Installment #7
Chapter Two
Little Ark
Arkmount Children's Psychiatric Center, or "Little Ark," is a
secure psychiatric treatment facility situated in the southeastern corner
of the two-hundred-acre complex of grounds and buildings in downstate New
York that is Arkmount Psychiatric Center, or "Big Ark." Big Ark
has its own police and fire departments.
Little Ark is designated by the state Department of Mental Health as an
acute care facility. Treatment there is intended to be short term, focused
on the rapid easing of a patient's most severe symptoms, enabling the child
in a relatively brief period of time to be returned home, placed in foster
care or a less restricted facility, or sent back to jail in cases where a
patient has been referred for observation by the state's department of DFY,
Detention for Youth. The ages of the patients at Little Ark generally range
from 11 to 18, although children as young as 8 or 9 are occasionally
admitted. The average length of stay is 48 days, and the cost per child
averages $870.00 per day.
Little Ark serves a seven county "catchment area" covering four
thousand square miles. At any given time there are between thirty and sixty
patients inside its locked confines, which encompass the school,
residential areas or "cottages," and an infirmary. There are
private patients, children who have been voluntarily admitted by their
parents, but the majority of patients are referred by other treatment or
residential centers, social service agencies, and the courts. Depending on
sex and overt symptoms, patients are housed in one of three cottages, the
Male Adolescent and Intensive Care Units, for boys, and the Female
Adolescent Unit, for girls.
The median age of a boy in the Intensive Care Unit is 16, and the average
age of onset of the symptoms that eventually brought him to Little Ark is
7.5. Intensive Care Unit boys, deemed potentially the most dangerous, have
usually been assigned one or more of four DSM Axis I diagnoses: Psychotic
Disorder, Coded 298.90, primarily schizophrenia or paranoia which involves
delusions and a totally skewed perception of reality; Major Affective
Disorder such as Bipolar or Manic-Depressive, 296.0; Major Depression,
296.20, or other conditions that affect mood such as Explosive Disorder,
characterized by sudden, violent and dangerous outbursts of uncontrollable
rage; Conduct Disorder, which can include Attention Deficit Hyperactivity
Disorder, criminal activity, chronic truancy, and other patterns of
behavior that have brought the patient into serious conflict at home and in
school, and often with the police.
65% of ICU patients have a serious psychiatric disorder in addition to
behavior problems.
40% are African-Americans, 40% white, 20% Hispanic.
90% are not in the custody of a parent or parents; 10% came to Little Ark
from home, and of these only 10% have an intact family; 80% have a parent
who has a history of serious mental illness; 65% have a parent with a
history of serious substance abuse; 70% have at some time lived in a home
setting where there was serious domestic violence.
90% of the boys in the ICU have committed a serious assault, been cruel to
animals (often killing a family pet), committed major arson such as burning
down a school building, and/or committed a sexual offense---often the
molestation of a younger child.
50% have engaged in serious self-destructive behavior and have attempted to
commit suicide.
70% have been involved in drug or alcohol abuse.
30% have been referred to Little Ark by a Family Court judge for evaluation
prior to a judicial decision.
40% have been transferred to Little Ark from a private hospital because
they have committed major assault on a staff member.
85% have a history of one or more previous psychiatric hospitalizations;
most have a long history of school failure, outbursts of rage, property
destruction, assault on family members, sexual offenses, arson, robbery,
and drug possession.
The median age of girls in the Female Adolescent Unit is 15, and the
average age of onset of mental illness is 7.5.
AU girls have usually been assigned one or more of three Axis I diagnoses:
Major Affective Disorder such as Depression; Post-Traumatic Stress
Disorder (309.89); or Oppositional Defiant Disorder (313.81).
60% of AU girls are white, and 40% are either African-American or Hispanic.
80% are not in the custody of a parent or parents; 70% have a parent with a
history of serious mental illness; 50% have a previous history of sexual
abuse by a family member or other adult male.
70% have shown self-destructive or suicidal behaviors; 55% have a history
of serious substance abuse, often connected with sexual acting-out; 90%
have shown serious self-destructive behavior in the form of eating
disorders, especially anorexia (307.10) or bulimia (307.51), or both.
40% have a substandard I.Q.; 80% have had at least one previous
hospitalization, and many of these with previous hospitalizations have had
at least three or more.
The median age of a boy in the Male Adolescent Unit is 14, and the average
age of the onset of mental illness is 7.
Male Adolescent Unit boys have usually been assigned one or more of four
Axis I diagnoses: Post-Traumatic Stress Disorder; Major Affective Disorder;
Conduct Disorder; Oppositional-Defiant Disorder.
33% are African-American, 33% white, and 33% Hispanic.
50% are not in the custody of a parent or parents; 85% of those who do live
at home have a single parent, usually the mother; 50% have a parent with a
history of serious mental illness, serious substance abuse, and/or domestic
violence; 20% have a biological parent who has AIDS or who has died of
AIDS.
60% of MA unit boys have a history of assaulting family members and/or
peers, cruelty to animals, running away, frequent school suspensions, and
they harbor homicidal thoughts.
40% have a history of suicide attempts, such as attempted hanging,
wrist-slashing, walking into oncoming traffic, and/or overdosing on
over-the-counter medications.
MA unit boys average two to three years below grade level; 50% have had a
previous psychiatric hospitalization, and of these 30% have had two or more
previous hospitalizations.
At Little Ark the patients are awakened by the night staff between 6:30 and
7:30 A.M. They brush their teeth, shower, dress, and then have breakfast in
the dining room of one of their three respective cottages. Doses of
psychotropic drugs and other medications are given to the children for whom
they have been prescribed. From 8:30 until 9:20 A.M. on Mondays, Wednesdays
and Fridays, and from 11:00 A.M. until noon on Tuesdays and Thursdays, the
patients meet as a group with the psychiatrist assigned to the cottage,
Therapy Aides, and sometimes school personnel. These cottage gatherings are
a combination of group therapy and town meetings where problems, either of
an individual nature or those concerning group dynamics, are discussed,
predetermined individual "target skills" for the day are
reviewed, and then there are exercises in "conflict resolution"
during which patients practice their "target skills."
After cottage meetings on Mondays, Wednesdays and Fridays, and before
meetings on Tuesdays and Thursdays, the patients attend the hospital's
school, which is located at the opposite end of a long, wide corridor
linking it to the cottages. In school the children will attend classes,
which include recreational and occupational therapy in addition to the
standard academic subjects. They eat lunch in their cottage dining rooms
from noon until 1:00 P.M., and then return to school from 1:00 to 3:15 P.M.
All patients are scheduled for 45 minutes of individual therapy and 45
minutes of group therapy twice a week. There are additional group therapy
sessions for MICA patients---Mentally Ill Chemically Abusive, drug and
alcohol abusers---and for those suffering from Post-Traumatic Stress
Syndrome. Alcoholics may attend AA meetings at a community center in Big
Ark once a week. Depending on the availability of a parent or parents,
family therapy with a "primary," or unit, psychiatrist is
scheduled for 45 minutes a week. A TAP group, the Trauma Abuse Program for
boys and girls who have suffered repeated physical and sexual abuse,
including rape, meets separately.
In addition to the psychiatrist assigned to each cottage, there is always a
psychiatrist on call 24 hours a day. Little Ark is a "training
hospital" serving 25 regional colleges and universities, so there is a
constant influx of child psychiatry Fellows and Residents, student
teachers, medical students, psychology and social work interns, nursing
students, and occupational and recreational therapy students mingling with
the patients.
