State budget cuts threaten the futures of mentally ill children

Editor’s Note: To protect their privacy, some children are not named in this story. The Indy identified children with their parents’ permission.

“Who says country music makes you sad?” In the kitchen of his Chatham County home, Logan St. Clair explains the title of his science project that recently won an award at his elementary school. Zinnia plants exposed to music by Johnny Cash and Wilco, he found, grew faster than plants that weren’t exposed to music at all.

The Wright School was to Logan what Johnny Cash was to zinnias. Since kindergarten Logan had been defiant, a “wild child,” says his mother, Jennifer St. Clair, a social worker. Medications like Adderall, Concerta and Strattera didn’t help; he was eventually diagnosed with anxiety. In October 2007, Logan, then in fifth grade, received his first suspension from regular public school. Finally, having exhausted all other options, St. Clair met with a social worker at Carolina Outreach who suggested that Logan apply to Wright School, which treats children with severe mental, emotional and behavioral illnesses.

“It was the hardest thing to do as a parent, but we had tried everything else,” St. Clair says. “It’s like admitting there is a significant barrier to your child’s success and you as a parent can’t handle it.”

In February 2008, Logan enrolled in Wright School.

“We learned lots of good stuff,” says Logan, who, other than an amped-up restlessness, seems like any 12-year-old boy. “Share stuff. Be respectful. Be aware of what you’re saying.”

He pauses. “Being polite was hard for me.”

In August, he graduated. Two weeks later, he entered regular public school, where he earns mostly As and Bs, and excels in math and science.

“He has coping strategies,” St. Clair says. “He can remove himself and be calm. And he can accept the adult decision.”

A group of powerful adults in state government are deciding the fate of the Wright School. Gov. Bev Perdue’s proposed budget, which the General Assembly begins tackling this week, would close the nationally known school, located in Durham, and its counterpart for teens, the Whitaker School in Butner.

Wright and Whitaker have been on the chopping block before, but never in a recession this deep and in a budget crisis this severe. Facing at least a $3 billion shortfall, North Carolina would save $5.8 million over the next two years by closing the schools; it’s a small percentage of the overall $21 billion budget, but in desperate times, lawmakers are scrutinizing programs no matter how smallor how successful.

Wright’s size, success and uniqueness contribute, ironically, to its vulnerability. Each year, the school serves about 55 kids in a highly structured environment that combines individualized public school education with extensive mental health services. The “re-education principles” of finding a child’s strengths and centering on the family have turned around the lives of hundreds of troubled children over the past four decades, many area parents and social workers say.

The financial sticking point is that neither Wright nor Whitaker is eligible for Medicaid reimbursement, placing the financial onus on the state and its Department of Health and Human Services. Yet, the savings in closing the schools may come at a later, more expensive financial, social and human cost: Without appropriate services, these kids could easily wind up imprisoned or hospitalized.

State Rep. Nelson Dollar, R-Wake, is a member of the Health and Human Services Appropriations Subcommittee. “With all the problems we have with mental health in North Carolina, we have hospitals that are literally killing people. We constantly hear reports of violence on patients. We can’t keep some hospitals certified,” Dollar says. “Yet we have two schools that are success stories, that have made a difference in the lives of young people. They’re working well. It defies logic why we would be closing them.”

The Wright School is housed in an aging, low-slung brick building about 50 yards back from busy North Roxboro Road in Durham. A sign on the front bears the words “Wright Refuge,” so named because it served as a temporary home for children whose families had been disrupted during the two world wars.

Inside, the school is quiet, except for distant voices echoing from classrooms down the hall. “Adults don’t yell at kids here,” says Debbie Simmers, the school’s administrator for 25 years.

The halls are decorated in vivid colors and tattooed with “affirmations”notes that say “I will try to be positive” and “I am a good person.”

For roughly six months, kids live at Wright School five days a week, then go home each weekend. Most have been diagnosed with multiple problems, are behind in school, and need a wide range of services provided by therapists, speech and language pathologists and special education teachers. Some kids are developmentally delayed and have emotional disturbances; others have autism; still others have been diagnosed with severe mental, neurological or emotional illnesses such as oppositional defiant disorder, bipolar disorder, anxiety and attention deficit hyperactivity.

Over their short lifetimes, nearly all the kids have been prescribed a half-dozen or more medications, as doctors have searched for the right combination.

