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Kids, trauma and mental health

Alexander Gill
Alexander Gill

When parents who need mental health care go without, their kids often suffer. Children who grow up in chaotic or abusive environments are more likely to develop their own mental health problems. They’re also more likely to end up in jail or on the streets.

So the cycle often continues — at least in North Carolina, as Victor Armstrong knows all too well.

Armstrong has held some of the top mental health jobs in the state. When WFAE asked him about kids and trauma, he immediately thought of an adult from 30 years ago, when he was working in Child Protective Services.

Victor Armstrong, former Director of the NC Division of Mental Health for the North Carolina Department of Health and Human Services, and former Vice President of Behavioral Health for Atrium Health
Dana Miller Ervin
Victor Armstrong, former Director of the NC Division of Mental Health for the North Carolina Department of Health and Human Services, and former Vice President of Behavioral Health for Atrium Health

“This was a mother who was struggling herself with drugs and alcohol, and she did not want to deal with her child’s sexual abuse,” Armstrong said. “And I was trying to say how we’re going to get her treatment, and she said, ‘No, I was raped when I was her age, and I’m fine.’”

He added, “And I looked at her and, in my mind, what I wanted to say was, ‘You’re not fine. I mean look at you, look at how you’re living, and now your child is repeating this.’”

Today, research shows that children who experience a lot of trauma can suffer lifelong consequences — trauma like physical or sexual abuse, homelessness, poverty, living with violence, having a parent behind bars, and divorce.

“There’s that trauma that’s repeated, passed down,” Armstrong said. “Kids witness, you know, domestic violence, kids witness even some of the racism that the parents experience. It tells them a lot about their value, their self worth. It tells them a lot about how you survive. How you carry yourself in this world.”

The more trauma kids endure, the more likely they are to develop a host of medical and social problems, including learning disabilities and addictions. They’re also more likely to end up in the juvenile justice system and eventually in jail.

They’re even more likely to develop serious mental illnesses such as schizophrenia.

“All we see is the end result,” Armstrong said. “And oftentimes what we’re actually responding to and treating is the worst possible outcome of this combination of very, very complex things. And what we don’t know is, what would have happened if we had the right resources for the mother or the child – or for both?”

Armstrong has been the director of mental health for North Carolina’s Department of Health and Human Services, as well as the vice president of behavioral health for Charlotte-based Atrium Health. A constant in his career: The right resources are hard to come by.

Part of the problem is lack of access to care. There are 1.1 million uninsured adults in North Carolina.

But a big problem for kids is that the mental health system isn’t designed to treat traumatized kids before they predictably worsen. Insurance companies and Medicaid pay to treat specific diagnoses, Armstrong said. So kids have to get sick before they get help.

“You almost have to fail first because you’ve got to reach that diagnosis,” Armstrong said. “It's almost like we're pushing kids toward a diagnosis – to say, ‘OK, if you want this level of care, you've got to act out to this degree.’”

By the time Judge Elizabeth Trosch meets them, they’re criminal defendants.

 Judge Elizabeth Trosch, Chief District Court Judge for Mecklenburg County.
Dana Miller Ervin
Judge Elizabeth Trosch, Chief District Court Judge for Mecklenburg County.

“The vast majority of children who were coming into our delinquency court were experiencing some kind of behavioral health or mental health disorder and were in need of support or services that were either unavailable, inaccessible or unknown to them and their families,” Trosch said.

Trosch, the chief district court judge for Mecklenburg County, used to preside over juvenile court. The parents of many of the kids she saw needed help too, she said.

“Many, many, many, many parents were experiencing mental health disorders or illnesses,” Trosch said. “The majority [were] experiencing some version of traumatic stress themselves and in need of support and services that were not available to them.”

Trosch said she’s seen parents lose custody of their kids simply because they didn’t have access to mental health care. That loss further traumatized their children.

Cycling through the system

It may explain what happened to Alexander Gill. He was a 20-something man who’d been cycling in and out of the Gaston County jail. WFAE hoped to interview him last summer for this series. We couldn’t find him, but his Facebook page showed a young man who really wanted to connect with people.

“His smile would light up a room. He's always smiling, always joking,” said Annikka Jeffries, Gill’s aunt. She said he desperately wanted to fit in, to have friends. “He wanted to make other people happy. I just knew he was going to get himself together.” She thought he might even have a future on television someday.

Annika Jeffries outside her home.
Dana Miller Ervin
Annika Jeffries outside her home.

But Gill’s childhood was tough. His mom was addicted to drugs. She racked up a long record of arrests for things such as prostitution, assault and breaking and entering. She didn’t want to speak with WFAE, but Jeffries says the mother’s trauma left its mark on Gill.

Gill’s childhood, Jeffries said, included “walking the streets, being in drug houses, being left alone with his siblings for hours with a kerosene heater running.”

When Gill was 7, he and his two younger sisters went to live with Jeffries in Gastonia to keep them out of foster care.

“At the time, they told me that Alex only had attention deficit [disorder],” Jeffries said, “but then as time went by, I’m like, ‘It’s got to be more than that. Something ain't right.’”

Eight-year-old Gill told Jeffries he was planning to kill his sisters, then cover up the crime, Jeffries said. So she took him to a psychiatric hospital. It was the beginning of what Jeffries said was a decade of Gill’s cycling in and out of North Carolina’s juvenile mental health system.

The system is designed to treat kids in the community whenever possible. If that doesn’t work, they move to gradually more restrictive environments. But kids still may not get what they need. As Gill moved through the system, Jeffries said, he got more aggressive.

“He’s having to go to school with people [who are] … way older than him,” Jeffries said. “Their mental health issues may be even more severe than he is. But they done come from very violent environments themselves.”

