Discussion: Issues with Young Children

Building a World-Class Mental Health Care System for America

This is an exciting time for mental health in America. The scientific revolution in men- tal health over the past 25 years has given us a deeper understanding of the brain and its effect on human behavior and develop- ment. This research has established once and for all that mental health is an inseparable part of overall physical health and well- being. Thanks to the hard work of mental health professionals such as psychologists, we have many more innovative treatments and services that work.

Our progress in research and treatment is complemented by significant advancements in mental health policy. Just over the past few years alone, we have seen greater in- vestments in state and community mental health services and the publication of the landmark Surgeon General's Report on Mental Health—the most comprehensive review of mental health ever produced. We have seen significant progress on mental health parity: National mental health parity legislation was signed into law; more than 30 states have adopted parity laws; and more and more forward-thinking employ- ers, including the nation's largest employer, the federal government, are beginning to pro- vide parity for their employees. In addition, we are seeing steady changes in (he public's perception and acceptance of mental health.

However, even with all of this progress, our work is far from over. Recent school shootings and other acts of violence have sounded a wake-up call to the nation about the mental health needs of our children. Con- sider this fact: Of the one in five children with a diagnosable mental disorder, less than one third actually receive services. We have to address the severe shortage of children's mental health services and mental health professionals that is facing too many of our communities, confront insurance discrimi- nation, and support parents who are strug-

gling to meet the mental health needs of their children.

As 1 travel around the country, one of the greatest frustrations I hear from parents is that they cannot find the kind of services their children need. Al and I once met a mother in our home state of Tennessee who was forced to give up custody of her daugh- ter to the state when her insurance coverage ran out. This is a horrible dilemma facing too many parents with sick children. For many rural communities and isolated urban communities, treatment and services are sim- ply not available, and other communities are experiencing a severe shortage in specialized services for children and adolescents. We, as adults, must better serve our children.

Thus, if we are serious about giving our children a good start in life, we have to in- vest in community mental health services. We must expand programs such as the Na- tional Health Service Corps that bring men- tal health professionals to underserved com- munities, and we must find creative ways to attract more people to mental health pro- fessions and specialties that serve high-need communities in a culturally sensitive man- ner. In addition, we need to make greater use of the Internet and advanced technology to deliver mental health services. And, as we expand access to treatment and services, we must ensure that our nation's mental health system reflects our diversity and responds to the needs of all our people.

Schools have become one of the largest providers of mental health services to chil- dren. However, many of our schools do not have enough resources or support to meet this demand. School counselors, with long waiting lists of kids who need help, are over- worked and often cut off from the wider mental health community. Furthermore, teachers need more training to spot children in trouble and get them help early.

That is why I believe we need to put more mental health professionals in schools, give teachers and school staff training to recog- nize the warning signs of mental illness and behavioral problems, and build stronger re- lationships between schools and community mental health and social service providers. I am proud that the Administration's Safe Schools/Healthy Students initiative has helped communities create comprehensive school safety and children's health strate- gies involving everyone—from schools and parents to law enforcement and the local mental health system. We need to expand this initiative and encourage communities all across the country to adapt model strate- gies to their own needs. Preliminary find- ings from a Yale University School of Medi- cine study showed a significant increase in the number of children admitted to hospital emergency departments because of a psychiatric-related emergency (Harby, K. [2000, May 17]. Childhood psychiatric emer- gencies on the rise. Reuters Health News- wire. Report on a study by Yale University School of Medicine pediatric emergency specialist Dr. K. Santucci). I also believe the mental health professional community such as psychologists, social workers, and other counselors should find creative ways to sup- port the schools and families in (heir com- munity. This could mean creating support systems for school counselors and teachers, involving graduate students in community programs, asking the business community to get involved, or creating stronger links between researchers and community-based providers. These steps would help fill the gaps and deliver quality services to children and families in need.

