For years Susan McParland has fought for the rights of youths to receive adequate mental health treatment. First as a public interest lawyer, and now the director of an advocacy group called the Michigan Association for Children with Emotional Disorders (MACED), she has seen young offenders with serious mental disorders remain in detention centers instead of getting the treatment that could change their lives.

"I've been representing kids for a while now to get them mental health treatment, and I've seen them getting shifted over to the juvenile justice system," said McParland.

But McParland and others know that detention centers are not always ideal places for rehabilitating juveniles with mental health illnesses.

According to indicators from new screening tools used in states like Michigan and Pennsylvania three out of four youths in the juvenile justice system show signs of some sort of emotional or mental health disorder. And for years no system has been in place to weed out for treatment the individuals at highest risk, the ones who will only get worse if they remain detained.

One teenager McParland helped was confined to a detention facility for assault. The boy had Aspergers Syndrome, a condition similar to autism. But McParland said his condition was never properly diagnosed while he was detained as an adult for his offense.

At one point, an officer at the facility knocked the boy unconscious for not making eye contact. "People with Aspergers don't make eye contact," McParland said.

McParland came to the boy's rescue and threatened to file a lawsuit under the Americans with Disabilities Act. At that point the boy was discharged from the facility.

"It's funny that it was only after the letter threatening litigation," said McParland.

Stories like this shed light on the problem of mental health care in the juvenile justice system that states around the country are investing time and resources to reverse.

But help is on the way.

Reforming the System

In Michigan, for example, Gov. Jennifer Granholm last December created a mental health commission to study the present mental health system and make plans to improve it.

"We're really taking a look at the entire system...to see if there are different ways we can do funding, [and] different mechanisms we can use to deliver services," said Barbara MacKenzie, the director of policy and program development for Michigan's Bureau of Juvenile Justice, and a staff member of the commission.

The commission has finished most of its research and is now preparing to present its recommendations to the governor. And, according to MacKenzie, they have identified several places to target their reforms.

"We don't have enough people in Michigan to provide services to the kids even when we can pay," MacKenzie said. "There's really a shortage of adolescent psychiatrists."

She said the reason for the shortage is because treating youths requires an extra year of training, the cases are generally more difficult, and they are not paid any more than regular psychiatrists.

To combat this, the commission is looking for "some way to enhance the amount of money that flows into medical schools to do more recruitment," MacKenzie explained. She said she hopes schools can advertise the profession as a way to deeply impact the lives of children.

MacKenzie identified another way in which they hope to reform the system. She said the very nature of the commission, made up of people from different government agencies, public citizens, corrections and probation officials and others, promotes cooperation between the different sectors, so treatment can go beyond just hospital visits or check-ins with probation officers.

What has happened in many cases, MacKenzie said, is that youths are released from the justice system and they return home to the place where their troubles started in the first place. "Returning them to the same dysfunctional neighborhood without a lot of services there could lead to recidivism," she said.

MacKenzie said the commission has looked into implementing a standardized way of assessing each individual's health. A good assessment tool, she said, would look into each area of the child's life and identify where is the greatest risk, and allow a treatment program to be tailored to the individual.

Screening: A First Step

As a means of quickly identifying which youths are at the highest risk when they enter the juvenile justice system, several states, including Michigan, have begun using a screening tool called the Massachusetts Youth Screening Instrument (MAYSI-2), developed by two faculty members at the University of Massachusetts Medical School.

The Juvenile Detention Centers' Association of Pennsylvania (JDCAP) has for four years worked on a project, funded by the Pennsylvania Commission on Crime and Delinquency, to study the effectiveness of the MAYSI-2.

According to a report written by Dr. Elizabeth Cauffman, who has worked as a research consultant for the JDCAP's project, "the MAYSI-2 is intended to serve primarily an 'alerting function' to provide juvenile justice staff with a method of identifying youths in possible need of more in-depth assessments who might otherwise go unnoticed or untreated."

Based on their answers to yes-or-no questions in seven categories, youths are determined to be either below or above certain cut-offs of risk levels. Youths either are determined to be at no risk, in the "Caution" category or in the "Warning" category. The seven categories the MAYSI-2 tests are alcohol/drug use, angry-irritable, depressed-anxious, somatic complaints, suicide ideation, thought disturbance and traumatic experiences.

According to Melissa Valentine, the director of the mental health project at JDCAP, detention centers in Pennsylvania are required to follow up with any youth that falls into the caution or warning categories. Depending on the resources available to the detention center, appropriate treatment is then identified.

Four years into the project, Pennsylvania has a solid sense of the number of youths in the justice system that ought to receive treatment. For example, about 35 percent of girls in juvenile justice think about suicide, compared to just under 20 percent of boys. And 55 percent of girls were determined to be depressed or anxious, compared to 35 percent of boys.

The next step for the JDCAP is to continue to devise ways in which the numbers can be used to provide better treatment. According to Valentine, the professors who developed the MAYSI-2 are in the process of studying the impact that the tool has had and the ways to use it to provide better services.

While states like Michigan and Pennsylvania plan for reform and test new tools, advocates like McParland continue to apply the pressure. And MACED is playing a role in advocating for that change as well. They have recently begun a program, funded by the W.K. Kellogg Foundation, to, according to a recent press release, "identify and advocate for needed reforms."

They are studying detention facilities around the state and analyzing public policy. "They have an important voice," said MacKenzie, "to tell government what it needs to do."

And armed with the results of the mental health commission's report, they're doing it.