LITTLE ROCK, Ark. — Since the dark ages of insane asylums, we would like to think treatment for mentally ill people has evolved— especially when it comes to treating children.
Here in 2023, according to dedicated advocates charged with keeping tabs on psychiatric residential treatment facilities in Arkansas, there is a serious crisis.
"The nickname that some of us had for it was the misery mill," said Stefan Spect, a man who said he survived placement in one of the 13 psychiatric treatment facilities in the state.
"The large part of the day these kids live in these facilities, they're literally sitting around, and that's never going to end well," said Reagan Stanford, a lawyer for Disability Rights Arkansas, which is the watchdog group mandated by the federal government to monitor anything that affects the lives of Arkansans with disabilities— including kids with mental and psychiatric issues.
"There was no hope of ever actually any kind of psychological treatment, it was psychological mistreatment, and they knew it," said Spect, when he referred to his time in Millcreek Behavioral Health in Fordyce. "You essentially have a constant state of chaos."
"They are supposed to be a safe environment for kids with the goal of getting the treatment they need to move out, and what we're seeing is that that's not happening," said Tom Masseau with Disability Rights Arkansas.
That's why Stanford and her boss, Tom Masseau, have been trying to raise alarms about a crisis.
Out of frustration, Disability Rights Arkansas started a publicly accessible database of inspections, incident reports, and police logs. Spect explained that the documents don't begin to capture the tension and potential danger he and others faced at Millcreek.
"Essentially most of the day you are locked inside of a small living area," he said. "They have a TV but it was often broken because it would get broken during altercations, and you could be beaten half-to-death by a guy just for looking at them at the wrong time."
During 10 months of last year, the 162-bed facility just off U.S. 79 in Dallas County logged nearly 60 issues that needed investigating, including issues that showed staff members charged with assault or theft.
That's about the average for all 13 locations across the state.
The issues also included kids escaping— or elopement, with Millcreek having seen at least one escape every month in 2022.
As you read all the incident reports that DRA posts online, you can see patterns emerge. Patients, or clients as they're sometimes called, have often faced violent threats from peers.
Reagan and Masseau both pointed to a pair of distinct problems: Understaffing, especially of support workers, and a lack of actual therapy taking place from the overworked professionals who are there.
"At most of the facilities, they're getting one hour of individual therapy a week," said Stanford. "There's one facility that is giving them one hour of individual therapy a month...at a psychiatric inpatient residential facility."
No one from Millcreek spoke with us on camera, but they did send written responses to a couple of our questions.
They confirmed that the labor environment has posed challenges but, said that they follow strict staffing protocols to ensure safety. As for care, the statement said they consider their staff to be "healers."
All patients have a prescribed treatment plan developed by a licensed psychiatrist, with one-on-one therapy at least once a week. They consider group therapy, recreation, family therapy, and school as part of their quote "ongoing milieu" that occurs daily.
"Millcreek is in good standing with Arkansas Child Care Licensing Agency, and Arkansas Department of Human Services. Millcreek is very proud of our history of providing quality care under the most difficult circumstances, our innovations to give patients hope, and most importantly, the overwhelming amount of good that we were able to accomplish for those we serve who are in critical need,” the statement said.
Millcreek's accreditation illustrates part of the complicated problem
Identifying that avenue to find solutions is very difficult amid an alphabet soup of state government agencies within the state Dept. of Human Services— as well as an executive panel called the Child Welfare Agency Review Board.
"The way the law is written, we have to take it to the board and we can make a recommendation," said Tonya Williams, Director of Child Care and Early Childhood Education at DHS. "We do. We've made several of them in the last three years."
"It's in the collaboration of all the entities involved," she said. "The way it's going to have to work is getting all the people together to talk about how do we do this better, and then making sure that any concerns are reported to the appropriate parts of agencies that can do something about that."
Getting all the people together to talk is supposed to happen once a month when the board holds public meetings. DRA planned to present new evidence last month, but the December meeting was canceled amid scheduling conflicts.
Meeting minutes from 2022 indicated that the board spent much of its time deciding appeals from people who were disqualified from jobs, or becoming foster parents because of past criminal records or drug or alcohol problems.
Those appeals spoke to the desperation in staffing.
"[Potential workers are] hearing things [about how difficult the work is] that makes it even less likely that you're going to get even qualified people," said Williams. "And not only that but even unqualified people who don't want to come to work for probably less than ideal pay."
Some facilities have staffing issues worse than others.
Perimeter Behavioral of Forrest City has had mandated corrective action extended twice due to staffing and security issues in the past year. The facility has since agreed to stop taking in new clients.
Even the sprawling United Methodist Children's Home of Little Rock needed to take action at the start of the year because an inspection found some staff were on the job before background checks were finished.
Notably, Methodist Family Services CEO, Andy Altom, is also the chairman of the review board. He has properly abstained from voting on items involving his facilities, but he's one of a few board members that have tried to oversee the system and run a facility at the same time.
"You're building the plane while you're flying it," said Williams. "I think it's much more complicated than saying let's take a few parts out. I think there are probably a few things that we could tweak that would help."
Williams and the folks at Disability Rights Arkansas have agreed on improving the skill level of who gets hired.
"We have the lowest licensing standards across the country," said Masseau.
"They are the minimum," added Reagan.
"I look at the age requirements," said Williams. "Our licensing requirements are very minimal, and the age is young [to get a job]."
By changing who is able to get hired in these facilities, DRA hopes it could lead to changes in the boardroom.
"A lot of these facilities are nonprofits," said Masseau. "They have boards and I think it's important that the board members of these facilities really go beyond the administration buildings to actually go the into the units and begin talking with the youth, instead of having these glamorous fundraisers to raise money."
"We need to sound off alarm bells to the average citizen," said Spect. "If they have a child that is experiencing mental illness then they should think twice about sending them to one of these well-marketed facilities."
Each person we spoke with has been actively trying to focus on the kids, by recognizing what they've already gone through and going from there.
"At the end of the day, it has to be about the kids. And it has to be making sure that the kids are safe," said Masseau.
"Honestly, I sit here and cry some days," said Williams, whose experience in early-childhood education lead her to frame the crisis as rooted in the same way these kids started out.
"Nobody could believe that 12 and 14 year old children are having these experiences. And I just think how, how did our society... because I don't think it's a parent thing. I think it's a societal thing like we should all be ashamed," she added.