Few medications worked for Linda McDonough’s adopted daughter, who has been expelled from two daycares, two summer camps and suspended several times from a Chapel Hill elementary school. “The school and I called the police all the time. It was chaos. I couldn’t even keep her in the house,” McDonough says. While McDonough was driving on the interstate, her daughter hit her in the head with a metal object, nearly knocking her unconscious. “She has no impulse control. She has no ability to plan or think about the consequences. We’re the parents that when Eve Carson was murdered we thought, ‘That could’ve been my child.’ And we weren’t talking about Eve Carson.”

Eventually, her daughter was placed in a self-contained public school classroom for emotionally disturbed children. She felt isolated; there were only five other children in the class, all boys. Finally, a therapist recommended Wright School.

Like most parents of Wright School children, McDonough was emotionally threadbare when she brought her 10-year-old daughter there. Diagnosed with several disorders, most notably anxiety, her daughter had been hospitalized three timeseach time for a weekat a cost of $21,000, which was covered by Medicaid. After seven months at Wright, her daughter will graduate next month. “I can’t envision a future had we not received this intervention,” McDonough says.

On a recent afternoon, McDonough’s daughter sewed a doll emblazoned with a wide grin. She told jokes to her therapists. She happily played kickball with her 23 schoolmates. “At public school she had no friends,” McDonough says, adding that her daughter loves science and math. “Now she has friends.”

The kids’ erratic behavior has pigeonholed them as social outcasts, and many Wright School kids, emptied of self-esteem, are emotionally fragile. Building them up and reinforcing their strengths is an integral part of the school’s “12 principles of re-education.”

“Everybody has some time in the day that is cool for them,” Simmers says. “Children should experience joy every day.”

Re-education is a concept pioneered by renowned psychologist Nicholas Hobbs, who in 1963 started the Wright School as an experimental program in part with a $650,000 grant from the National Institute of Mental Health.

His approach blended elements of education, childcare and treatment. Hobbs, who died in 1983, wrote that children “have a tremendous desire to learn and to do well; that destructive and self-defeating behavior must be faced; that young people can help each other sort things out and arrive at good choices; that the world is rich in things to learn; that life is to be savored at each moment; and that decent, caring adults are absolutely essential in the lives of children ….”

Because the kids need structure, every minute of the day is scheduled; reminders are tacked to the walls. The children accumulate points and receive awards and privileges. No good deed goes unnoticed.

The ratio of adults to kids in a treatment group is 4 to 1. Teachers and counselors chart every action to measure a student’s progress and to help them improve their impulses. If a child completely loses control, he or she goes into the time-out room, which is lit, white-walled and about the size of a bathroom. The time limit is five minutes. The room does not lock.

On a recent Wednesday afternoon, a group of boysonly two of the current Wright School students are girlspainted birdhouses they had built.

“What do you do if you get frustrated?” a teacher asks gently.

“Take deep breaths,” one boy replies.

“Be quiet and sit still,” another chimes in.

Kids who just months ago may have been rushed to emergency psychiatric wards are now learning self-control. When admitted, only 20 percent of 98 kids scored in the normal range on a behavior scale rated by their parents, according to a two-year study conducted in 2006 by Duke University and the Wright School. By the end of their treatment, three-quarters of the children scored within the normal range, parents reportedand stayed that way at least six months after they left the school.

“They keep things incredibly structured, which is very important for kids with mental health issues,” says Whitney Hibbitts, a social worker not affiliated with the Wright or Whitaker schools. “It’s behavioral intervention in place 24 hours a day. I can do therapy with a child for an hour a day, but he or she might be in an unstable environment the rest of the time.”

That stability is due in part to the Wright School’s connection with parents and the regular school system. Wright School staff help kids transition back to regular public school, often meeting with those teachers and counselors on an individualized plan for the child. Staff also coach parents on behavioral plans for the family so that the expectations, rewards and consequences are consistent.

“I tell parents, ‘You have an exceptional child and you’re going to be parenting them way longer than you dreamed,” Simmers says. “Parents need a break. It’s very labor intensive. At parent seminars they get to see they’re not alone.”

“You’re part of a team,” says McDonough, a single parent who has another daughter whom she home-schools. “They don’t talk down to you. It was so wonderful to sit next to other people who had lived my life. They offer hope to us and the kids.”