As we continue to address the acute short- age of children's mental health profession- als, services, and emergency bed space, we must also address the enduring problem of discrimination against mental illness by many of our nation's health plans. This bla- tant form of discrimination denies people the treatment they need and the coverage they deserve to remain healthy. Several stud- ies and surveys show that the cost of men- tal health parity is minimal while the ben-

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468 NEWS FROM WASHINGTON, DC

efits to people are just and humane. We need

to build on the progress we have made on

parity by guaranteeing health coverage and

mental health parity for every child in

America. We cannot fail to meet the chal-

lenge of ensuring that mental illness and

physical illness are treated equally by every

health plan for everyone in America.

I am always moved by the struggle facing

the parents of children with mental illness.

Imagine their emotional pain as they face

the challenge of raising their kids with so

little support. With conditions such as au-

tism, schizophrenia, bipolar disorder, and

depression, it is often difficult to get an ac-

curate diagnosis, and once you have a diag-

nosis, many unanswered questions remain

about appropriate treatments and medica-

tion. All of these parents struggle with the

financial and time burdens of caring for chil-

dren with special needs.

One of the greatest challenges facing these

parents is helping their children get the treat-

ment they need while holding down a job to

make ends meet. These mothers and fathers

often have to take time off from work to

take their children to appointments, attend

parental and family therapy sessions, re-

spond to emergencies at school, or support

their children through a crisis. Not being there

for their children not only could hurt their

children's recovery and development, but in

some cases the parents can be cited for ne-

glect as well. When children need hospital-

ization, another element of stress is added

to family life.

Unfortunately, many of these parents find

themselves unable to take time out of their

workday, whereas many others are forced

to choose between helping their children and

keeping their jobs. No parent should ever

have to make this difficult decision. Several

years ago, I founded a child and family ad-

vocacy organization called Tennessee Voices

for Children, which hears from parents all

across the state who are facing these diffi-

culties. One mother moving from welfare

to work was raising a son with bipolar dis-

order. She was often called to school to

address her son's behavior in class. Her em-

ployers did not have flexible leave policies,

and she was ultimately fired from her job.

She lost four jobs in 2 years and eventually

returned to welfare.

Does it not make more sense to support

her as she cares for her child and goes to

work? Although there are many parents who

face this stark reality, there are many em-

ployers who are working to find creative

and reasonable solutions that help employ-

ees balance their responsibilities at home

and at work. Tennessee Voices for Children

worked with one family with a teenage son

who had just returned from a residential

treatment program. The mother could not

leave her son at home alone and decided to

bring him to work after school. This ar-

rangement soon proved difficult for her son

and her employer, and the mother feared

she would lose herjob. With mediation, the

employer agreed to allow the mother to leave

work in the early afternoon, take her son

home, and finish her day's work using a

company computer from home. In another

case, the father of a child threatening sui-

cide was able to create a flexible work sched-

ule with his employer. While his wife

worked during the day, the father stayed at

home to be with their son. In the evening,

after the mother came home, the father went

into work for a few hours in the evening to

keep up with any pressing matters. It was

not easy, but it worked.

We need more of these kinds of flexible

arrangements. We need to help employers

better understand the needs of parents of

children with mental illness and help parents

and employers understand how our nation's

family leave laws apply to mental illness

just as they apply to other illnesses.

Because of the limits in private health care

plans and public mental health services, some

parents of children with severe menial il l-

ness face an even more difficult decision—

whether to give up custody of their children

so they can get the intensive services they

need.

Consider the dilemma of this typical par-

ent. A mother has a daughter with severe

attention deficit hyperactivily disorder who

has been causing problems at school. Over

time, the daughter's disruptive behavior es-

calates, and she has several stays in psychi-

atric hospitals. Each time her daughter is

hospitalized, the mother is told that no men-

tal health services are available in her com-

munity. Desperate, the mother turns to the

child welfare system and gives up custody

of her daughter in hopes that her daughter

will finally get treatment (Bazelon Center

for Mental Health Law. [2000, March]. Re-

linquishing Custody, p. 10).

No parent should have to choose between

custody and care. That is why we must work

aggressively to find commonsense solutions

that help these families stay together and get

the services they need.

In this period of unprecedented prosper-

ity, now is the time for us to work together

and find lasting solutions that create the kind

of world-class mental health care system that

helps people live up to their fullest poten-

tial. It is good for our families. It is good for

our communities. And, it is the right thing

to do.

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