Janice Dykstra asked herself a question, worrying again about the girl she took in as an infant and raised as a daughter.
What the hell was she going to do now?
The girl, Luci Feekes, has critical and ongoing mental health needs, prone to self-harm and aggressive behavior. And now her treatment center was insisting on a discharge.
The staff at Aurora Plains Academy in Plankinton, one of the more intensive care facilities in South Dakota, also insisted 17-year-old Luci isn’t ready to come home.
“There was a lot of helplessness and not a lot of hope,” Dykstra said of the early October call from Aurora Plains. “And I still don’t have much hope to be honest with you.”
Aurora Plains did not respond to an interview request.
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The teenage girl who was raised by Dykstra and calls her “mom” is falling into a void, and the descent is slow and frustrating.
Dykstra, 51, has fought it at every turn, trying to cobble together whatever support is out there in a world of nearly insurmountable financial barriers and dwindling options for care.
She has been looking for mental health help for Luci in South Dakota for more than seven years. She is still looking.
Treatment centers take Luci in and then send her away, at the same time insisting she still needs care. The hunt for an alternative comes with the pressure of trying to come up with funding to pay for education – a requirement for placement. Sioux Falls public schools have said Luci doesn’t qualify for funding.
No one seems to be able to help. Not the nonprofits, not the hospitals, not the private treatment centers or even the state psychiatric hospital.
So the question she asked after the Aurora Plains call was a good one. It was practical. Because Dykstra needs mental health care for her girl and she can't seem to find anywhere in the state.
Not always because providers are unwilling, but also because some of the state's most intensive facilities feel Luci is beyond their ability to help.
NOWHERE TO TURN
Luci’s first residential treatment placement was at Children’s Home Society. It took more than a year for her to get in, and when she was finally admitted on a scholarship program it came as a sign of hope.
Luci’s aggression grew worse during her stay. Providers swiftly discharged her when she slammed her bedroom door on a staff member’s fingers, Dykstra said.
“I was told by her therapist that it was time to say ‘uncle,’ in other words it was time for me to give up on her and let the state deal with her,” Dykstra said.
Children's Home did not respond to an interview request.
Luci was a danger to other children, staff at the center wrote in her discharge papers, “unwilling and unable to work on her treatment plan goals.”
Luci was 11.
She has bounced around South Dakota's mental health care system ever since, finding temporary help before providers hit a breaking point.
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There were many short stays at Avera Behavioral Health’s crowded inpatient program – the only one available to children in Sioux Falls. There were stays at the Human Services Center in Yankton, where they strapped her to a board to restrain her during outbursts. There was also a series of nonprofit treatment centers where Luci found temporary refuge only to be discharged without a resolution, each time with staff insisting she still needed help – only, somewhere else.
She was discharged two months early from Summit Oaks, the residential treatment program run by Lutheran Social Services. Summit Oaks discharged her to the Dykstras "due to continued aggression and lack of progress."
Luci's discharge records cataloged nearly 100 suicide attempts during her seven months in the LSS program. Amy Witt, the nonprofit's vice president of children and youth services, declined to comment for this story.
Later, there was Our Home Inc., a center in Parkston. She was discharged again due to behavior, though Dykstra said she feels Our Home's staff did everything they could to help.
Our Home, which offers 92 beds between centers in Parkston and Huron, creates a treatment plan based on the individual needs of each patient.
There are unique cases where a patient who comes to them seems beyond the reach of the program, said Jenise Pischel, Our Home's executive director.
“It is a tight rope walk for every facility in the state to make sure we're balancing the safety of Luci," Pischel said. "That we're balancing the safety of the other youth that are in the facility, and then staff.”
A NEW FAMILY MEMBER
Luci used to carry around drumsticks.
She wanted to join the Lincoln High School marching band when she was old enough, like her sisters, said Tim Dykstra, Janice's husband.
"We'd go to all the band competitions and she'd come along," Dykstra said.
Luci came to the family through Child Protective Services when she was 10 months old, taken from her biological parents because she was being neglected.
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At the time, the family believed Luci was Janice Dykstra’s niece. Testing later showed there was no blood relation. Officials told the family if they didn’t take on the guardianship for Luci, she would enter the foster care system.
Janice Dykstra grew up not knowing her biological father and refused to let Luci grow up without parents.
“We just decided it was something we needed to do,” Dykstra said.
There had been no structure in Luci’s early life. She slept all day and was up all night, and had never worn shoes, Dykstra said.
She and Tim worked to give their newest family member as much stability as possible.
Problems started in kindergarten, about when Luci was first diagnosed with ADHD.
Janice Dykstra calls it Luci’s “switch.”
“When it's off, she’s a perfect kid, sweet, caring, loves to be around her family,” Dykstra said. “How you shut it off, I don’t know.”
Luci’s mental health diagnoses evolved as she moved between providers. Same for the list of medications prescribed by doctors.
She was most recently diagnosed with bipolar disorder, attention deficit hyperactivity disorder, oppositional defiant disorder and reactive attachment disorder, according to discharge documents from Aurora Plains.
