Maryland's four state mental hospitals on any given day house about 70 young people committed by juvenile court judges, sometimes without a finding that they are mentally ill, according to lawyers who filed a lawsuit on the youths' behalf.
These children, psychiatrist Marvin Schwarz believes, "sit in state hospitals, and some regress . . . some become angry, some withdrawn . . and some begin to belong there after being there for a while."
Under Maryland law, a juvenile court judge may order a child committed if he decides such treatment is "best suited" to the youth's welfare. But a state mental health official says these orders place in hospitals a "small number" of children who never belong there and a larger number who are held longer than they should be.
Lawyers for the youths have been fighting for almost two years in U.S. District Court in Baltimore to have the law allowing these commitments declared unconstitutional and for the system to be changed.
Schwarz, who toured the hospitals and studied cases at the lawyers' request, says he found children who did not belong in the hospital when he saw them, children who never belonged there at all and some who had never been seen by a psychiatrist before they walked through the hospital doors.
Though Schwarz and the mental health officials disagree on the number of children in hospitals who do not belong there, both sides agree that some children "are imappropriately placed."
Some of the youths clearly belong in mental hospitals, says Schwarz, who practices in Forest Park, I11. "But my concern is the procedure they go through. It often does not determine if they belong there or not. It is just a matter of chance."
A lawyer for some of the defendants, including juvenile court judges and state mental helath officials, defends the current law on juvenile commitments. Assistant Attorney General Judith Sykes says it is not only constitutional but allows more flexibility than the court would have if bound by the standard required to commit an adult-that he be dangerous to himself or others.
Legal Aid Bureau attorney Susan Gauvey, representing the youths, argues that the juvenile standard is too broad and allows the commitment of children who do not belong in hospitals.
Psychiatrist Schwarz points to the case of a 13-year-old boy committed by a judge in 1976 to Spring Grove Hospital Center. "His psychiatric evaluation didn't make sense, and I'm not sure why he was ever sent there," Schwarz said. The boy remained in the hospital for 18 months, although hospital personnel had recommended this discharge three months after he was committed, according to allegations in the lawsuit.
Dr. Alp Karahasan, deputy director of the Mental Hygiene Administration and a child psychiatrist, says he agrees with Schwarz's findings in the case of the 13-year-old youth. The boy's "psychiatric diagnosis did not indicate much was wrong," Karahasan says. But the hospital was powerless to discharge the boy without some place to send him and a judge's approval, Karahasan says.
Often these children do not have families to go home to. They are from foster homes or broken homes or have parents who do not want them back, according to Karahasan. So the mental hospitals must turn to other state agencies to find new foster homes or private group homes or treatment centers to take them. The families and private facilities can, and often do, refuse to take such children.
In one case a social worker became so desperate to find a proper placement for a child, he placed an advertisment in a newspaper seeking help, according to Schwarz.
In these circumstances, the hospitals are the only places that cannot refure to take or keep a youth.
The mental hospitals, says Schwarz, become "victims" of the system too. "The tragedy is that these kids can sit there, and the private agencies can turn them down."
Both he and Karahasan pointed out that hospitalization beyond the proper point can cause a child to "regress."
The hospitals "are not hotels, they're not boarding schools," says Schwarz. Youths can become "like small children, unable to care for themselves. Many don't have any families at all. The institution becomes their home," the psychiatrist said.
The children committed to the institutions have come before the juvenile court for problems ranging from disobedience to habitually running away and on charges ranging from disorderly conduct to killing a foster parent, according to psychiatrists who have reviewed their cases.
For the judges' part, Schwarz says they may have no other options but to place the child in a mental institution. In they don't want to put the child in a training camp, or on the street, a mental hospital may be the only option. "There are not enough group homes and other settings," he said
The youths' lawyers have therefore asked the court to order the defendants to present a plan for creation of "appropriate, less restrictive alternatives to hospital confinement."
The state's juvenile court judges, who as a group were named as defendants in the lawsuit, were not called to the stand in U.S. District Court last week during a hearing on the case.
Two former juvenile court judges in Baltimore refused to comment on the lawsuit. District Court Judge John C. Tracey of the Montgomery County juvenile court said that in Montgomery youths are committed to mental hospitals only after a hearing in which members of a special disgnostic team testify about their condition.