“Falling!” a boy announces, standing on top of a desk, his back to the room. “Fall now!” his classmates and teachers reply. They plant their feet, extend their hands and brace for impact.

Trust does not come naturally to Wright School kids. They may have been suspended or expelled from regular public school, sometimes escorted by police. Some have been hospitalized. Many have a history of fighting, attempting suicide or running away. Some have been sexually traumatized.

They are all no older than 12. Many have never had a friend.

The boy falls.

His friends catch him.

Only the hardest cases are admitted to Wright. Each county or region has an agency responsible for oversight and management of publicly funded mental health services. (Orange, Person and Chatham counties are under one region; Durham and Wake have their own.) For their children to qualify, parents must appear before the agency’s Care Review Committee, composed of professionals from community mental health agencies.

The committee discusses the child’s case and reviews information with parents and therapists before referring him or her to Wright School. In addition, the agency director must approve and sign the referral. The Wright School’s admissions team generally accepts any child referred to them by the agency, albeit not immediately, as there is almost always a waiting list. In the case of Wright School, it can be two months.

Kids end up at Wright School because there are few, if any, community-based services that can deal with their multiple, complex problemsand provide them with a public school education. (Many of the kids were previously on homebound instruction, which can provide as little as three hours of direct instructional time each week.) Locked and unlocked group homes, specialized foster care, day treatment, residential treatment centers and psychiatric facilities may offer some of the therapies, but parents and mental health professionals likely would have to piece together a treatment plan at several places. Alexander’s Children Networ in Charlotte vaguely parallels the Wright School, but children do not come home each weekend. At Wright, the kids go home and, with their parents and siblings, learn to become a family again.

Unlike other mental health programs in North Carolina, Wright doesn’t receive Medicaid funding and thus relies almost solely on state money to operate. (It also receives some federal educational funding since it is a public school.) The 60-year-old building would need renovations or, more likely, would need to be rebuilt to qualify as a Medicaid facility. The Triangle Community Foundation rents the building and land to the state for $1 a year. In the case of Whitaker, it would be added to the state’s inventory of vacant buildings.

There are also educational and treatment parts of the Wright School program that fall outside Medicaid eligibility. For example, Medicaid does not pay for residential mental health programs in which kids go home on weekends. (Hobbs launched the re-education program before Medicaid.)

If the Wright School did qualify for Medicaid funding, it could receive the same amount as a comparable residential treatment facility: $205 a day per studentabout $1.75 million annually, nearly three-quarters of its yearly operating budget.

At an average cost of $45,000 per student, on its face Wright School is cheaper than youth development centers, which are run by the Department of Correction and offer education, therapy and mentoring. A 2005 legislative report estimated the annual average cost per child in a Youth Development Center as $104,000. That adds up: According to the N.C. Department of Correction, 469 children between the ages of 10 and 17 were ommitted to a Youth Development Center in 2008.

Michelle Turner, a crisis intervention counselor at the Chapel Hill Police Department, says closing the Wright and Whitaker schools would “increase the number of our responses.” Currently, Chapel Hill Police respond to between six and 12 crisis-related calls per month, usually from parents or schools about violent, out-of-control children. “There is an overwhelming lack of structured environments for these kinds of kids,” Turner says. “The schools are going to be impacted as well. The mental health system is in a crisis state itself. What are the preventative things that could help things down the line?”

Violent children can become violent adults. They are either admitted to psychiatric facilitiesmany of the state’s are notoriously substandard and dangerousor prison. In 2007, more than half of all inmates in North Carolina’s state prisons suffered from at least one mental disorder, according to a state Department of Correction report; a quarter of those inmates were diagnosed with serious mental illness.

According to a Whitaker School report, of the last 200 students admitted, there were 56 reports of previous serious assaults against their peers, 84 assaults on family members and 81 admissions to juvenile justice facilities two or more times.

“What we know is we have no place for these very disturbed kids to go,” says state Sen. Ellie Kinnaird, D-Orange, who spoke in favor of keeping the schools open. “They are too dangerous to leave in the community,” adds Kinnaird, co-chair of the Mental Health and Youth Services Committee. “Wright School is evidence-based; it works. They return the children to the community where they can live normal, productive lives. We’ve got to break the cycle of crime and deal with mental health problems at a very early age.”

