You'd think New York State might have learned something from the disastrous consequences of "deinstitutionalization" of the mentally ill, right? The "reform" ultimately left thousands of mentally ill adults to wander the streets. But in February the state's Office of Mental Health announced plans to do it againthis time putting the squeeze on a crucial form of care for violent, antisocial teens.
The plan gives a dangerous option to New York State's 14 privately run, state-funded residences for seriously disturbed adolescents. It allows them to get rid of beds through attrition and then use the funding for the beds to provide more patients with services in their homeswhich won't work for the hardest cases among the kids. Up to 150 of the 500 beds now available may disappear, even though demand for this kind of intense supervision remains high, with a waiting list of more than 100 youngsters in New York City alone.
What sorts of kids need such care? Consider 16-year-old "Danny," a resident at Manhattan's Aichhorn Center. When seized with paranoid delusions, Danny has on several occasions bitten adults and other children in order to infect them with the chronic hepatitis virus that he carries. By the time he was 13, his mother had placed him in various homes and programs a total of 57 times. Like most of the other teens in these residences, he has amply demonstrated that receiving treatment at home is not a viable option: he is simply too destructive and uncontrollable to live in the community.
The state's plan won't affect Danny or the other patients who are already receiving care. But Dr. Michael Pawel, executive director of the Aichhorn Center, knows just what's in store for the teens who continue to languish on waiting lists and are now even less likely to receive the residential treatment that they need. "This recalls the worst excesses of adult deinstitutionalization," he says. "The adult prison population swelled with the mentally ill when they were pushed out of hospitals. It was bad enough doing it to grownups." Indeed, armed with the lessons of experience, why would a civilized society refuse to save its most troubled children from a tormented life of crime, homelessness, and self-destruction?