On a chilly afternoon last March, 10-year-old Timothy was taken by ambulance to one of America’s largest state-run asylums for youth, the Henry Horner Children’s Center on Chicago’s Northwest Side.
Though barely over 4 feet tall, the chunky, big-boned boy with freckled cheeks, tawny hair and hazel eyes was described in psychiatric reports as “a danger to himself and others.”
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To this day, psychiatrists do not fully understand the roots of his mental disability, but they have long agreed that he is beyond the control of his mother, Kathleen Keegan, a single working woman who struggled through two turbulent divorces to raise three sons in a tiny, cozily furnished Des Plaines mobile home.
When he was 9, Timothy goaded classmates into fights, and when they landed punches on his face, he went back for more.
He threatened to beat his grandmother with a curtain rod, assaulted one of his brothers with a coat hanger, and chased the other with a pizza cutter. He slapped and pinched his face until it turned splotchy red.
One afternoon while playing alone in the trailer home, Timothy killed the family’s 3-month-old kitten, Misty.
“I think deep down he didn’t mean to do it,” his mother said. “He just doesn’t stop the way a normal child will. It’s like he likes pain.”
When he told neighbors that he was going to carry a gun, they told his mother that it was just kid’s talk.
“It isn’t,” she said.
As Timothy bristled with inexplicable rages and lashed out at his family, Kathleen Keegan plunged into the state network charged with serving the growing population of mentally disabled children.
She talked to police, social workers and school administrators, attended family-therapy sessions, and sat in the waiting rooms of countless state officials.
But 3 years after his disabilities became glaringly obvious, Timothy still is not in the setting that psychiatrists say he needs: a therapeutic boarding school.
Instead, the boy has been shuttled between schools and locked psychiatric facilities while his condition deteriorated.
Timothy’s odyssey illustrates the gross inefficiencies of the Illinois child-care system and the bewildering mental disabilities it is up against.
Unlike many of the state’s 159,000 children diagnosed with mental disabilities, Timothy did not lack for attention. His mother was able to marshal a battalion of state and private experts, but the roots of his problem have largely remained a mystery.
He has variously been diagnosed as suffering from major depression, severe conduct disorder, attention deficit and hyperactivity, “organic mental disorder with explosive features,” bipolar disorder, and expressive language disorder.
He has been given full therapeutic trials on some of the most common drugs to treat mental disorders, including lithium, Tegretol, Inderal and Prozac, but none seemed to work.
At first, his mother kept Timothy’s bills, reports and rejection letters in a pink suitcase in a broom closet off the kitchen. When the suitcase overflowed, she started using shopping bags.
Those in charge of the Illinois system for troubled children call it one of the most complicated and difficult to access in the country.
“The general rule is that each state agency is overwhelmed and underfunded and tends to look at disposing of problem kids in the most expeditious way: that is by viewing them as someone else’s responsibility,” said psychiatrist Dr. Alan Morris, who in January was appointed head of state mental health services for children.
The various agencies “typically come with their own baggage, their own turf issues, budget constraints, and their own barriers that stand in the way of collaboration,” said Gary Seelbach of the state Community Residential Service Authority.
Kathleen Keegan does not blame state officials for their failure to cooperate with one another and deliver services to Timothy. She knows his needs are complex and profound. But she and officials who have dealt with the boy’s case said they believe that the delays were ultimately as costly to taxpayers as they were destructive to Timothy.
In March 1992, Timothy arrived at the squat brick “cottages” of Horner, the centerpiece of the state’s fractured system for caring with mentally disabled children, where some of the most troubled children wind up after they have been shunted through the bureaucracy.
At Horner’s receiving office on that afternoon, Timothy was examined by psychiatrist Dr. Thomas Affeldt, a Department of Mental Health staffer.
Affeldt asked the boy to name two large cities, the date, his birthday, and the president’s name. He also had Timothy demonstrate that he could add and subtract two-digit numbers.
Timothy was “friendly, alert, cooperative and verbal,” Affeldt reported. “He says that he . . . can handle himself at home.”
Timothy told Affeldt, “I promise to get better.”
The boy had poor impulse control, poor judgment, a learning disability, a behavior disorder, and “really hasn’t shown motivation to change,” Affeldt wrote in his report.
“This makes for a poor prognosis.”
Nevertheless, he denied the boy admission to Horner because “he does not require this restrictive setting.”
As Kathleen Keegan and Timothy left, a staff worker slipped her a note with the phone numbers of Tough Love, Big Brother and the Department of Children and Family Services.
“Be persistent!” the note said.