Ultimately, Gill would cycle in and out of the most restrictive environments for troubled kids, called psychiatric residential treatment facilities — or PRTFs. Critics call them “kiddie jails.”

Researchers at the University of North Carolina found that some PRTFs may do little to improve children’s mental health. And studies have found that locking kids away in large, disciplinary settings with a lot of other troubled or violent kids can make them worse.

“A PRTF itself is not an evidence-based practice. It's a level of supervision,” Armstrong said. And you have the level of supervision so that you can do these other evidence-based practices.” But, in the end, kids are locked up.

PRTFs, he said, have “some pretty good providers who do really good work with the resources they have available to them.” However, he said, “We don't have enough providers who are really skilled in dealing with trauma [and]… skilled in dealing with kids that have dual behavioral and developmental disability type needs.”

Armstrong added: “We’re oftentimes trying to force [children] into the resources we have.”

For Gill, each move, each new facility, meant he never had stability or permanent relationships, his aunt said. His schooling was repeatedly interrupted, and he kept switching doctors and medications.

The number of Gill’s diagnoses grew. Attention deficit hyperactivity disorder, intermittent explosive disorder, conduct disorder, substance abuse and bipolar disorder are all mentioned in Gill’s records.

When Gill turned 18, Jeffries lost any say in his care. He went to live in a shelter.

In the end, Jeffries said, he just wanted to be with his mom on the streets.

“He was so hurt from not being with his mom. He was like, ‘I'm gonna be just like my mom. I’m going to smoke crack,’” Jeffries said.

Then Gill started to rack up dozens of arrests for drug possession, larcenies and resisting arrest. It’s a sad but predictable story for many kids who’ve gone through deep trauma without proper care.

Vulnerable communities suffer

It affects kids of all races, but Trosch says especially children of color like Gill, because they’re more likely to experience trauma.

“The reality is that people of color are more likely to be living in our poor neighborhoods,” Trosch said. “People of color are disproportionately arrested and presented to the magistrate for booking into the Mecklenburg County jail. And people of color are disproportionately incarcerated pretrial in our jail.”

Nationally, Black people are more likely than most other groups to be poor and homeless — both traumatizing experiences in themselves. A University of Massachusetts study found that 60% of Black people reported incarceration by an immediate family member, compared to 42% of Hispanic people and 37% of white people. Black children are more likely to end up in psychiatric residential treatment facilities and four times as likely as their white peers to end up in the juvenile justice system.

Ben David, North Carolina cistrict attorney for New Hanover and Pender counties.
Dana Miller Ervin
Ben David, North Carolina cistrict attorney for New Hanover and Pender counties.

Ben David, district attorney for New Hanover and Pender counties, says trauma affects kids from every racial and income group, both urban and rural.

“But when you focus on trauma, specifically childhood trauma, and say we need to get the right resources to the children experiencing this trauma, what you end up doing is positively impacting communities of color and impoverished communities, because that's where a lot of this trauma lives in our state,” David said.

The family court in New Hanover County has been trying to reduce repeat infractions by nonviolent offenders by addressing childhood trauma. Its work is based on research that shows childhood trauma can affect brain development in infants and small children. Scientists call it “adverse childhood experiences” or ACEs.

“Childhood trauma is the reason that we're seeing so much domestic violence and gang violence,” David said. “And so if we can take care of our children now, then we're not going to have them as victims or as defendants later.”

David is also a co-chairman of the chief justice’s Task Force on ACEs-Informed Courts. It’s a two-year effort working with several North Carolina universities to instruct district court judges — those working directly with families.

“What we've come to understand is that a lot of times we shouldn't be asking what's wrong with you, but what happened to you?” David said.

In July, the task force will begin to pilot the first of five local “safer baby courts” so children of struggling parents get removed from the home quickly to prevent further trauma. Infants or toddlers will live with a foster family while their parents get help. Parents will continue to see their kids, stay involved in their lives and take parenting classes or get child-parent therapy.

“What we're hoping to do is to literally bring that baby and that mother into court and say, ‘Make me a promise: Stay alive, stay alive next week. Stay alive two weeks from now,'” David said. “‘We're going to see you every other week over this next year, while you're getting drug treatment, while you're getting mental health counseling, while you're getting your life right.’”

The goal is to reunite parents with their kids. Similar courts are up and running in Florida. Their data show that the courts help kids reunite with their parents sooner. Kids are also less likely to be removed a second time.

The five North Carolina pilots will be funded with nonprofit and foundation money. David said the task force is asking the General Assembly for funding for state coordinator positions, and for $300,000 to research the courts’ efficacy.

Ultimately, it hopes the General Assembly will be willing to do more, including using victims’ compensation funds to help pay for care for kids suffering from the after-effects of trauma. David also hopes the General Assembly will reinstate funding for drug treatment courts, which it eliminated more than a decade ago.

Those five pilots will be a drop in the bucket for a state of nearly 11 million people. Most of North Carolina’s kids will still end up in a system that’s slow to recognize the toxic effects of trauma on small kids. It’s a system Annikka Jeffries said was inadequate to help her nephew.

WFAE never got to speak to Alexander Gill. A few weeks after we started to search for him, the police found his body in a tent behind a homeless shelter, dead from a drug overdose. The toxicology report found alcohol, fentanyl and methamphetamine in his system.

He was 23.

“He didn’t stand a chance,” Jeffries said. “That's why I was so desperate for help and beg[ged] for so much help from the mental health system. Because I knew that's the only chance he had was to get well and to get mental help. But they made it worse.”

Mona Dougani contributed to this story.

This story was corrected to accurately reflect wording in the companion broadcast story.

Additional resources:

What are psychiatric residential treatment facilities?

This story is part of a collaboration between WFAE and FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.

Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.