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The majority of mentally ill people are not violent -- and violent people are mostly not mentally ill. But when violence and mental illness, or cognitive disabilities like autism, intersect, the results can be especially ugly, particularly among children. When we think about acts of uncontrolled violence, we often think of teens and young adults acting out, struggling to adjust to changing brain chemistry, or dealing with untreated mental illness. However, extreme mental illness can also happen in very young children, and treating it can be especially challenging because of their age -- and the lack of social support, which puts parents in ugly positions.
Recently, the Phoenix New Times posted an excellent investigation on parents living with -- and sometimes not living with -- violent children. It raises some critical questions about the state of mental health resources in America in general, but specifically for children, because when people under 10 are violently mentally ill, there are almost no resources for them. While their cases are rare, that doesn't make them any less heartbreaking or difficult to deal with.
Parents are familiar with tantrums and tough days -- all kids have them. But imagine extremely violent episodes that can last for hours or even days, with children lashing out, destroying furniture, harming themselves, or hurting family members and pets.
One night last fall, Turner and his wife, Terri, smelled sulfur and found their 16-year-old adopted son inhaling fumes from a spray can in his bedroom, a steak knife at his feet. When confronted, he got violent — ultimately resisting Brian's efforts to restrain him, punching holes through walls, ripping through dry wall, and running out of the house. Later, they would learn that the boy had told his older sister the day before that he'd found a knife and wanted to hurt his parents, 'said that he wishes that Dad died. I told him, Don't ever say that again,' his sister described in a handwritten testimonial.
The best treatment for such cases involves extensive therapy paired with medication to address the chemical imbalances in the brain that cause it, and to get to the root of behaviors to help children process their responses to situations in more emotionally healthy ways. Sometimes this necessitates institutionalization or extended inpatient therapy while children adjust and get comfortable working with professionals. Unfortunately, such treatment often isn't available at all, or is prohibitively expensive: Upwards of $10,000 a day, in some cases.
This leaves parents in an untenable, and terrible, position. Their children have an illness that requires expensive and serious treatment that many insurance plans won't cover, and they can't pay for it out of pocket. The behavior of their children may be escalating because they aren't getting treatment or can't access the level of care they need. Some parents end up calling the police for help when their children get out of control, and that can result in fatal encounters between mentally ill children (usually teens) and police.
One option is to borrow substantial amounts of money and plead for funding from a variety of sources.
The other is to turn children over to the state.
Both are terrible choices, but a growing number of parents are giving their children up because they don't know what else to do, and because their backs are against the wall when it comes to funding and support. They don't have enough money to get their kids the care they need. They also lack the social and community supports they need to raise violent children -- and their kids can't live at home, because the risks to themselves and others are just too high. Consequently, parents who love their children and experience anguish at the thought of giving them up have only one option -- entrusting them to the care of the state, and hoping that the government can provide their children with better care.
Consequently, a number of states are starting to face a growing number of children with traumatic brain injuries, severe mental illness, and significant cognitive disabilities who violently act out and need inpatient or institutional therapy. They can't and shouldn't go into the foster system -- nor should they be on adult wards or imprisoned without any care -- but the state may lack the resources and the facilities for helping these children.
In Arizona, for example, a specialized facility that cares for violent children isn't available, forcing parents and the state to ship children to states with facilities that do offer that level of support. Daily fees are expensive, but more than that, there are a limited number of patient beds available, and competition can be fierce. A strange game of "whose child is the most violent" can arise, with parents, care teams, and officials struggling to extend services to as many children as possible.
Meanwhile, other children in the family can suffer as parents dedicate their financial and emotional resources to a child in urgent need of help. Everyone loses out, and the result is an unpleasant ripple effect that spreads across families and communities, with violent children sometimes ending up in untenable situations. It's not always possible to get a child into the right residential care, for example, and as a result children may go into locked adult wards or even into juvenile detention facilities where mental health resources are limited.
For parents, these are awful choices to be making. While mental health advocates are working to improve treatment options and availability, many families need help now, raising the question of why their communities haven't moved forward to support them. Raising a violent child and working on accessing care can be frightening and stressful. It's even more so when parents are working alone.
In the short term, respite and relief care are critical for patients who need help providing care to their children. We need to be lobbying lawmakers and mental health facilities to expand the number of beds for children with violent behavioral problems, and to increase the number of facilities specifically designed for children with these issues. We also need to be talking about this issue in a way that doesn't demonize mental illness; the problem here isn't mental illness or other underlying health conditions, but the need to access care in a nonjudgmental environment. Parents shouldn't be blamed for children with behavioral problems -- this is not a matter of "spoiled" or "coddled" children who need to be toughened up.
Above all, we should have compassion for parents struggling with this difficult issue: Whether we are mentally ill, parents, people with a history of violent behavioral issues, or people from any number of other perspectives, we should be able to recognize that this is a terrible situation to be in, and that all the choices parents face in this position come with great costs.