When the state sent their 17-year-old daughter 3,000 miles away to a residential facility for troubled youths in Utah last year, Tony and Caroline de Jetley did everything they could to get her back — appealing to the courts and politicians and launching an online social media campaign.

“I fought it tooth and nail,” Tony de Jetley told the Hono­lulu Star-Advertiser.

He says their daughter suffered from a history of sexual trauma and drug use. She began running away from home when she was 12 years old and was eventually locked up at the Hawaii Youth Correctional Facility on Oahu, the state’s only juvenile jail.

There “she was safe, secure and getting her GED,” said de Jetley.

But after running away again during a home visit, Hawaii’s Office of Youth Services, which oversees the correctional facility, decided to send her to Falcon Ridge Ranch, a residential treatment facility for girls in Virgin, Utah.

“It was heart-wrenching,” said de Jetley, thinking of his daughter so far away.

Their daughter, who has since returned to Hawaii, is one of a growing number of youths that the state has been sending out of state to residential treatment facilities that specialize in treating youths diagnosed with serious mental illness, substance abuse issues or behavioral problems that can sometimes get them in trouble with the law.

The youngest has been between 10 and 11 years old, according to Hawaii Department of Health officials who place the youths.

Between 2004 and 2013, the Health Department sent only a handful of youths to the mainland every year for treatment. In 2013, five kids were sent out of state. The number jumped to 22 in the 2014 fiscal year and to 35 in the 2015 fiscal year.

During the first six months of this fiscal year, which began in July, the state has already entered into 47 contracts with mainland facilities. However, health officials say that there could be several contracts for a single youth if they switch facilities, and some contracts may not be fully executed. They didn’t have exact numbers for how many youths have been sent to the mainland so far this year.

“We don’t like doing it, we don’t want to do it,” said Stanton Michels, chief administrator for the Health Department’s Child and Adolescent Mental Health Division. “But sometimes we feel compelled for the benefit of the kids. It’s better to send them to treatment facilities than prison.”

Michels emphasized that the vast majority of youths in their system are able to undergo treatment in state.

Hawaii youths can end up in mainland treatment facilities through several avenues: They can be referred through the Health Department’s Medicaid program, in which case the treatment is voluntary. They can also be referred by the courts or the Office of Youth Services, which oversees the Hawaii Youth Correctional Facility. For kids who are incarcerated, guardianship is transferred to the Office of Youth Services, which was the case for de Jetley’s daughter.

Daniel Ulrich, the Child and Adolescent Mental Health Division’s medical director, said that sending youths to the mainland is a last resort, when all local treatment options have been exhausted. Usually the cases are severe.

But critics say that more needs to be done to develop the support services locally — something officials from the Health Department and the Office of Youth Services are already exploring.

Unintended consequences

In 2014, the Legislature passed progressive legislation designed to limit the population at the Hawaii Youth Correctional Facility to adolescents who had committed serious crimes and who posed a risk to public safety. The juvenile justice legislation was widely supported by Family Court judges, policymakers and lawmakers. Act 201 unanimously passed the Legislature and was signed into law by Gov. Neil Abercrombie.

Policymakers found that locking kids up for minor offenses did little to help youths who really needed treatment for trauma, mental illness or drug addiction.

The measure has been successful in reducing the number of youths at the correctional facility — the inmate population has fallen to under 20 kids, down from about 80 to 90 a few years ago, said Ulrich.

However, health officials worry the decline in youths being sent to the correctional facility is driving up the number of youths needing to be sent to secure treatment facilities on the mainland. Hawaii lacks such a facility.

“That’s the theory,” said Michels, who cautioned that health officials are still scrutinizing the data.

Hawaii has contracted with facilities in states throughout the mainland, including Utah, North Carolina, Texas, Michigan, Minnesota, Arizona, Tennessee, Indiana, Montana, Oregon, Arkansas, Illinois and Pennsylvania, according to state procurement data.

The facilities vary in their level of security. For instance, the Capstone Academy in Detroit is a high-security facility where youths can be subject to physical restraints and seclusion, according to the facility’s program manual. Other facilities don’t allow patients with serious behavioral problems and bill themselves more as therapeutic retreats.

Lax government oversight alleged

Private, for-profit treatment facilities, which began to multiply in the 1990s, have been controversial.

They offer an alternative to youth incarceration and give parents struggling to find help for severely disturbed children an option of intensive, around-the-clock care. However, mental health advocates worry about the lack of government oversight.

In 2007, a report by the U.S. Government Accountability Office found thousands of allegations of abuse at residential treatment facilities throughout the country dating from 1990, some of which led to the death of patients. Further investigation also found instances of untrained staff, ineffective management and deceptive marketing.

Regulation of the industry is also uneven. States “have taken a variety of approaches ranging from statutory regulations that require licensing to no oversight,” according to the GAO investigation, which also found that there were no federal laws that defined or regulated the programs.

Eight years later, Mental Health America, a national advocacy group, says those same concerns persist.

MHA “believes that despite improvements, deficiencies in residential facilities for children with mental health conditions are widespread, that the recent growth of non-community-based, for-profit programs is a matter of serious concern, and that urgent action is needed to address issues of quality of care in residential treatment facilities,” according to a policy statement issued this year.

Locally, a shortage of facilities

Marya Grambs, executive director of Mental Health America’s Hawaii chapter, emphasized the added hardship for Hawaii families that have to deal with the extreme geographic separation from their children.

“There are certain facilities that we just don’t have for adolescents. It is kind of unconscionable that we don’t have them,” she said. “How can the state not have space for mentally ill kids?”

Merton Chinen, executive director of the Office of Youth Services, agrees that more services are needed locally. He said his office has started looking into creating a separate residential facility on the correctional facility’s campus.

“When there are youth that have many different needs and complex disorders, we have found that we really do need to create something here that would address that,” he said. “It makes a lot of sense to keep them here so we can work with their families, which is a critical part of treatment.”

As for Tony de Jetley, he says he’s still angry with the state.

While at Falcon Ridge Academy, he said, his daughter developed Stevens-Johnson syndrome, a potentially lethal condition, in reaction to a drug the facility prescribed. He said she ended up in intensive care, but the facility never notified him or his wife. They only learned about it later in a Facebook message from their daughter.

Falcon Ridge Ranch did not respond to requests to comment on the allegations.