When our system fails

How the lack of accountability, data, and transparency hurt our communities

Halloween was a blast this year. COVID-19 has had this dampening effect on almost all activities the last two years, including Halloween. While COVID-19 is still very much a part of our lives, our management of it has only continued to improve. This means that Halloween this year felt a bit more like the Halloween’s of the past. People weren’t as afraid to engage, candy was handed out in person instead of using creative pully systems, and in general it just felt more like Halloween should.

And just because Halloween is over doesn’t mean that the scares stop. It was actually the day before Halloween when I read one of the more troubling pieces I have read in a while. In an article published in the New York Times, two journalists go deep on a story about a juvenile detention center in Louisiana. I am not going to lie, it’s a very hard piece to read, and brought me, someone who has worked in these systems, to a place of anger. “How could we let this happen?” was the one of many questions I asked alongside the journalists who did the deep work.

I won’t go into too much detail about the article here, but will simply say that it highlights a major problem that many families face when their child needs more help than they can provide - where to send them. In the case of several of the kids in this article, many were sent to this juvenile detention centers because they had run ins with the criminal justice system and this was the next step in their “treatment.” Said differently, for many of these kids, these facilities were meant to be a therapeutic environment where they received help that would allow them to better manage their emotions, control their behavior, or just learn new life skills. As the article goes into detail on, they received everything but that including abuse and trauma.

But is this article and this one facility really just an outlier? I doubt it. I remember fresh out of college I took a job as a case manager where I spent a lot of time in these type of facilities. I saw that when kids get involved in the juvenile justice system, they are exposed to other kids and environments that aren’t always great. Even at 22 I was pretty shocked at how rough it was. I started to think of their time in the juvenile justice system as a problem on top of a problem, and for many, that’s the case.

The juvenile justice system is not alone in this - the mental health system, especially inpatient facilities can be just as bad. The problem with both these settings? We don’t always know if they are any good, and when we or our family are in a situation where we need help, we are desperate and don’t have a lot of options. This got me thinking a lot about what we need to do.

First, there must be accountability for bad actors. Not all facilities are staffed with abusers or are mismanaged as egregiously as the one in the New York Times article. But for those so called leaders who are not taking action to protect the kids they are supposed to be serving, they should be help liable and not simply let off with a hand slap or given another job at another facility doing the same thing. Lives are ruined and they should be held accountable. Lawsuits and publicly calling out these leaders is a good start.

Second, we need to know more about these facilities and their leadership. Because of a lack of data and transparency, we can’t always compare apples to apples. There’s been a lot written on this so I will spare you the diatribe and simply say that our lack of clear quality and outcome metrics for most things related to our health is in need of a major update. For states to keep sending kids to these facilities simply because there is nowhere else or for the state to keep paying for care that doesn’t help shouldn’t occur. If we held people and facilities accountable based on data, it would allow for us all to be more informed in who we engaged for care and we could better “vote with our feet” rather than play the lottery every time we needed help.

Finally, this article reinforces that having silos that operate in relative isolation from one another doesn’t work. Consider that somewhere between 65 and 70 percent of the 2 million children and adolescents arrested each year in the United States have a mental health disorder. If we only tackled the criminal justice side without addressing the mental health or substance misuse side, what have we really done? Integration needs to be more than a buzz word - it needs to be a foundational principle that we pursue in all our redesign efforts.

Our systems fail us all the time. It’s a true shame that we have not been able to rectify decades of mistakes that keep care fragmented and frustrating. We should be doing a better job of holding leaders accountable, and do so with an eye on the things that matter - safety, quality, and improvement in outcomes. To get us to this place we need to have better data that allows us to see what’s going on behind the scenes. - to see the real face behind the mask. After all, Halloween is over, isn’t it?