During the car ride back to the trailer park, Timothy started to fidget with the radio and got in a fight with his mother. Hoping to relieve the tension and give him and his brothers a treat, she stopped at Eng’s House of Chop Suey on Oakton Avenue and bought a takeout dinner.
Walking back to the car with her arms full of steaming cartons, she saw that Timothy was gone.
For an hour and a half, Kathleen, her mother and one of his brothers searched the snowbound subdivisions of Des Plaines looking for the tousle-haired 10-year-old in black sweat pants, canvas sneakers, and a waist-length jacket with no hood or winter cap.
“I didn’t think he would make it home,” his mother said.
When they returned, Timothy was sitting in the living room, laughing.
Not until the end of March, a month in which police were called to the house when Timothy broke a neighbor’s window and then again when he destroyed his room with a hammer, would he finally win a place in Horner.
Within two months, in May 1992, Horner officials decided that Timothy was no longer in acute crisis and no longer needed to be in a psychiatric hospital.
But “for lack of an appropriate after-care plan,” he remains there, agency records show, while state officials wrangle over who should pay for the treatment they all agree he needs: a long-term residential school for children with severe emotional and learning disabilities.
Some states have created ways of dealing with mentally disabled kids whose needs cross agency boundaries.
In Virginia, the Interagency Consortium on Children’s Mental Health blends the budgets of several state agencies so that local communities can serve specific children and seed new neighborhood-based services.
The Alaska Youth Initiative combines staff from the state education and mental health departments to serve mentally disabled youth who are most at risk of hospitalization and chronic care.
In Ohio, county-level “clusters” of child-care agencies pool funds and coordinate services to the state’s most troubled and troublesome children.
Such overarching agencies save tax dollars by speeding service to the kids, thus reducing their time in the social-service net and also the need for costly, protracted litigation and administrative hearings.
In Illinois, Seelbach’s little-known Community Residential Services Authority was created in 1986 to eliminate precisely these sorts of child-destroying disputes, but he concedes that it was sent into battle with little ammunition.
The authority has a staff of four people, including a secretary.
Its annual budget has been frozen at $177,000 for the last five years.
It has no legal power to force other state agencies to cooperate. It cannot dictate how to apportion the costs of caring for children with complex needs that cross agency lines. It cannot cut checks on behalf of specific kids.
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“I’m not so sure how seriously we’re taken,” Seelbach said.
Out of the 159,000 Illinois schoolchildren identified as mentally disabled, last year the authority handled 288 cases.
“A drop in the bucket,” Seelbach conceded.
When he was 2, Timothy wouldn’t watch TV with the rest of his family. He went into another room and took apart his toys, Kathleen Keegan said.
“I just always thought he’s real hard to handle.”
The medical history of her family includes diabetes, epilepsy, headaches and emotional problems, a state report shows, and there has been heart disease and substance abuse in his father’s family.
Timothy’s mother and father divorced when he was 6, state records show, and Kathleen Keegan’s second marriage also ended in divorce.
The shifting, sketchy evaluations that have marked Timothy’s case are not uncommon in the field of children’s mental disabilities. Clinical diagnoses like attention-deficit disorder have only recently been recognized by schools and state agencies, while others like mental retardation are falling out of use.
“He doesn’t fit into any easy categories,” said Dr. Norman Chapman, one of Timothy’s psychiatrists. Timothy is not remorseless, sociopathic or out of touch with reality, Chapman said, but he cannot control his behavior.
When he was 7, his mother enrolled Timothy in a private, boys academy in Glenwood in the hope that the school would bring structure and discipline to his life.
A language examiner there noted that Timothy’s reading skills were above average but that he was difficult to test because he wouldn’t sit still. During the next two years, he became increasingly defiant with teachers. In November 1990, Timothy was expelled for chronic misbehavior and attacking other students.
In 1990, Chapman reported that the school would not allow him back unless he was taking psychotropic medications.
Kathleen Keegan enrolled Timothy in 4th grade at the Rupley Elementary School in Elk Grove Village. On his first day, he got in three fights. Classmates chased him off the bus on the second day.
In November 1990, Timothy was admitted for the first time to Forest Hospital’s psychiatric unit after breaking furniture, assaulting his family, and hitting himself in the face.
The hospital and Chapman treated Timothy for weeks after the family’s medical insurance coverage ran out, his mother’s records show.
But Timothy ultimately had to be discharged from Forest because of what one psychiatric report calls “insurance exhaustion”-a malady that is becoming more common as the cost of health-care soars.
So Kathleen Keegan had to turn to the state. Chapman said Timothy needed to be in a therapeutic boarding school that combined around-the-clock supervision, learning and counseling.
