Minnesota kids with mental health needs cycle through juvenile justice system, often without options

A 12-year-old hunched over the table, doodling with highlighters on scrap paper as his public defender made the case that Minnesota’s mental health treatment system has failed him.

The boy, K.J., had been accused of multiple auto thefts. But criminal proceedings were halted after a court-appointed psychologist twice found him incompetent to stand trial. Instead, like many other high-risk kids, he remained locked up for weeks on end at the Juvenile Detention Center (JDC) in downtown Minneapolis because the county could not find a secure residential facility to take him.

“It horrifies me that disabled children can be put in jail because the government doesn’t have anything better it can do with them,” said his attorney, Tracy Reid. “It’s also simply uncivilized.”

Across the state, child welfare advocates say they cannot find adequate, timely rehabilitative services for the kids who need them the most.

So Minnesota children with complex mental health needs — often those who also have a history of aggressive behavior or low IQs — languish in juvenile detention and emergency rooms, are transported to out-of-state facilities or sent home to family members incapable of managing their severe behavioral disorders. The situation has reached a crisis point in Hennepin County, where at least 21 youths have been ruled incompetent by the court this year, stalling pending delinquency cases and preventing accountability through the juvenile justice system.

This small subset of minors is responsible for a disproportionate number of cases in Minneapolis, police and prosecutors agree, fueling a cycle of catch-and-release exacerbated by the dearth of placement options.

Although the number of kids entering the juvenile justice or social services systems with complex needs has grown in recent years, the number of licensed residential treatment facility beds for children has shrunk by more than a third since 2005.

Few new ones have emerged to fill the gap for juveniles who require the kind of intensive therapy not available through community-based programs, or those who have absconded from lower-level facilities.

“I will be blasted for this, but sometimes you are hoping the kid commits a crime because then there’s a place for them to go where you’re not worried where they’re going to sleep tonight,” said Benjamin Stromberg, an assistant St. Louis County attorney whose office handles child protection and juvenile delinquency cases. “Nobody wants these kids in detention — we all understand that. But sometimes it’s the one place where they are not going to be hurting anybody or hurting themselves.”

Residential facilities often have long waitlists and deny kids if they aren’t able to handle their specific issues, such as sexually aggressive behavior or substance use disorder.

Psychiatric residential treatment facilities, known as PRTFs, are one step below hospitalization and are supposed to take children with severe aggression, who present a safety risk to themselves or others. This year 281 kids were referred for placement in the four such facilities in the state, according to Department of Human Services (DHS) data, but only 66 got in.

While the facilities are licensed for 150 kids, they were only serving 85 as of June, according to the therapeutic provider association AspireMN. Staffing challenges keep them from taking more kids, executives at several PRTFs said, and while they want to accept as many children as possible, they have to ensure a kid is the right fit.

“Can they manage the [child’s] behavior with the culture, with staff and kids that they have?” said Larry Pajari, CEO of Northwood Children’s Services, which runs a PRTF. “Nobody wants to put other kids that may be vulnerable at risk either, so that’s the balancing act.”

Only 25 children from Hennepin County, the state’s most populous, have gotten into the psychiatric facilities since the first one opened in 2018, county children’s mental health area manager Neerja Singh testified in court, citing DHS data. Singh, a former deputy director of behavioral health at DHS, said children of color generally have not been able to get mental health services at the same rate as white youth.

K.J., who is Black, was among the many children unable to get into a psychiatric residential treatment facility in Minnesota. All four rejected him, citing low IQ. Yet, that score was likely invalid due to his “lack of engagement” on the test, which was conducted virtually while he was detained at the JDC.

Hennepin County officials insisted the only place they could find for K.J. was 1,000 miles away in Virginia. That was untenable for his family, who would only be able to visit once a month.

While kids can wait months or more than a year to get into residential facilities, a survey of some youth treatment providers — which range from detention centers to group homes to high-intensity psychiatric programs — found a third of their beds are empty.

“There are beds, but there’s no one there to staff them,” said Hennepin County Commissioner Jeff Lunde, who was co-chair of a state working group that examined gaps and barriers in the systems for children who cannot safely remain at home. “You can make more money at Taco Bell than you can working at these facilities.”

The working group’s report published early this year highlighted complex problems. Licensing and certification for residential treatment facilities is slow and overly complicated. Inadequate data sharing makes it hard to track what happens to kids. Low reimbursement rates to treatment providers mean they can’t pay enough to attract personnel, contributing to persistent staffing shortages.

