The state's recent response to an Elkhart murder reinforces a longstanding perception that Indiana’s mental healthcare system for children is badly broken.
Bob Segall/13 Investigates
ELKHART, Ind. - Firefighters arrived at the smoke-filled apartment to find it was covered in blood.
They carried out Maria Torres who, minutes earlier, had been stabbed to death inside.
Within the hour, crime scene tape stretched around the quiet Prairie Street apartment complex, weaving through playground equipment and blowing in the July breeze, as investigators searched for an unlikely suspect.
"Surprise [for] a lot of officers when they heard the story and they heard who we're looking for," said Elkhart Police Sgt. Chris Snyder.
According to court records, Torres was watching TV when she smelled smoke coming from her step-daughter's bedroom. When she entered the room to investigate, the 12-year-old girl stabbed Torres with a kitchen knife. She stabbed her father, too, before running away.
Police caught the 12-year-old, who was sent to the Elkhart County Juvenile Detention Center.
She told authorities a fictional character on the internet told her to kill her step-mother, and she said she had been asking for help for months because of strange voices in her head.
Weeks of psychological testing followed.
Two psychiatrists and a psychologist all determined the girl was suffering from Dissociative Identity Disorder, a mental illness characterized by multiple and distinct personality states that have power over a person's behavior.
At the same time, a court-appointed guardian determined she was showing "increasingly dangerous behavior" that was "a clear risk to herself" and others.
The girl's arms were covered in deep, self-inflicted scratches, so detention center staff took away all sharp objects. Even pencils were off limits.
Two weeks after the murder, Elkhart County Magistrate Deborah Domine decided the detention center must provide the girl one-on-one supervision. She also ordered probation officers to explore an alternate placement to keep the girl safe and to get her treatment.
That is when the tragic case took an incredible twist.
A 12-year-old girl was about to discover what other Indiana kids with severe mental illness know all too well: there is nowhere to go.
Declaring an emergency
While most juvenile court cases are closed to media and the public, Domine granted WTHR's request to review the girl's case file.
That file shows month after month, Elkhart County could not find a single mental health facility to accept the 12-year-old.
A September 17 entry states: "The Court finds that the Elkhart County Probation Department has investigated multiple placements and contacted providers across the State of Indiana. To date, no placement has been located that is willing to accept [her]. Efforts to locate a placement are continuing."
On October 22, court records show: "In spite of extensive efforts by Elkhart County Probation, no placement has been located to date. The Indiana State Hospital is unwilling, to date, to admit the child. The child continues to need treatment."
As summer turned to late fall, facilities across the state had all refused services to a youngster who was literally begging for help.
At a November 16 competency hearing, the magistrate was clearly frustrated. Finding the girl not competent to stand trial, Domine ordered the State Division of Mental Health to end its stonewalling.
"Common sense suggests that an emergency exists here," the magistrate wrote. "While she lingers in detention waiting for a facility that is willing to treat her, her condition worsens and she remains a risk to herself and other children housed in the detention center; she needs treatment now."
Her order listed, by name, 16 separate healthcare facilities that declined treatment – both state and private facilities scattered from Elkhart, Bloomington and Richmond to Indianapolis, Columbus and Evansville.
"To date, every treatment program contacted refuses to admit [her]. The only option available is a State Hospital placement through the Division of Mental Health," Domine wrote. "[This] is a child and she is accused of a horrible crime …. the community needs protection. This child needs the help she has been begging for and to date has not received."
Despite additional objections from the state, in early December – more than 120 days after the young murder suspect was taken into custody – the 12-year-old was transported to the Larue Carter State Psychiatric Hospital in Indianapolis, where she is now receiving treatment.
A matter of money
The case is far from unique.
A recent Eyewitness News investigation showed families across Indiana often wait many months -- even years -- to get mental health services for their children.
Why does it take so long?
Indiana faces a critical shortage of child psychiatrists. The vast majority of Indiana counties don't have any.
And following 30 years of defunding and closing state mental institutions in favor of private, for-profit, community-based facilities, Indiana now has a severe shortage of beds to accommodate kids who need in-patient treatment for chronic mental illness.
Treating psychiatric conditions is also very expensive, and healthcare providers frequently collect far less reimbursement for treating patients with mental disorders than they receive for treating those with physical disorders.
Simply put, mental health specialists are hard to find, facilities are often understaffed, and even those that do not have long waiting lists frequently decline the most challenging cases because they are not profitable.
"More and more of the kids are needing one-to-one staffing, and we are struggling to have enough staff to staff our facilities," said Bonita Schrock, vice present of child and adolescent outpatient services at Oaklawn. The mental health treatment facility in northern Indiana is one of the providers that declined to treat the 12-year-old now charged with killing her step-mother.
"For kids who have really severe developmental disabilities and mental illness, we don't have the capacity. The higher-need kids, they need the most services and we're just not able to spread ourselves everywhere," Schrock explained. "These are incredibly difficult jobs for incredibly low wages, and we need to weigh the needs of the child with the needs of the other children we serve."
Mental health advocates say long wait times are the norm in Indiana – at both private and state facilities – even when dealing with mental health emergencies.
"It comes down to money. Everything comes down to money," said Charlotte Fletcher, a board member for the Elkhart chapter of the National Alliance on Mental Illness. "But still, how in the world does it take four months to get help for a case like that? That's crazy. Somebody should step in to help."
Fishing for help
The secretary of Indiana's Family and Social Services Administration agrees.
"We can't allow something like that to happen," said Dr. John Wernert, after he was briefed on the case by 13 Investigates. Wernert's state agency oversees state mental hospitals and outreach efforts for treating the mentally ill. He says the Elkhart case highlights a systemic problem: the state's slow response to help kids in crisis.
"The reality is we've done a poor job working together with other agencies. We need to work together ... and it shouldn't be a matter of having to go on a fishing expedition to find someone willing to take them."
But for thousands of mentally-ill kids across the state, that "fishing expedition" to find help is an everyday reality.
"We can't get our child in a facility where he needs to be," said Amanda Lawson, whose 9-year-old son, Talin, suffers from mental illness.
What worries the Kokomo mother most is Talin's bipolar disorder triggers unpredictable and often violent behavior.
"Things have gotten worse as he's gotten older – and more violent. He's literally beaten me. I've ended up in the hospital," she said. "He comes up to me after and tells me how sorry he is for hurting me. That's what hurts more than anything is I don't think he means to do it. There is a disease inside of him. But I worry about what he could do one day if he doesn't get the right treatment."
"Horribly broken system"
Some Indiana judges are worried, too – and they point to the recent murder in Elkhart to drive home the point.
"These children are a danger to themselves or others. They're a danger to their own family. They are going to be adults someday and they're going to have their own children, and it's going to spiral out of control," said Morgan County Circuit Judge Matthew Hanson. "The system is broken, and it seems to be getting worse."
Hanson has repeatedly criticized the state for not helping its most mentally-ill children.
In 2012, he wrote a scathing ruling against the Indiana Department of Child Services.
"Not until a parent/child are at wits end will the DCS consider helping these children and their mental health issues," he wrote. "It would seem DCS is simply waiting around until the child commits such egregious or dangerous acts that the [juvenile delinquency] system has no choice but to file charges ... and then the DCS can simply ignore any pleas thereafter to aid such a child."
The judge lashed out at DCS after the state refused to assist McKenzie Ashkettle. The 12-year-old Morgan County girl was diagnosed at a very young age with long list of psychotic and developmental disorders.
Despite her violent behavior, more than 80 calls to police, and being turned away by more than two dozen mental health facilities, DCS would not help.
"They refused because I wasn't neglecting her. They said there was nothing they could do," explained McKenzie's mother, Amber. "We then reached out to every mental health facility in the state, and it was just one excuse after another. Nobody would help her. Nobody. It was ridiculous."
Judge Hanson agreed. He ordered the state to provide McKenzie with treatment – pointing out that kids with serious mental health problems should not have to commit a crime before they are eligible to receive help.
"We're the state of Indiana and we're supposed to be doing better by these kids, but we're not," Hanson told 13 Investigates during a recent visit to his courtroom. "We have a horribly broken system that needs fixed immediately."
Indiana's Department of Child Services sees things differently.
"Broken? Absolutely not," said DCS chief of staff Doris Tolliver. "There are absolutely opportunities to improve. There are always opportunities to improve, and it's a work in progress."
She insists changes are already happening. Four years ago, following Judge Hanson's scolding, the agency launched a Children's Mental Health Initiative to provide Indiana kids with better access to treatment. It's designed to centralize services throughout the state so families can get mental health treatment in their own community. Some of that treatment is reimbursed by the state.
More than 700 children have utilized the program so far.
But more than 71,000 kids in Indiana are currently dealing with serious mental health issues, and across the state, families with a mentally-ill child tell WTHR they have never heard of the Mental Health Initiative.
"We need help," said Amanda Lawson. "We have no idea where to go. And we shouldn't have to wait for our child to become a criminal to get help."
Long after the state implemented its Mental Health Initiative for children, recent developments in Elkhart show state agencies are still reluctant to provide services to mentally-ill kids -- even those in the most dire circumstances.
Hanson believes more tragedies like the one in Elkhart are likely.
"Don't be surprised when these types of cases keep popping up," he said. "The sad thing is these little time bombs are all out there waiting to go off. We should be afraid of that, and if we don't do more to stop it, it's going to keep happening."
A change of course
Wernert says the state does have a plan.
FSSA recently announced it is building a new state psychiatric hospital. The flagship facility in Indianapolis will include a children's unit, and it will diagnose and treat mentally-ill Hoosiers from across the state.
"This will offer a new model of care. We can't just medicate these kids. They need more intensive, longer-term therapy and family therapy to make a difference," Wernert said.
The state also plans to train and hire more child psychiatrists.
The announcement may offer a glimmer of hope to thousands of Indiana families suffering with the effects of mental illness. But it comes too late for Maria Torres' and her step-daughter.
The girl, whose murder case remains open in Elkhart County, just spent her thirteenth birthday in a state mental institution – an institution that didn't want to get involved until a court forced it to help.