Judicial Administration of Mental Health Services for Juvenile Offenders

By FRANK A. CAMMARATA A N D MICHAEL WILLIAM R . STOTT

I NTRO DUCT ION

The need for mental health consultation services to juvenile courts i s well documented. For policy makers, the practical consideration is the efficient provision of ser- vices consistent with the function and pur- pose of the court. In New York State there is no uniform approach whereby family courts receive such services. With unspecified legis- lative mandates family coiirts i n New York State have developed diverse arrangements based on local resources and expediency. However, the recently enacted Juvenile Jus- tice Reform Act of 1976 inandates mental health evaluations for a specified group (de-

Aicthor’ s address: Frank A. Cainmarata Clinic Administrati\.e Dircctor Erie County Family Court

Psychiatric Clinic 25 Delaware Avenuc Buffalo. Neu. York I4202

Michael Williatn R. Stott ‘4ssistant Professor Departiiient of Psychology Houghton College Hottghton, New York I4744

signated felons) under the jurisdiction of the family court. This law has raised the concern of the New York State Office of Court Ad- ministration as to whether or not local family courts are able to meet the legislative man- date.

The purpose of this paper is to review the implications of the mental health mandates of the Juvenile Justice Reform Act, describe the services of the Erie County Family Court Psychiatric Clinic, and offer a reconimended administrative model which has de- monstrated benefits.

J U V E N I L E JUSTICE REFORM ACT 1976 The historic objective of juvenile courts is

to meet the needs and best interest of the juvenile offender. A recent change in Ne\v York State law, however. reflects a philosophical shift of objectives balancing the needs of the offending child with the right of the comniunity to be protected from the dangerous delinquent. The Juvenile Justice Reform Act of 1974 became law effective February I , 1977 and amended existing Edu- cation, Mental Hygiene, Family Court, and Executive Law. Though referred to as a rc - form act, it may be seen as regressive by cliiltl

FRANK A. C\MMARATA and MICHAEL W I L L I A M R. STOTT

advocates, because the law stipiilLitcs longer and more restrictive iiistitlitioiiiil pliiceinents for fourteen- and fifteen-year-old juveniles who coininit serious crimes.

Of interest to tlie aiithors is tlie enlightened feature of the siiiiie I;iw which clearly and iinanibiguorisly inandates mental health ser- vices to he atljiidicatecl juvenile felons desig- nated hv tlic . let . ‘I’hc services include ps~cliodia~iicistic asessment (intellectual. achicuciiieiit, ; i d personality testing), as well as pychi;itric inter\k\vs. Specific directi\.es are given to the assessors to attend to intelli- ge I ICC, acatlc mic achieve men t , eiiio t ional 5 ta I) i I i ty , iiieii t a I stat us, i m p 11 1 se control , sociological determinants, lethality, illid need for restrictive placements. Additionallv, the law requires the State Department of Mental Hygiene to pro\.idc rcstricti\,c placements for the treatment of the mentdly ill jii\fcnile fe- lon, Current Mental Hygienc Law, which this Act amends, makes inadequate provi- sions for the mentally i l l juvenile felon.

~

“Whereas in the past the psychiatric clinic only evaluated adjudicated offenders, re- cent legal concerns and changes in mental health laws have altered this practice. At- torneys have raised the question of the competency of mentally defective and/or mentally ill children assisting in their own defense. When this issue is raised in court, the clinic staff provides an immediate as- sessment of the juvenile to determine his mental competency.”

Llnfortunatelv, the reform x t applies to a very sniall percentage of all ju\.enile offen- ders, neglecting the less serious fclons, those charged ivitli niisdemeanors and status offen- ders. The mental health iiccds of the lattcr categories ma!. be equal to or greater than the needs of the iiiorc serious felons. Research indicates that the rccidiiism rate of status of- fenders is greater than that of felons. Status offenders arc reported to be aimilar in their offenbe histories to jur,eniles who commit misdcnieanors and felonies.

PSYCHIATRIC C L I N I C OF E R I E COUNTY FAMILY COURT

Thc Psychiatric Clinic of the Erie County Family Court is a specialized service that has evol\.ed over three decades in response to the need for mental health consultation to the coiirt. ‘The clinic is located in the court build- ing. Prior to 1962, the senice was pro\.ided only to juvcnile offenders appearing before what was then Children’s Court. The New York State Family Court Act of 1962 ex- panded the jurisdiction of that court to in- clude adult offenses, such as child abuse, neglect, nonsupport, and assaults within the fanii l~~. The clinic now addresses itself to all offenses o\’er which the court presently has jurisdiction. O f the 970 cases processed by this clinic in 1975, there were 609 children

With a philosophy of maintaining profes- sional identitv, but sharing interdisciplinary responsibilities, this clinic is able to provide all of its services with a staff of one clinic adniinistrator, three clinical psychologists, one social worker, and the equivalent i n part- time employment of one full-time psychia- trist. This professional staff, with the support of four secretaries, make up the entire per- sonnel team.