Lawmakers did not act on the working group’s recommendations last session, but some legislators said they will be looking at the issue next year. Rep. Kim Hicks, DFL-Rochester suggested a state-operated PRTF might be needed to serve kids who fall through the cracks, including those who are “really explosive” or run away.

DHS officials noted that PRTFs are just one option in a larger service system. They said efforts are under way to address the state’s behavioral health crisis, including additional funding last legislative session for respite services and behavioral health services in schools. They also noted there’s a children’s mental health hub of providers working together to try to find places for some kids with complex needs.

“DHS continues to review current options for expansion of the children’s continuum of care and working with community partners, other administrations, and other departments to identify the best path to address the increasing complex needs of youth,” the agency said in a statement.

Meanwhile, counties — which run juvenile detention centers and handle child protection and mental health case management — are at the front lines. And they are trying their own solutions.

Ramsey County got $5 million from the state last year to create therapeutic youth treatment homes serving teens with serious mental health issues who have been found guilty of delinquency offenses. The centers will ultimately allow minors to seek treatment in their own neighborhoods, close to family support networks, but they haven’t opened yet.

In Stearns County, 22 kids – many of whom had aggressive behaviors — spent a total of 67 days at the County Administration Center in 2021 and 2022 because hospitals, residential treatment centers and law enforcement couldn’t handle their needs. But officials said that after they created an early-intervention Juvenile Community Action Team two years ago the number of kids who have to sleep in the building has dropped.

Hennepin County is assembling another workgroup with other counties and plans to offer preliminary recommendations and legislative proposals by early January. As they wait for state action, Hennepin County has offered “seven figures” to encourage providers to serve more kids, Lunde said. But he said treatment organizations, which are already struggling to hire staff and wary of additional licensing challenges, turned them down. Now, he said, counties are talking about pooling resources to encourage providers to expand or specialize in certain client needs.

“Trying to get kids out of the [juvenile detention center] that shouldn’t be there because we have a lack of resources is my priority today,” County Administrator David Hough said, noting that there’s a long list of other children’s mental health needs, including building up services to help kids remain at home.

K.J.’s mother begged for intervention as his behavior escalated last spring. He repeatedly absconded from a North Side group home and was later expelled from school for attempting to drive into the building to fight a classmate, court records show.

He bounced in and out of the JDC, racking up new delinquency cases even after an incompetency ruling by the court — a determination meaning that K.J. was not capable of understanding the legal proceedings or assisting in his own defense.

That’s not an uncommon occurrence for a boy his age. All four children 12 and younger charged with a delinquency offense in Hennepin County last year were found incompetent to proceed, according to county data.

Hennepin County took custody of K.J. through a child protection case in August, promising to secure him adequate treatment. But every facility the county approached in Minnesota either rejected K.J. or had an extensive waiting list. For weeks, he sat in the understaffed JDC, frequently in isolation — despite a state law that forbids warehousing a nondelinquent youth there for more than 24 hours.

“It’s helpless,” his mother, Kendra, told the Minnesota Star Tribune in September following a court hearing. “He’s not getting no treatment; he’s suicidal.” The Star Tribune is not using her last name in order to protect the boy’s identity.

Although county officials acknowledged it was “not an ideal situation,” they defended the decision to house him in detention, given his runaway history, until a more permanent placement could be identified. They had refused to pick him up, in defiance of a court order.

“We don’t want him to get hurt or hurt someone else,” Mandee Kleckner, Juvenile Justice Behavioral Health Initiative program manager, testified last month.

Given a chance to testify about the conditions inside the JDC, K.J. described a bleak environment where he was often confined to his cell all day and feared for his safety.

“I don’t want to stay there,” he said, adding that he’d recently been jumped by another kid.

Reid accused the county of being in contempt, saying leaving him in detention “is not a lawful or humane solution.”

Judge Todd Fellman ultimately declined to hold the county in contempt of court, writing that it had “acted in good faith” to identify a place for K.J.

But the child remained in detention for several more weeks as the county continued pushing for an out-of-state placement in Virginia against Kendra’s wishes, because officials felt it was the only facility available to meet his needs.

Exasperated and having lost faith in Minnesota, his mother took matters into her own hands and moved to Chicago. Kendra hoped the new environment, closer to his older siblings and ailing grandmother, would offer a fresh start.