Author Topic: Coercive Treatment of Adolescents - Dr. Huffine  (Read 1502 times)

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Offline katfish

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Coercive Treatment of Adolescents - Dr. Huffine
« on: April 19, 2006, 12:21:00 AM »
Dr. Charles Huffine, MD
Youth rights, a major societal failure.

In treatment facilities that treat kids (including hospitals) in almost all areas of the country except my state, the state of Washington, youth rights are violated when they are forced into care, especially forced to stay in a facility. Why are youth rights not violated in the State of Washington? Let me explain. We have an unusual law, a law that is constantly threatened by regressive elements of our legislature. That law states that youth must consent to their mental health and substance abuse treatment from the day they turn 13! Why 13? The thinking of the legislators who drafted these laws is lost in history, but there are hints. They also gave reproductive health rights to all post pubertal woman in this same time period. All these laws came about in an era of consciousness over reproductive rights in the 1970?s. The drafters of the legislation did not have the advantage of good data, but these laws do make some sense based on more recent research. Puberty happens for almost all youth before 13 and is near completion by that time. Social expectations change when youth are post pubertal. Youth are forced to make many complicated judgments at this time in their lives as they become more independent players in society. Social choices are foisted on youth whether they are prepared or not. They have to make choices that require judgment, even if their brains are not fully developed to the point that they can exercise adult like judgment. We know that emotional arousal will cause a youth?s social judgment to deteriorate. Adolescents depend on their parents, and sometimes other adults in their lives, to moderate their having more independence in their communities and more complicated social choice making. Mostly this parental guidance works for youth if it is respectful and lovingly delivered. Mostly, once in a calmer state after a conflict with parents over a reprimand or limit setting, youth will come around and see the wisdom in their parents concerns. But what happens when youth are not blessed with parents who are competent to offer such good advice, or don?t have their adolescent child?s interests uppermost in their heart and mind? It is these exceptions where there is need for clarity about youth rights is. When can youth competently exercise judgment regarding major decisions in their lives?

Some research has found that sometime between 12 and 14 (12 and 15 in another study) individuals make as good a judgment about their health care, including mental health and substance abuse services, as did youth at 18, or even those 25 years old. Suffice it to say, some individuals at all ages make terrible judgments, especially when emotionally charged up, but the research supports youth having a capacity for competent, confidential and self determining decision making on all health care matters at age 13 or 14. The right to consent equals the right to NOT consent. One without the other is meaningless. The right to refuse protects youth in my state from being forced into any coercive care in the same way as adults are protected. So let me explain that when youth are forced into care in my state why their rights are not violated.

When is it alright and necessary to force individuals into protective treatment?

It is important to understand the conditions under which individuals can and should be coerced into care. The commitment laws of most states are designed to address those situations when an individual is in eminent risk of lethally harming themselves or someone else due to a mental disorder, or are so incapable of functioning due to such a disorder that they present an immediate risk of incurring harm. My state is very strict in observing these criteria before they detain such an individual. Each person detained must be screened by a trained County Designated Mental Health Professional (CDMHP) before they can be held for 3 days. At the end of an initial 3 day period a court hearing must occur where the individual is represented by an independent attorney. If the evidence continues to indicate a high degree of eminent risk of harm the individual must stay for an additional 14 days. At the end of 14 days a rigorous legal process sorts out those few individuals who don't respond to crisis level care in 14 days of hospitalization and must be detained for 90 to 180 days. In the state of Washington all youth 13 and older are subject to this process if they are to be detained for a mental disorder. In Washington State there is an alternative method for detaining youth designed to address outrageous behavior that may not be recognized as due to a mental disorder. This process is called either an ?At Risk Youth? (ARY) or ?Children In Need of Services? (CHINS) petition, both of which can inform the judge that a child is at risk due to emotional problems indicated by their behavior. A judge can detain a youth, ages 13 through 17, for 5 days maximum. A longer stay can be theoretically initiated if a parent physically takes a youth to a hospital and the hospital evaluates and accepts them based on the same criteria. An appeal process involving an attorney is possible if the youth is hospitalized. That process, if completed successfully for the youth would take no more then 30 days. No hospital has ever detained a youth under this provision in our current law for fear of a law suit.

So what makes an involuntary commitment for an adult or a youth over 13 not against their rights? It is that a legal review process with access to an attorney is assured. Such a process is the rule in involuntary treatment, and the ARY and CHINS petitions. Of course, if a youth breaks the law a judge may order them to treatment in lieu of jail, but that is not involuntary treatment, it is just giving a youth an option to not go to jail, even if it feels like a "deal they can't refuse."

Involuntary residential care outside of such a legal process cannot be therapeutic, no mater how humane and well intended the staff, as it undercuts and essential aspect of adolescent development, the achievement of autonomy. It is NOT therapeutic because the loss of rights does damage to a sense of self. It undercuts the formation of a personal identity. As with restraint and seclusion, it may be necessary to save a life, but it has a very large cost. It represents a failure, or an absence, of community-based treatment. In such circumstances, such active coercion needs to be ended in the shortest possible time, preferably only a few days. Individuals detained, even in a state of psychotic thinking, should be offered trauma support and counseling, similar to what is commonly recommended after an episode of restraint, to undo the damage caused by such coercion.