The services of the clinic include those considered hv Russell to be appropriate ser- \ices of ;I progressi\.e court clinic.4 Specifi- cally, it p r o d e s psychological and psychia- tric ciduation of children and adults referred by the court after adjudication to assist in arri\ ing at the best dispositional alternative. The iiiriltiplicity and complexity of alterna- tiws necessitates precise rehabilitative and dispositional directitrs. The court, in provid- ing indi\idualized justice to the offender, is obligated to ascertain the very specific needs of the individual and to secure the most ap- propriate senices to meet those needs. Cer- tain juvenilc offenders present coinplex dis- positiondl and placement problems. The lcariiiiig disabled, nientally retarded, epilep- tic, and inentally i l l youngsters require specific treatment if maintained in the com- munity and specialized institutional care if placement i s required. Olczak and Stott in

XI7d 361 :ICltlltS.

J U D ~ C I A L ADMINISTRATION OF MENTAL H E A L T H SERVICES

their paper, which dealt \vith placement of retarded i u ven i le offe tide rs, concluded that psychological testing, especially intelligence testing, “can be part of the program of tho ii g h tf ul , some t i ni e s s 11 c c e s s fu 1 place- ments. ” 5

Whereas in the past the psychiatric clinic only evaluated adjudicated offenders, recent legal concerns and changes in mental health laws have altered this practice. Attorneys have raised the question of the competency of men- tally defective and/or mentally ill children assisting in their own defense. ‘The literature, though replete with references to the issue of adult competency, has only recently attended to the issue of juvenile When this issue is raised in court, the clinic staff provides an immediate assessment of the juvenile to deterniine his mental conipe- tency. Present New York State mental hygiene laws limit involuntary commitment of persons who are mentally il l to psychiatric hospitals except when they are frankly dangerous to themselves or others. This re- sults in many family offense petitions being filed in family court against acting out men- tally ill family members. Under a provision of the New York Family Court .4ct (Sec. 251), judges may order a respondent committed involuntarily for hospital observation and treatment for a period not to exceed thirty days. Psychiatric clinic staff provide ini- mediate consultation with judges prior to the exercise of this judicial option. When a re- spondent is considered appropriate for hos- pitalization the clinic coordinates the referral.

A second aspect ofthe more formal method of consultation to the court is the review by clinic staff of all petitions for county financial aid for the education of handicapped chil- dren. While the decision to affirm or deny a petition for aid is a judicial one, the Erie County Family Court delegates review re- sponsibility to clinic staff possessing expertise in this area. In 1975, 700 such assessments were provided to the family court judges.

While difficult to document, the frequency of informal consultations provided to the court by the clinic staff remains an essential component of tlie consultation service. It is

also difficult to measure the impact of these informal consultations; IioweLcr, they do provide the total family court system with immediately available mental health opin- ions.

Diagnoses, recommendations, and consul- tations are the priority services of the clinic. Although the clinic and court view mental health treatment as critical to the entire popu- lation, served by family court judges, treat- ment has only been provided to juveniles, and then on a limited basis. This clinic. however, has developed a referral linkage with two co m m ti n i ty agencies to bring their specialized treatment ser\ices to the court it- self. A very satisfactory arrangement exists with The Psychiatric Clinic, lnc. , a prii,ate agency, which is tlie primary contractor for children’s outpatient psychiatric services in Erie County, and tlie Association for Re- tarded Children to have a staff niember from each of their agencies housed in the clinic to guarantee linkage and treatment of court- referred clients with their services.

The clinic also provides a direct service to the probation and detention departments. After a juvenile has completed a psychologi- cal and psychiatric evaluation a case confer- ence is called, which includes probation of- ficers, to “share professional knowledge in the difficult task of managing and helping offen- ders.”’ Additionally, tlie clinic provides con- sultation to the detention staff and conducts weekly seminars in case conferences with their ed iica tional personnel .

The clinic shares its professional expertise with community agencies, colleges and uni- versities, and professional schools through seminars, field work placeinents, and interri- ships. Currently, staff members are conduct- ing research inquiries into the personality of juvenile offenders and the treatment needs of abusive and neglecting parents.

The entire program of the Erie County Family Court Psychiatric Clinic outlined above has historically demonstrated its flesi- bility, service capacity, and operational intcg- rity for the past thirty years. This clinic, thcre- fore, expects to fulfill the new mandatc f o r diagnostic services to adjudicated juvenile fel-

November. 1977 1 Jirr~cni lc Jiisticr 5

FRANK A. CAMMARATA and MICHAEL W I L L I A M R. STOTT

ons without modification of present policy or programs, as well as to continue to provide a broad range of mental health services for the court.

RECOMMENDED ADMINISTRATIVE ORGANIZATION

Our success in delivering the mental health services specified above is largely due to our administrative and organizational arrange- ment. The mental health component of this court is a service of the court, not a service to the court. That is, the Administrative Judge of Family Court is the administrator over all functions of the court, including the psychia- tric clinic. The clinic, therefore is directly ac c o u n ta bI e to the ad in i n is t ra t i ve j u dge , who, with his judicial colleagues, are the primary consumers of the clinic’s services. Such an administrative arrangement integ- rates mental health services into the very function of the court, rather than offering them as ancillary or independently accessible services. It may serve as a model to other family courts, as they carry out the designated functions of the Juvenile Justice Reform Act of 1976.