SOUTH DAKOTA'S MENTAL HEALTH GAP
For Luci, it has become unclear where help will come from.
The state’s mental health system is short on providers and access is a problem in rural counties. In South Dakota there are fewer mental health providers per capita than most other states, according to annual rankings released each year by Mental Health America. The state has a population-to-provider ratio of 660-to-1, which ranked 39th in the nation.
A state map of mental health provider shortage areas simply looks like a blanket of blue, covering every county except for Fall River County and the state’s two metropolitan areas.
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The state’s only psychiatric hospital – the highest level of mental health care available in South Dakota – was struggling from a crippling shortage of workers last winter. Workers broke down in tears and said they were "stretched" and "traumatized" by their workload, according to a federal report.
Ken Cole took over as the hospital’s top official in June. He said HSC's ability to serve patients in the 47-bed adolescent program isn’t affected by staffing levels. Making sure there is room for both long-term care and emergency holds is always a concern, Cole said.
“It’s a balancing act,” Cole said. “On a day-to-day basis to try to look forward and see, can we take this voluntary admission and still have enough beds?”
A previous investigation by the Argus Leader found thousands of South Dakota children with diagnosed mental illness, who qualified for help, were slipping through the cracks. State leaders knew about it years ago, but took almost no legislative action to address the problem.
The number of children not receiving treatment remained largely unchanged.
Carla Miller heads a group that works with South Dakota children and their families, connecting those who have special health needs with educational resources.
The Dykstras are a facing a familiar problem, said Miller, executive director of South Dakota Parent Connection.
“There is a Bermuda Triangle, where there’s a gap in services,” Miller said.
THE SPECIAL EDUCATION QUESTION
Tim Dykstra wonders if they missed a window.
Luci was losing control, and Sioux Falls public schools seemed unwilling to address the seriousness of her condition.
“I think the school district failed her,” Dykstra said. "I'm positive that if would have been able to find help in the early stages, we would have been able to turn it around."
Seeking residential treatment for Luci, the family asked the Sioux Falls School District to put her on a special education plan so she would qualify for the necessary funding.
The district's special education department determined Luci was not eligible.
“According to what staff reported to me the team did not have the documentation for an adverse affect (sic) on educational performance,” a school official wrote in a June, 2012, letter to the family.
Hawthorne records show Luci had been disciplined nearly 20 times in two years for violent and aggressive behavior against her classmates. At home, the family had been calling police to help calm Luci down.
Sioux Falls school officials can't comment on a specific case, said Deb Muilenburg-Wilson, senior director of special services for the district.
There are children who are diagnosed with a mental illness but still don't qualify for special education. More often than not, however, those students do qualify for the program, Muilenburg-Wilson said.
If they don't, it's because they didn't meet all three criteria:
- Did they meet standardized scores to qualify as having a disability?
- Does it affect their learning?
- Do they require specialized instruction?
The district has made strides in providing mental health help to its students, introducing programs and adding specialized positions.
“We want to work with our community and we want to work with families to find resources," Muilenburg-Wilson said.
More than 21,000 children in South Dakota qualify for special education and the federal funding that comes with the program. About 5 percent were approved due to an emotional disturbance.
If a student is battling depression or anxiety, but performs well enough academically, she doesn’t qualify for help.
“That’s where it can become frustrating for families because they certainly have a need,” Miller said. “It just becomes: Under whose umbrella of care?”
Disability Rights South Dakota is the state agency responsible for protecting the rights of adults and children with mental illness under federal protection and advocacy laws. That includes ensuring adequate access to care.
Inpatient psychiatric treatment costs thousands of dollars per week. Special education funding is often a barrier, said Tim Neyhart, executive director of Disability Rights.
"Oftentimes, schools will say, 'well that doesn't happen here so it doesn’t impact their education,'" Neyhart said. "You hear some disdain in my voice. And you hear it correctly.”
In the cases of alleged abuse his agency investigates each year, the most common complaint from patients relates to a failure to provide appropriate mental health treatment.
Between 2015 and 2017 there were 32 total allegations of abuse, of which 18 stemmed from a lack of appropriate mental health care.
DISAPPOINTMENT AND COMPROMISE
Janice Dykstra started grasping for the same sources of help she always reaches for when another provider gives up on Luci.
She emailed the Medicaid office to learn her options. She reached out to HSC to see if they had a bed for a longer-term voluntary admission – they don’t at first. She continued to work with staff at Aurora Plains, who promised to help find alternative placements and agreed keep Luci past the discharge date if needed.
A center in Colorado denied Luci’s admission to their program “due to the severity of her self-harm and her aggressive behaviors,” according to an email from Aurora Plains.
Dykstra wondered, isn’t it their job to help?
HSC in Yankton responded again, this time after being contacted by the Argus Leader for a story. Turns out, they do have a bed for Luci.
It’s something. A place for her girl to go.
But Dykstra is skeptical.
How long before they give up on Luci?
https://www.argusleader.com/story/news/2018/10/31/south-dakota-mental-health-bermuda-triangle-suicide-prevention/1674051002/Bagikan Berita Ini
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