Drastic Measures 

The 11-year-old who cried rape is a sign of larger mental health issues.

Last week, Memphis was riveted by news that an 11-year-old girl had fabricated a story about being raped. A week before, the city was shocked by the girl's story and her subsequent naked flight through the Cooper-Young neighborhood to find help.

After uncovering the truth, police administrators acted quickly, sending out a bulletin saying the rape allegation was "no longer [being] pursued." The girl, who is mildly retarded, was then charged with making a false report, picked up from Peabody Elementary School, and taken into custody at Juvenile Court. Although she was soon released to her mother, the charge came as a shock to court administrators.

"To be honest, we were all a little bit surprised by the charge," said Juvenile Court chief administrative officer June Wood. "I've never heard of anything like that." The girl will undergo mandatory counseling at a private treatment facility, which is not unusual, according to Wood. "When a child this young is engaged in something like this, it would be enough to have this court step in and ask questions," she said.

The court's most recent annual report shows its Evaluation and Referral Unit handled 7,761 children in 2001. E&R counselors follow children during treatment, get feedback from the mental health facility, and funnel that information back to the court. They also try to discover any issues that need to be handled by law enforcement.

Why the charge? One Juvenile Court employee said the charge is a mask for a much larger problem within the juvenile mental health system: the rising cost of services. Asked if the girl was processed in order to receive treatment at the court's expense, Wood said: "That could very well have been one of the motives. We consider that [false allegation] as just another cry for help."

How much does such an evaluation and treatment cost? For patients referred to Charter Lakeside Behavioral Health System, outpatient care costs $398 per day. Inpatient care runs $1,440 a day. Juvenile Court maintains relationships with 61 public and private referral agencies. Providers accept various forms of insurance, including TennCare, which is the insurance carrier for many young patients in the system. But reimbursements may not cover all expenses, and clients can end up with little or no care.

"Like adult jails, with the reorganization of mental health services, mental health patients are underserved," said Wood. "We get children who cannot or will not access services through traditional avenues that are identified and payable through TennCare. We have an increasing number of kids who have serious mental health issues, and we tend to see the kids who don't have the resources or the variety of support systems that are necessary to sustain them." Although Charter Lakeside accepts TennCare, some other facilities do not.

TennCare's mental health care issues are handled and funded through the state's Department of Mental Health and Developmental Disabilities. That department works with referral agencies. Fees for TennCare patients are negotiated with each facility, said department spokesman Tony Troiano. Brokered reimbursement amounts with TennCare are confidential.

To help young people navigate the system, Wood and the Juvenile Court have created a collaborative with the provider community: the Juvenile Justice Mental Behavioral Health Collaborative or Just Care for Kids. The court works with the Department of Children's Services and various community agencies to manage reimbursement rates, guarantees, and specialized care.

Still there are children who fall through the cracks, said Wood: "Our most serious concerns are the working poor -- those who don't qualify for TennCare but also don't have adequate private plans." Wood calls them "80/20" kids, from the adage that 20 percent of the kids will use 80 percent of the resources and create 80 percent of the problems. The Peabody student could fall into this category. Not only did the student make a false rape allegation, Juvenile Court counsel said the girl had been sexually assaulted in a separate incident.

As the reimbursement system gets more complex and less accessible, more troubled youth will fail to get proper mental health care. "It's not a large number of kids, but all of us in different agencies know these kids. We know them by name, and they are very ill," said Wood. "There will always be kids who need longer-term intensive supervised care. We really have some needs; we have to make the services available."

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