by Jinpa Lhamo

Created on: February 16, 2008

In the late 1980's I was the sole provider of mental health services in a remote, rural part of the US. Although specializing in adult assessment and treatment, I was occasionally called upon to assess and treat adolescents and school age children, as there was no other clinician available in the area.

One day a school age boy was referred to me for outpatient treatment. In looking over his record at the clinic, it was clear that the boy was in severe difficulty with acting-out behavior. In the record was a psychological evaluation from a Neuropsychologist (in a distant metropolitan area) that stated very clearly that the boy needed inpatient, residential treatment for his emotional and behavioral difficulties. The report was a detailed, excellent documentation of the boy's performance during the evaluation that supported the need for residential treatment. In addition, the report warned that without treatment the boy was at risk for more serious problems, as were the systems in which the boy functioned. The boy's parents had exhausted their resources in trying to get help. They really wanted the child to have treatment and were unwilling to give up on him.

Having done an assessment interview myself, I brought the treatment record with me to a treatment planning meeting conducted by the 'treatment team' (composed of officials from school, town and county) on behalf of this boy. At the meeting I emphasized the urgent nature of the boy's condition, supported by the report from the Neuropsychologist. I stated emphatically that my findings, during the assessment interview, were completely congruent with the Neuropsychological Evaluation.

In addition, I pointed-out to the treatment planning team that the boy's history of separation from his mother during early childhood, one of a number of separations endured by the boy, caused him to display a serious emotional detachment and lack of relatedness when it came to his violent behavior toward others. I told them in lay terms that the boy had little capacity to be empathic or sorry toward those he hurt.

Responses, to the case I made for residential treatment required by this boy, were met with general, non-specific answers that were really non-responses. When I persisted in trying to put some definite plans into place for residential treatment, the team admitted that they were glad to have the boy go on and commit a crime so that the Criminal Justice System would assume responsibility for providing treatment; this was

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