At just 8 years old, Julian was suicidal and violent. “I thought my child would some day wind up in jail,” says his mother, Jaime Daly.

He was institutionalized at John Umstead Hospital until his parents demanded that he be discharged. Now 9, Julian is scheduled to graduate from Wright School in May. He is catching up academically and will return to regular public school next fall.

“It’s a total 180 degrees. The place is amazing. They have taught him how to redirect his anger,” Daly says. “He is such a sweet kid and they brought it out of him.”

This week, the Senate begins whittling away at the state budget, proposed by Gov. Perdue; the House will tackle it next week. While the Health and Human Services budget is focusing on acute mental health needscreating 111 more inpatient psychiatric beds at a cost of $12 millionit does not adequately address early intervention. The prospects for Wright and Whitaker are dim, unless lawmakers tap some of the $105 million in unappropriated funds.

“It’s an unfortunate cut” to close the Wright and Whitaker schools, says David Kochman, communications director for Gov. Perdue’s office. “There are a lot of hard decisions. But they serve relatively few children and they don’t get Medicaid reimbursements. We did try to ease it with a six-month delay for a transition to get kids into residential treatment facilities or group homes.”

However, there are few, if any, appropriate mental health services in North Carolina, particularly for severely mentally disturbed young children, says state Rep. Verla Insko, D-Orange, co-chairperson of the House Health and Human Services Appropriations Subcommittee.

“We may have to send those children out of state,” Insko says. “It would be sad to take them out of their community.”

State Rep. Nelson Dollar disputes Perdue’s contention that Wright and Whitaker students can be treated in the community-based settings. “I don’t think it can be done,” says Dollar, a member of the House HHS Appropriations Subcommittee. “With these people, it’s not a matter of sending them to a group home.”

But state Sen. Doug Berger, D-Granville, sounds less optimistic about the schools’ future. The co-chairman of the Senate HHS Appropriations Committee anticipates the budget cuts will be even deeper due to reduced income and state tax revenues. Moreover, the $5.8 million savings could help cover the increasing number of uninsured children in North Carolina. An additional 8,000 kids would be served by expanding the child health insurance program, which Perdue’s budget funds at $4.3 million. “We need to do the greatest good for the greatest number of people,” says Berger, whose district includes the Whitaker School. “There are kids like [those in Wright and Whitaker] who are in group homes where they can qualify for Medicaid. The level of expenditure is touching a small population.”

But for each of those kids at the Wright and Whitaker schools, the money has enabled them to have possibilities, to have a future.

Logan St. Clair, for example, plans to become a carpenter. “I want that school to stay open. If I hadn’t gone, I would have less achievements,” he says, thumbing through his tall stack of awards and recognitions he earned at Wright School: for giving 110 percent, for being a peer tutor, for “keeping problems small.”

“Before, I was nervous and scared and happy. Now I’m just happy.”

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Resources

• The Durham Center: 501 Willard St., Durham; 560-7200, durhamcenter.org
• Orange-Person-Chatham County Area Program: 100 Europa Drive, Chapel Hill; 913-4000, opcareaprogram.com
• Wake County Human Services, Child Mental Health: 212-8405. Emergencies, 250-3133. There are several locations for county human services: www.wakegov.com/humanservices/locations
• Carolina Outreach: 2670 Durham-Chapel Hill Blvd., Durham; 251-9001, carolinaoutreach.com
• National Alliance for Mental Illness, North Carolina chapter: 309 W. Millbrook Road, Suite 121, Raleigh; Helpline: 800-451-9682, naminc.org
• Disability Rights North Carolina: 2626 Glenwood Ave., Suite 550, Raleigh; 877-235-4210, www.disabilityrightsnc.org
• Family Advocacy Network: P.O. Box 2253, Chapel Hill; 942-8083, www.mha-nc.org
• Mental Health Association in North Carolina: 1331 Sunday Drive, Raleigh; 888-881-0740, www.fan-mhaorangeco.org
• ARC of North Carolina: 343 Six Forks Road, Suite 320, Raleigh; 800-662-8706, arcnc.org
• Family Support Network of N.C.: 200 N. Greensboro St., Carr Mill Mall, Second Floor, Suite D-9, Carrboro; 800-852-0042, fsnnc.med.unc.edu