sexual abuse at Lansing is described above. 477 HRW/ACLU telephone interview (name withheld), August 2006. 478 Youth Division Counselor, who supervises staff on a unit. 479 HRW/ACLU telephone interview (name withheld), June 2006. 480 Recent scholarship, moreover, emphasizes the importance of human relationships to girls’ development and sense of well being. Speech by Marty Beyer, Psychologist/Juvenile Justice and Child Welfare Consultant, in “Girls and their Unique Needs in the System,” at “Beyond These Walls: Promoting Health and Human Rights of Youth in the Justice System,” April 8, 2006. 481 United Nations Rules for the Protection of Juveniles Deprived of their Liberty (“U.N. Rules”), adopted December 14,1990 by General Assembly Resolution 45/113, rules 81-83, 85; United Nations Standard Minimum Rules for the Treatment of Prisoners (“Standard Minimum Rules”), U.N. ECOSOC Res. 663C and 2076, adopted July 31, 1957 and May 13, 1977, paras. 46-48. 482 United Nations Standard Minimum Rules for the Administration of Juvenile Justice (“Beijing Rules”), adopted November 29, 1985 by General Assembly Resolution 40/33, para. 1.6. 483 Beyer, “Girls and their Unique Needs in the System”; see also Marty Beyer, “Fact Sheet: What Does It Mean to Design Services to Fit Girls?,” p. 5. 484 HRW/ACLU telephone interview (name withheld), August 2006. 485 HRW/ACLU telephone interview with social service provider in the Staten Island Residential Facility, November 21, 2005. Additionally, Legal Aid Society attorneys visiting the Tryon facility observed a cultural gap separating staff from the girls: “The staff we met were from the Albany area and seemed to be completely removed/unfamiliar with New York City and the reality of the girls’ lives at home. While the staff seemed well-intentioned, there seemed to be an obvious divide between staff and residents.” Legal Aid Society site visit. 486 For example, well over a hundred such complaints were filed in Tryon in 2005. It is important to note, however, that because girls’ names are redacted from the grievance logs provided to HRW/ACLU by OCFS, it is impossible to discern how many grievances were filed by a single girl. 487 See, for example, Lansing Grievance #4678 (9/03). 488 Legal Aid Society site visit. 489 HRW/ACLU interview with Devon A., Albany, New York, February 28, 2006. 490 Facilities Grievance Logs, passim. 491 Beyer, “Girls and their Unique Needs in the System.” 492 Tryon Grievance #9424 (8/05); Tryon Grievance #9245 (6/05). 493 Tryon Grievance #9428 (9/05). 494 Some training does appear to occur at the facilities. See, for example, Lansing Monthly Report, January 2006 (reference to staff receiving “[T]rauma training”); Lansing Monthly Report, December 2005 (training on “Suicide Risk, Reduction and Response with Signs and Symptoms of Mental Illness”); Tryon Monthly Report, January 2006 (“Understanding Traumatized and Maltreated Children, Core Con[c]epts” training conducted by clinical staff for line staff of one unit). 495 That this occurs was confirmed by in an HRW/ACLU telephone interview with a knowledgeable source (name withheld), August 2006. 496 Tryon Monthly Report, January 2006, p. 14. 497 HRW/ACLU telephone interview (name withheld), August 2006. Examples given by the interviewee are staff telling girls that they do not need prescribed medication, and staff interfering with protocols such as providing a self-mutilating girl with an ice cube to use on her arm rather than a sharp object. 498 Office of Children and Family Services, “Facility Operational Guidelines: Tryon Girls Center – Mental Health Services,” document dated December 20, 2005. 499 HRW/ACLU telephone interview (name withheld), August 2006. 500 Tryon Monthly Report, February 2005, p. 15; Tryon Monthly Report, April 2005, p. 14. (“There is an ongoing problem that occurs when youth are released to the community and their Medicaid accounts are not activated.” Further detail and descriptions of specific instances appear in each report.). 501 This phenomenon has been documented in particular with respect to adult prisoners subjected to isolated confinement. See, for example, Human Rights Watch, Ill-Equipped: U.S. Prisons and Offenders with Mental Illness (New York: Human Rights Watch, 2003), pp. 53-60, 145-169. 502 Letter from Sandra A. Brown, Assistant Commissioner, Public Affairs, to HRW/ACLU, January 11, 2006. Letter from Kathleen R. DeCataldo, Records Access Appeals Officer, to HRW/ACLU, March 9, 2006. 503 According to some experts, girls more frequently manifest their mental health problems through self- destructive behavior, such as suicide attempts and lesser forms of self-harm, whereas boys are more inclined toward outwardly violent behavior. Speech by Marty Beyer, Psychologist/Juvenile Justice and Child Welfare Consultant, in “Girls and their Unique Needs in the System,” at “Beyond These Walls: Promoting Health and Human Rights of Youth in the Justice System,” April 8, 2006. 504 See, for example, Tryon Monthly Report, January 2005, p. 15-16 (“One resident had an Urgent Care visit because of inserting staples into her arm. She has a history of doing this on many occasions in the past . . . One resident inserted another staple into her calf.”); Tryon Monthly Report, April 2005, p. 2 (“One youth put a staple in her wrist.”). Tryon Monthly Report, October 2005, p.2 (a girl “plac[ed] a staple beneath her skin). The nature and extent of self-harm among girls at Lansing cannot be discerned because Lansing’s administrators do not regularly include such information in their reports. 