I personally believe that if our laws that protect youth rights in mental health and substance abuse treatment were changed from 13 to 16 or 18, the State of Washington would have a flood of locked residential programs emerge around Seattle just as in Idaho, Utah and Montana. I strongly believe that we will not solve the problem of unsafe, non-therapeutic, inappropriate residential treatment until youth are given rights to consent to care in all 50 states. If Idaho, Montana and Utah and all other states had such laws, and had strong Protection and Advocacy agencies in their states to assure adherence to such laws, we would not have the problems we do today and youth such as most of you would no longer endure the abuse and humiliation you have suffered.

Giving youth legal rights doesn?t take away parental rights.

Assuring that youth under 18 have rights would not cause them to run amok. It is an insult to youth to assume that the much maligned stereotype of an unruly teenager is the rule. It is a very clear minority of youth who are out of control of their parents and in these cases the breakdown of parental authority and respect most often represents a serious emotional problem for the youth, or within their family. Almost always families have the resources to instill decent values in their kids and kids don't violate such values with their behavior without guilt and shattered self esteem. We know that caring parents who set limits and intervene on the basis of their love for their kids are successful at influencing their kids and can be assured that their youth's behavior will be reasonably safe and decent. It is also true that if trust between parents and youth has been broken by parents who are abusive themselves, or have neglected their kids, a youth's behavior may very well reflect their upset with such parents. Allowing parents to place such kids in horrible facilities is simply a continuation of that abuse. We also know that youth from decent, ?good enough? families do things, and will continue to do things, with peers that would give parents heartburn if they knew. Incurring some risks; i.e. learning to not be stupid with drugs or alcohol, handling sexuality responsibly, learning to drive a car safely are all not without risks, but are normative challenges for youth in our communities. Youth who are upset due to depression or anxiety or some other mental health problems may act out their pain with gross and inappropriate behavior, (1.e. cutting themselves, abusive drinking, gorging and forced vomiting, shoplifting or getting into fights) but good evaluation and treatment can help youth to no longer need to do these kind of things to express their pain. In these types of situations parents need the support and skill of someone who can work with their son or daughter and have the tools to define and treat the problem. Parents with troubled youth need support and it is the obligation of a mental health therapist to either provide such support or arrange support for such parents. A community based treatment within the context of a mentor like relationship with a therapist is more respectful of a young person who has to find their own way through the complexities of growing up, but it is also more respectful of parents who need a sense of community support if they are to handle the rough edges of parenting a youth with significant emotional problems.

My views on the need to limit coercive care stems from my success in treating youth in their communities, amongst all the so-called bad influences. It is born of my learning the power of strength based care and believing that every young person has talents and capacities that are untapped in their adolescent years and that supporting the growth of maturity and uncovering such capacities is the best form of treatment. My views are also shaped by an appreciation of social and family context. I am very aware that families and communities can fail youth. Families of emotionally troubled youth need ?clued in? therapists to work to correct such difficulties while helping youth cope with often non-optimal growing up conditions. I have seen the power of helping families and building community as an alternative to ripping a kid out of their family and community.

Clearly community based care for troubled youth is preferable. We need to do much more to think through if and when there are medically necessary reasons for forcing youth into hospitals or residential treatment programs. Their may occasionally be such circumstances, but current research is insufficient to forge an informed opinion on this issue. Certainly we know that such interventions, when the result of an involuntary treatment process, should be rare and brief and subject to legal scrutiny. I hope that these thoughts will inspire some discussion, and possibly some debate. I plan to participate on this website in discussions about ?good therapy? and provide some thoughts from the land of sympathetic professionals. ... &Itemid=79
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Offline Curious John

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Coercive Treatment of Adolescents - Dr. Huffine
« Reply #1 on: April 21, 2006, 10:03:00 PM »
It was my understanding that most programs required a forced consent anyway. The more you refused, the harder the intake process.
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »

Offline Anonymous

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Coercive Treatment of Adolescents - Dr. Huffine
« Reply #2 on: April 29, 2006, 10:55:00 AM »
UNderstnading teh issues of Academia- I don't think CH is suffering from this issue... I think we can all agree our drug policies are considerably dated and ridiculous- I think that this is a huge concern, but once a kid is in the system this is somehting a little different... no hugely different, but midly in that we're talking parent's rights vs youth rights.  

Rights of states or citizens to ensure their safety b/c a kid is using drugs, selling drugs etc. is often an over-reaction, but this then has to do with how we handle 'criminal' activity and whether or not we agree certian things are indeed 'criminal' and the degree of rehabilitation vs punishment.  

I would argue our drug laws are too stringent, that they generally don't make a whole hell of a lot of sense.  That should be addressed b/c from there the 'punishment' or forced rehabilitation (if that's what why do in WA) would make more sense... I think preventative is also key and community care is accessible so that, prior to a kid ending up in the system or being self destructive in general, he has some idea of their existing an alternative...
Not sure how often kids are court mandated--- that's tricky...
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »