For Barbara and Brandon Collins, it was another bad day. Earlier that morning, in his classroom at a special school for children with mental illness, 7-year-old Brandon had lost control again. He attacked schoolmates twice his size, viciously cursed his teachers and had to be physically restrained. Barbara had to retrieve her son from the school and, for the third time in recent months, have Brandon admitted to the psychiatric wing of a local hospital.
Late in the evening, an exhausted Barbara finally returned to her Hobart home. She insists that Brandon is intellectually gifted and a sweet boy when he can control his emotions. Having him go back to a residential treatment center is a last resort. But she recognizes the pattern that is occurring. "The teachers said if we can"t get him under control this time, then he will have to have residential treatment again." She paused, and then sighed heavily. For a mother and her child who has bipolar disorder, there are far too many days like these. But earlier this month, there was a good day for the Collins. On Oct. 1, U.S. District Judge Richard L. Young ruled that Gov. Frank O"Bannon"s administration violates federal law by refusing to pay for the room and board costs of psychiatric residential treatment for children like Brandon Collins. This policy, held by O"Bannon and his predecessor now-Sen. Evan Bayh, has long been harshly criticized by mental health advocates and juvenile justice officials ("Michael and the Monster," NUVO, Dec. 14, 2000). These critics say Indiana children who are refused appropriate treatment suffer needlessly, and often end up in juvenile prisons and later in the adult correction system. Brandon, one of the children featured in previous NUVO articles on this topic, is also one of the plaintiffs in the lawsuit challenging the O"Bannon policy. By the time Brandon was 5 years old, he had already been hospitalized four times for violent behavior, including self-mutilation and attempts to stab his mother and cut his own fingers off in a fan. His doctors referred Brandon, a Medicaid recipient, to residential care. But the O"Bannon administration refused to pay the costs of that care through Medicaid. The only way Barbara Collins could obtain the care Brandon"s doctors prescribed was to turn to the Lake County welfare system, and the only way the county would provide those services is if Barbara signed over custody of Brandon, making him a ward of the state. Barbara says the decision to relinquish custody was gut-wrenching. "No one knows a child as well as a parent does," she says. A recent change in Indiana law was supposed to remedy the dilemma faced by parents like Barbara Collins by allowing their children to obtain psychiatric services without the parents being forced to make them wards of the state. But since the O"Bannon administration refused to pay for residential psychiatric care under Medicaid, the financial burden remained with individual counties. Advocates say that many counties cannot afford to pay for the treatment costs, and those that pay will do so only if the parent signs over custody. Brenda Hamilton of the Mental Health Association in Indiana says parents are still being told that the only way to get residential care for their mentally ill children is to turn the children into the police as "incorrigible," thus providing an entrÈe into the juvenile court system. "When all the insurance money is used up, schools, residential providers and even courts and lawyers tell parents they have no other option," Hamilton says. The hope, often a misplaced one, is that juvenile judges will order treatment instead of incarceration. Residential psychiatric treatment for children, which is not covered under most private insurance plans, can cost as much as $100,000 per year. It is not completely clear how many Indiana children will be affected by the Collins ruling, but a recent survey of the state"s community mental health centers concluded Indiana has an unmet need for several hundred treatment beds for severely mentally ill children. Young"s decision would remedy this situation, but O"Bannon may still appeal and delay the effect of the judge"s order. That prospect angers advocates who have been struggling with the O"Bannon policy for years. "I don"t know why the state would want to overturn a decision that will insure that kids with severe mental illnesses get the help they need," says Jacquelyn Bowie Suess, the Indiana Civil Liberties Union attorney who represents Brandon Collins and the other children in the lawsuit. Cynthia Collier, spokeswoman for the state"s Family and Social Services Administration, says the O"Bannon administration is still analyzing its options for responding to the court ruling. Collier insists there is no disagreement that children like Brandon Collins should get help, but there is a question of who should pay for those services. "To be frank, with our current state fiscal situation and the expanding rolls of people on Medicaid, it is important we look at costs," she says. But Barbara Collins says O"Bannon should look beyond mere money considerations. "My son is not a statistic," she says. "This is a little boy, not a dollar sign. And he didn"t ask for this to be happening to him."