Breakthrough in Case for Children Stuck in Costly Mental Institutions

September 28, 2007 12:00 am

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Federal Judge Orders Expert to Oversee New Approach to Mental Illness

LOS ANGELES – In a breakthrough ruling that affects more than 25,000 California children suffering from serious mental illness, U.S. District Judge A. Howard Matz has ordered an expert to oversee the expansion of home- and community-based mental health services for children who would otherwise end up in costly group homes and institutions.

The order was handed down this week in the case of Emily Q., a young Latino woman whose problems escalated rather than improved as she was shuttled from placement to placement.

“Emily’s case opened the state’s eyes to the tragedy of abandoning children in institutions where their mental illness often worsens,” said ACLU of Southern California senior counsel Melinda Bird, lead attorney in the case. “The court’s decision this week means California must increase its efforts to keep children in home-like settings, where research shows they are more likely to improve.”

When disability rights advocates met Emily in 1997 at Metropolitan State Hospital in Norwalk, she was 18 and had spent more than half her life in mental institutions, in isolation and restraints or heavily sedated because of her violent behavior. Emily said her outbursts came out of her desperation. “I am terrified that I might end up here forever,” she said.

In 1998, advocates filed a lawsuit, Emily Q. v. Bontá, against state officials, arguing that children in mental institutions and group homes could be better served by offering one-to-one behavior aides or “coaches” in their homes and communities. In 2001, the federal court granted a judgment in favor of the plaintiff children, ordering the state and counties to offer a new Medi-Cal mental health service known as Therapeutic Behavioral Services.

This week Judge Matz found the state program still did not comply with his judgment. The court-ordered reforms seek to shift children from expensive group homes to cheaper and more effective home-based services. Currently more than 9,000 children are in group homes, at a cost to taxpayers of $500 million a year. In contrast, behavior coaches cost less than $15,000 per year and enable children to remain safely at home with their families.

Emily was finally released from state hospital into outpatient care in October 2003. Today she is living in a small house outside Los Angeles, where she volunteers in the community and has joined a church group. In nearly four years she has not had a single hospitalization, nor has she injured herself or anyone else.

“Emily’s success story shows both the desperate need for reform, and the wonderful possibilities that emerge when it occurs,” said Bird.

Judge Matz has ordered the parties to report back to him by October 15, 2007 with names of the proposed special master to oversee future compliance. Other counsel in the case are Robert Newman of the Western Center on Law and Poverty, Michael Kluk and Maggie Roberts of Protection and Advocacy, Inc., Jim Preis of Mental Health Advocacy Services of Los Angeles and Ira Burnim of the Bazelon Center for Mental Health Law.

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