BENEFITS The administrative arrangement enjoyed

by this clinic and court has maximized several i i n po rta n t conditions.

PHYSICAL LOCATION

Modlin, Porter, and Benson. in evaluating mental health services to the criminal justice system, argued persuasively for the physical placement of such services within the crimi- nal justice Their research cited sev- eral often overlooked benefits of physical prox- imity of mental health services to the courts.

(a ) ‘I’he offciidcr nccd not pcrforni thc dual role of pro1)ationcr ;iiid patient o r find his \\a! in two different and oftcn 311-

titlieticd social systems. (1)) I Ic caniiot play one aLitliority figure

against ;inother. (c) Iliider tliis arrangcn~ciit, the criininal j o s -

ticc personnel do not feel tlircateiicd hy

tlie inciital health professionals’ i i i idue cncro,ichiiients 011 their functions.’

We would add, from our experience, that mental health professionals are not threatened by the court and its trappings. Cohabitation m in i mi zes tradition a1 stereotypes of“hanging judges” and “bleeding heart” mental health workers and maximizes constructive collaboration in meeting the multidimensional needs of clients.

ACCESSIBILITY

White, in his reivew of mental health ser- vices to the Cambridge, Massachusetts courts, noted, “judges are generally less ac- cessible than probation officers.” Although is “some cases” the clinic staff in that situation was able to meet with judges, accessibility seenu to have been through the medium of “pamphlets, reprints, memos, and other brief written materials that deal with some of the issues. ” White recognized, however, “the clinician’s personal contact with judges if far more effective than the written materials.” Personal contact in our experience flows naturally and is enhanced by our administra- tive arrangement. The clinic staff meets regu- larly with judges on matters of policy, pro- gram, budget, and administration. Of equal importance are the many court social func- tions attended by clinic staff. Accessibility, therefore, is direct, personal, and mutual.

IMMEDIACY

Mental health crisis frequently occur in courtrooms. Specifically, in the juvenile/ family courts. explosive outbursts of juveniles, suicide threats, and bizarre or un- usual behavior of defendants require ini- mediate attention. In the Erie County Family Court, immediate consultation in the court- room, if necessary, and attention to the needs of the client are available by the clinic staff.

SPECIALIZATION

The staff of the Erie County Family Court Psychiatric Clinic is recruited on the basis of their mental health expertise and their in-

h Juvenile Justice I November, 1977

J U D I C I A L ADMINISTRATION OF MENTAL HEALTH SERVICES

terest in the work of family court. T h e uniqueness of our administrative arrange- ment and our recruiting policies has led to the development of mental health specialists whose full concern is occupied by the needs of family court expressed through their service, research, and teaching. Specialization of ser- vice reduces administrative and supervisory confusion which results from the understand- able unfamiliarity of community agencies with the juvenile justice system. In com- prehensive mental health services, court- related services frequently require an inordi- nate amount of supervision.

EFFICIENCY

Both the mental health and juvenile justice systems are sensitive to inappropriate de- mands for service. Frequently, mentally ill juveniles are referred to family court as status offenders and juvenile delinquents to mental health services as emotionally disturbed. A certain degree of overlap is unavoidable be- cause a juvenile problem is rarely a discrete psychiatric or court phenomenon. Formal and informal linkages between family court and the mental health system have been de- veloped assuring more appropriate system utilization. Thus, we are able, with a signifi- cant degree of success, to bind judicial im- peratives to the maze of existing community resources.

CONCLUSION In summary, new juvenile justice legisla-

tion, current research, and successful experi- ence suggest the advantages of a mental health service component administered by the family court, rather than ancillary to the court. Both the clinic and the court are able to maintain their individual professional iden- tities, while at the same time share a common facility, language, allegiance, and objective.

FOOTNOTES ‘See in Family Luw (New York: Matthew Bcnder 8.

*lbid. 3C, W. Thomas, “Are Status Offenders Really so Diffe-

rent?” Crime and Definquenry 22 11976): 438-455. 4D. H. Russell, “Juvenile Dclinquencv,” Psychiatric

Annals 5 (1975): &35. SF‘. V. Olczak and M. W. R. Stott, “Family Court

Placement of Mentally Retarded Juvenile Offenders and the Use of Intelligence Testing,”CriminalJustice and Behavior 3 (1976): 23-28.

6R. Roos and T. Ellison, “The Mentally 111 Juvenile Offender: Crisis for Law and Socieh.”JuvenileJustice 27 (1976): 25-32.

Company, 1976) p. 750.

’Riissell, “Juvenile Delinquency.” 8H. C. Modlin, L. Porter, and R. E. Benson. “Mental

Health Centers and the Criminal Jiistice System,” Hospital and Community Psychiatc 27 (1976): 7 I & 719.

91bid. 1°S. L. White, “Providing Family-Centered Consulta-

tion to a Juvenile Court i n Massachusetts,” Hospital and Community Psychiatp 27 (1976): 692-693.

November, 1977 /Juvenile Justice 7