But Arlington Heights-based School District 59 officials resisted putting Timothy in such a place, calling it “too restrictive an environment.”
District 59 Special Education Chief Merlyn Swanson said the decision was based on a combination of ethical, educational and financial factors.
Timothy could be taught at a therapeutic day school, where he got one-on-one attention, Swanson said. Although he still got out of hand at home, caring for him there wasn’t the school’s responsibility, Swanson said.
Such day schools cost an average of $13,000 a year, compared with $47,300 for residential facilities, and the money was a factor, Swanson said.
But at the heart, it was a moral choice:
“The basic question to be addressed is, should the state take responsibility for raising this child?” Swanson said. “Built into our system of beliefs is that the best environment for the child is the family. That whole orientation has served us well through the centuries and still does.”
District 59 officials eventually decided they were willing to fund the educational portion of a residential facility for Timothy, but they wouldn’t pick up the tab for his room, board and out-of-school therapy.
Kathleen said that was fair: The school should not have to pay for problems a kid has when he is not in school.
But over the next months as Timothy’s repertoire of behaviors came to include attacking his family, head banging, and destruction of property, he was hospitalized five times, including two brief stays at Horner.
Soon after he was admitted to Horner, his mother applied for a Department of Mental Health individual-care grant to pay for help for Timothy.
As part of the application, he was evaluated by a team of department specialists that produced dozens of pages of densely worded reports.
State social worker Laurence Lehman noted that Timothy “is quite beyond his mother’s ability to manage . . . and is largely beyond the ability of his special education school to manage.”
“Despite his tough exterior, he manages to also convey a desperate sense of fragility,” psychology extern Thomas Kelly reported.
At Timothy’s weekly family-therapy sessions, “gains have not been obvious,” noted Dr. Stephany Creamer, treatment coordinator at Timothy’s unit at Horner.
After all of the reports had been submitted, Kathleen Keegan received a single-page Mental Health Department form letter on June 26, 1992, notifying her that Timothy’s problems were not severe enough to warrant the state aid.
“A mental illness as defined by the rule was not documented,” the letter said.
In July 1992, Horner officials scheduled a discharge hearing for him.
“Our next step was not to pick him up at the hospital,” his mother said.
The process is called “lockout.” Local and state officials recommend it as often the only way to get care for the thousands of mentally disabled children like Timothy.
If a parent locks a child out of the house or does not pick him up when he is discharged from a state psychiatric facility, he will be put in the temporary custody of the Department of Children and Family Services, then be much more likely to be put into a full-time therapeutic facility, state officials said.
Psychologists and parents say the process can destroy the last fragile bonds of trust between the child and his overwhelmed parents.
“The system is set up to precipitate an enormous family crisis,” said children’s advocate Irene Nelson.
Kathleen Keegan refused to do it. “I don’t think it’s good for Tim to think I would abandon him,” she said.
Nelson brought Dr. Ronald Davidson, a former department official who now works at a mental health advocacy organization, to Timothy’s discharge hearings. He is also known for his extensive contacts in the media.
With the help of Nelson and Davidson, Timothy was able to remain at Horner.
His mother also brought the case to the Residential Services Authority. After deliberating for 5 months, the authority informed her in December that it would not take Timothy’s case because he had a pending conflict with only one agency, the Department of Mental Health.
Keegan was forced to file an administrative complaint against District 59, even though she thought the complaint was unfair, knew it had no legal basis, and “even though I think it’s a waste of Timmy’s time and taxpayers’ money.”
She wrote back to the authority and asked that Timothy’s case be reconsidered. She also reapplied for an individual-care grant. This time, she also informed both agencies that the media was following Timothy’s case.
On Jan. 26, the authority determined that Timothy needed residential care and said the bill for it should be paid primarily by the Mental Health Department, with District 59 picking up the school costs.
And the Mental Health Department, which has maintained Timothy in a locked facility for a year and 2 days despite saying he had no mental illness, suddenly decided that he qualified for a grant.
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Since then, the agencies have trying to secure a long-term residential facility for Timothy.
On a recent evening, he walked alone through a hallway of his Horner dormitory. A pronounced facial tic that he had begun to develop in 1990 has subsided, although his shoulders still twitched convulsively from time to time.
Wearing a rumpled, undersized T-shirt and cotton shorts, he paced in a figure 8, hugging the wall then turning abruptly to retrace his path through the stark, brightly lit hallway of the institution that for nearly a year has been his home of last resort.
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Next: Inside the Henry Horner Center.