The Bazelon Center for Mental Health Law

February 2007—Each year, thousands of parents are forced to relinquish their custody rights to the state in order to obtain mental health care for their children. Services to treat severe mental disorders in children can be extremely expensive and private insurance tends to run out after a few months, leaving even middle-class parents unable to afford the cost. Yet affected children are often ineligible for Medicaid because of their parents’ income and assets.

With no other way to get treatment for their children, parents are forced to choose between custody or care. The Government Accountability Office has reported that, in 2001, parents in 19 states placed 12,700 children in state welfare or juvenile justice agencies in order to obtain mental health services for them. That estimate is considered low, because 31 states did not respond to the survey. The Keeping Families Together Act as reintroduced in the 110th Congress seeks to keep these children with their families and includes two main components:

1) Family Support Grants to States

The KFTA would authorize $100 million in competitive grants to states, payable over six years, to create an infrastructure to support and sustain statewide systems of care to serve children who are in custody or at risk of entering custody of the state for the purpose of receiving mental health services. These grants would help states serve these children more effectively and efficiently while keeping them at home with their families.

The Family Support Grants could be used to:

• Foster interagency cooperation and cross-system financing among the various state agencies with responsibilities for serving children with mental health needs. This would help to eliminate fragmentation of services and would increase the capacity of agencies to share public resources. States already dedicate significant dollars to serving children in state custody, and KFTA grants would enable them to use those resources more effectively while still allowing children to remain with their families.

• Provide a comprehensive array of community-based mental health and family-support services for eligible children and their families that will be sustainable after the grant has expired.

• Facilitate the design of a state plan through a collaborative process involving state child-serving agencies, parents, providers and other stakeholders.

• Provide outreach and public education programs to increase awareness about the services available to eligible children and their families.

• Carry out administrative functions related to the programs and activities operated under the grant, including the development and maintenance of data systems.

KFTA would require states to provide matching funds over the six-year period of the program, ultimately equaling not less than $2 for each $1 of federal funds provided under the grant. States would also be required to report annually, beginning with the second fiscal year of funding under the grant, on the progress and success of the programs and activities. Not later than six years after the date of enactment, a final report to Congress would be required, evaluating states’ success in using the grants to eliminate the problem of custody relinquishment.

2) Federal Interagency Task Force

KFTA would require creation of a federal interagency task force, including the Substance Abuse and Mental Health Services Administration (SAMHSA), of the Office of Juvenile Justice and Delinquency Prevention, the Administration for Children and Families, the Centers for Medicare & Medicaid Services and the Office of Special Education, to examine mental health issues in the child welfare and juvenile justice systems and the role of these agencies in promoting access by children and youth to needed mental health services. The task force would also be charged with monitoring the family support grants, making recommendations to Congress on how to improve mental health services, fostering interagency cooperation and removing the interagency barriers that now contribute to the problem of custody relinquishment.