505 Tryon Monthly Report, August 2004, p. 1. The nature and extent of suicidal behavior at the Lansing facility cannot be discerned because Lansing’s administrators do not include such information in their reports. 506 Tryon Monthly Report, January 2003, p. 2. Shortly thereafter, the girl ran away from Tryon. She was apprehended and confined in a county jail for a two month period. Ibid. See also Tryon Monthly Report, March 2003, p. 2 (“There were numerous youth who remained on suicide watch for prolonged periods of time . . . [T]here was a youth who tied a phone cord around her neck.”); Tryon Monthly Report, April 2004, p. 2 (“”There was a though who was discovered with shoelaces tied around her neck. Fortunately, this youth was found conscious and it was necessary for the staff to cut the shoelaces from her neck and the youth was subsequently placed on suicide watch.”). The nature and extent of suicidal behavior among girls at Lansing cannot be discerned because Lansing’s administrators do not regularly include such information in their reports. 507 HRW/ACLU interview with Felicia H., New York, New York, May 4, 2006. 508 A “tag” is a street name. 509 HRW/ACLU interview with Alicia K., Syracuse, New York, February 21, 2006. 510 HRW/ACLU telephone interview (name withheld), August 2006. 511 Email message from Terry Kupers, M.D., M.S.P., to HRW/ACLU, June 22, 2006. 512 Ibid. 513 Ibid. 514 Review of Legal Aid Society attorney’s redacted notes of visit to the Tryon facility on December 28, 2005 (“Legal Aid Society site visit”). 515 HRW/ACLU interview with Tanya T., Albany, New York, February 28, 2006. 516 Tryon Grievance #9510 (10/05). The “Level” designation refers to the system of rules employed in OCFS facilities. Rules are categorized as Level I, II, or III. Violations of Level III rules are considered the most serious and result in one of a range of penalties including loss of privileges for 120 days and delayed release, home visit, or transfer to a lower security level facility. Office of Children and Family Services, Resident Rule Book, pp. 47, 64. 517 HRW/ACLU interview with Alicia K., Syracuse, New York, February 21, 2006. Facilities records indicate that a staff member “attempted to restrain a youth for scratching herself with a comb.” Tryon Monthly Report, February 2005, p. 2. 518 U.N. Rules, rule 27. 519 U.N. Rules, rule 53. 520 Pena v. New York State Div. for Youth, 419 F.Supp. 203, 206-07 (S.D.N.Y.1976) (recognizing constitutional right to rehabilitative treatment); Martarella v. Kelley, 349 F.Supp. 575, 585 (S.D.N.Y.1972) (“Where the State, as parens patriae, imposes such detention, it can meet the Constitution's requirement of due process . . . if, and only if, it furnishes adequate treatment to the detainee.”). Model practice guidelines prescribe, among other things, gender-specific screening and assessments of mental health issues such as suicide risk Specifically, “gender-specific screening of pertinent health and mental health issues, including immediate issues such as intoxication, suicide risk, and pregnancy status; family information; education/special education status; delinquency history; and history of violence.” Detention Conditions of Confinement through a Gender Lens, an addendum to Annie E. Casey Foundation, “Gender Lens,” Self-Inspection Instrument, p. 1. 521 U.N. Rules, rule 54. 522 Girls are sometimes aware of the existence of a court order and attempt to enforce it. See, for example, Lansing Grievance #7054 (9/05)(“Has not been seen by [name redacted] for counseling - court ordered”). 523 U.N. Rules, rule 49. 524 See generally, “Healing Girls in the Juvenile Justice System: The Challenge to Our Community,” Proceedings of the July 2003 conference of the Health and Medicine Policy Research Group. 525 OCFS, “2004 Annual Report,” p. 4 (Table 2) (“Screening was not performed for every admission, and youth may have more than one need.”); see also Anthony Ramirez, “Offender Program Criticized,” New York Times, February 1, 2001, p. B2 (citing findings by the state comptroller that 27 percent of youths with special needs were not evaluated upon entering the state juvenile justice system). 526 HRW/ACLU interview with Francine Sherman, Boston College School of Law, December 22, 2005. 527 See, for example, Tryon Grievance #9091 (3/05)(“Grieving Medical for not getting back to her on her results.”); Tryon Grievance #9100 (3/05)(“Wants her results back.”). 528 HRW/ACLU telephone interview (name withheld), June 2006. 529 Review of Legal Aid Society attorney’s redacted notes of visit to the Tryon facility on December 28, 2005 (“Legal Aid Society site visit”). 530 Ibid. 531 See, for example, Lansing Grievance #6001 (1/05)(“med. forms submitted in late November and December, not seen”); Lansing Grievance #6041 (1/05)(“Been at Lansing for 4 months and has not seen dentist yet”). 532 See, for example, Lansing Grievance #6281 (2/05)(“needs (illegible) asthma pump on the unit, had attack no pump, nurse off duty”). |