'A complete failure': The plight of 2 teens lays bare the absence of mental health care for girls
PROVIDENCE – The dire state of psychiatric care for teenage girls in crisis in Rhode Island is laid bare in two recent state Supreme Court rulings.
In both cases, the state Department of Children, Youth & Families failed to find placements for teenage girls with significant behavioral and mental-health issues, despite its efforts.
While sharing in a Family Court judge’s frustration with the lack of appropriate facilities for girls in Rhode Island, the high court vacated orders finding the DCYF in contempt for failing to place the children.
“This is not a situation where the department sat on its hands and made no attempt to address the problem or comply with the court’s order,” Justice Erin Lynch Prata wrote for the court.
The rulings come months after the state Office of the Child Advocate issued a scathing report about neglect and mismanagement at St. Mary’s Home for Children, the only residential psychiatric treatment center that accommodates teenage girls in Rhode Island.
They come, too, as St. Mary’s and the state are poised to begin construction on an $11-million, 12-bed addition to ease the desperate need for in-house psychiatric beds for adolescent girls.
Two teenagers' plights
The cases detail the plights of two teenagers with intense mental-health struggles in need of residential treatment during the COVID-19 pandemic.
The first involves a minor, identified as N.B., for whom the DCYF filed a neglect and dependency petition in August 2021 after determining that her mother was unable to adequately supervise her through no fault of her own.
According to the account, the teenager was brought to Hasbro Children's Hospital after she was caught drinking alcohol and then allegedly assaulted her mother and younger brother. After the emergency room refused to admit her, her mother refused to take her home out of fear for herself and her son, and the teenager was placed on a 72-hour hold at the hospital, then released to her maternal grandmother.
According to the account, the child had been admitted to Bradley Hospital and Hasbro numerous times after assaulting family members, and was refusing home-based treatment for her medical and psychiatric conditions.
14 referrals but no placements
The court granted the DCYF temporary custody of the girl, requiring the state to make in-state and out-of-state placement referrals.
The ruling indicates the DCYF sought an emergency placement at St. Mary’s, but staff there could not meet the child's needs. The state then made 14 referrals to in-state and out-of-state treatment facilities, but placement was either denied or pending review.
More than 150 days in the hospital
The judge found that the DCYF had not made reasonable efforts to appropriately place the girl and concluded that her rights under the Children’s Bill of Rights were being violated. He expressed concern that she was not attending school, had no tutoring, mental-health counseling, behavioral treatment or exercise, and was primarily confined to a hospital room.
The judge ordered that N.B. be placed at St. Mary’s, but in November 2021, the DCYF filed a motion to modify or vacate the court's order because St. Mary's had declined to admit her due to staffing shortages and her diabetes treatment regimen.
The judge modified the order, but directed that the DCYF needed to place her “forthwith in an appropriate level of care.”
On Jan. 14, 2022, N.B. was discharged from Hasbro to her mother’s home after spending over 150 days at the hospital.
`A complete failure’
The state challenged the judge’s determination that it hadn’t made reasonable efforts to place the teen.
In ruling, the high court observed the “ongoing harm” the teenager suffered due to her long stay at Hasbro and that the judge had deemed swift action was necessary.
“The situation was dire. Despite court orders, the child was receiving no mental-health counseling, schooling, or tutoring of any kind, and she had almost no contact with anyone other than her mother and hospital staff for months,” Lynch Prata said.
The court noted that “no one, not DCYF, CASA, nor OCA, was focused on providing, at a minimum, either the mental-health counseling or tutoring services N.B. needed.”
“This is a complete failure on the part of all of the agencies charged with providing for this child’s care,” the court said.
The court concluded, however, that the judge had abused his discretion because the record was “replete with evidence of the DCYF’s efforts to place N.B. at St. Mary’s or another appropriate facility” and no such placement was available.
More: Screams, runaways dashing through yards: Neighbors share what it's like to live next to St. Mary's.
30 referrals and no placements for teen struggling with self-harm
The second case involved a 16-year-old girl who made repeated suicide attempts after being admitted to Bradley Hospital in February 2021.
The DCYF filed a dependency petition in May 2021, believing that the girl’s parents could no longer provide her with adequate care or supervision, and was granted custody.
She was readmitted to Bradley Hospital in June 2021 and a month later, when she was nearing discharge, the DCYF began making referrals for placements at a psychiatric residential treatment facility, first in-state and then within New England, to no avail.
By December, the DCYF was still unable to find an appropriate placement, and the judge ordered a national search.
The DCYF made about 30 referrals, and only one, Mount Prospect Academy in New Hampshire, accepted her – but had a months long waiting list.
The judge found that the DCYF had not made reasonable efforts to secure adequate placement for the teen, though it had such facilities for boys.
The DCYF remained unable to find an appropriate placement for the girl and, in February 2022, she was discharged home from the hospital. Two months later, she was readmitted after a suicide attempt.
State 'unable to comply' with order to provide treatment
The state appealed the judge’s finding, contending he erred in finding the DCYF in contempt for failing to develop a psychiatric residential treatment facility for girls in Rhode Island. The state argued that, while that is a long-term goal, it did not have the present power to do so.
The high court vacated that contempt finding, determining that though the DCYF was in technical violation of the Family Court’s order, the state was unable to comply.
This article originally appeared on The Providence Journal: RI's absence of psychiatric care for girls a 'complete failure' says judge
