The Bazelon Mental Health Policy Reporter

Volume II : Issue 3 : May 9, 2003

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In This Issue:

New Studies Find Children with Disabilities at Increased Risk

Newsbytes:

• Proposal Threatens Access to Housing
• House Passes Special Education Bill
• Senate Confirms Sutton Nomination
• States Underutilize Children’s Mental Health, Substance Abuse Screening Tools
  

New Publications from the Bazelon Center

New Studies Find Children with Disabilities at Increased Risk

Two new government studies point to serious failings in systems serving children with mental or emotional disorders— failings that are tearing families apart and putting children at risk.

Neither the juvenile justice nor the child welfare system is designed to address children’s mental health needs. Yet increasing numbers of children with mental or emotional disorders end up there.
In a report released last month, the US General Accounting Office (GAO) documented at least 12,700 cases in fiscal year 2001 of children placed in child welfare and juvenile justice systems so they could access needed mental health services.

Such placements are devastating to families. Children with mental health needs face the added stress of being displaced and feeling abandoned. Meanwhile, parents have to give up their say about key aspects of their children’s lives, sometimes even losing track of where their children are living.

The GAO identified several factors that influence parents’ decisions to relinquish custody:

• Gaps in and limits on mental health coverage—Some mental illnesses are not covered and families often face limits on the intensity or duration of care that private insurers will pay for. Medicaid, the main public funder of child mental health services, covers a limited number of children who could benefit from mental health services. Both public systems and private insurers often fail to cover the intensive community-based services that could reduce a child’s need for more expensive residential treatment.

• Limited child mental health resources—Parents may be encouraged to take drastic measures to make their children a priority for scarce mental health resources.

• Lack of coordination—Eligibility requirements for services often differ from agency to agency, making it difficult for children to obtain coordinated care. According to the GAO, some service providers and officials have also “misunderstood the role of their own and other agencies” and have given parents incomplete or inaccurate information, creating service gaps for children with mental health needs.
Approximately 3,700 children were placed in child welfare systems, according to the GAO. The report found that another 9,000 were “placed” in the juvenile justice system by police who had detained children—sometimes at parents’ request—for delinquent behaviors that stemmed from or were related to their mental or emotional disorders.

The GAO’s findings may be just the tip of the iceberg. Data on custody relinquishment are not generally tracked and officials in 32 states—including the five with the highest child populations—did not respond to the agency’s request for data on custody relinquishment.

A report by the National Council on Disability (NCD) released last week also found reason for concern. NCD found that failings in systems serving children with mental disabilities, particularly in schools, are leading to placement of an increasing number of children in the juvenile justice system. Advocates fear that this exposure may put children at risk of involvement with the criminal justice system later in life.

The Bazelon Center believes that these disturbing trends can only be addressed with a coordinated effort between states and the federal government aimed at removing barriers to needed mental healthcare for children.

Fortunately, there are signs of hope in the U.S. Capitol. Principled leaders from both parties are working to enact legislation to address the sad state of America’s systems of care for children with mental and emotional disorders.

The Family Opportunity Act (S. 622 and H.R. 1811) has been reintroduced by Senators Charles Grassley (R-IA) and Edward Kennedy (D-MA) in the Senate and Representative Pete Sessions (R-TX) in the House. The bill would reduce the need for parents to seek services through the child welfare and juvenile justice systems by increasing the number of families eligible to receive Medicaid’s comprehensive mental health benefits

Along with Senator Pete Domenici (R-NM), Senator Kennedy is also working to enact mental health parity legislation so private insurers could not deny access to needed services because of stigma and discrimination. Senator Susan Collins (R-ME) and Representatives Patrick Kennedy (D-RI) and Pete Stark (D-CA) have also committed to lead efforts to improve America’s child mental health system.

Let’s hope the lawmakers are successful. Too many children with mental or emotional disorders and their families have suffered too long for the system’s failures.

NewsBytes

Proposal Threatens Access to Housing
People with disabilities suffer the highest level of unmet need for federal housing assistance of any eligible population—a trend that could be exacerbated if a proposal backed by the Bush Administration is enacted. Congress has before it legislation that advocates fear could reduce access to affordable housing for people with disabilities. Modeled after the 1996 “welfare reform” law, H.R. 1841 and S. 947 would establish the Housing Assistance for Needy Families (HANF) program. The program would convert the existing Section 8 housing voucher program into a block grant to states. Currently, housing authorities are subject to federal guidance that requires them to provide a certain percentage of housing assistance to people with disabilities. The proposed legislation would eliminate this guidance, leaving people with disabilities at the mercy of housing authorities, which, in the past, have favored assistance to other populations over helping people with disabilities.

• Advocates can register their opposition to the legislation by contacting Senator Wayne Allard (R-CO), Chairman, Subcommittee on Housing and Transportation: 202-224-5941 and Representative Bob Ney (R-OH), Chairman, Subcommittee on Housing and Community Opportunity: 202-226-3463
• Read H.R. 1841 online

House Passes Special Education Bill
The House of Representatives last week reauthorized the Individuals with Disabilities Education Act (IDEA), including provisions that could threaten access to free and appropriate education for children with mental and emotional disorders. H.R. 1350, "The Improving Education Results for Children with Disabilities Act," was approved 251 to 171. The Bazelon Center blasted the vote as “a giant step backward for children with mental and emotional disorders.” The Senate is expected to introduce IDEA legislation soon.

• Read the Bazelon Center press release on passage of H. R. 1350
  

Senate Confirms Sutton Nomination
Despite strong opposition from advocates for the rights of people with disabilities, on April 29, the Senate confirmed Jeffrey S. Sutton to be U.S. Circuit Judge for the Sixth Circuit. In court and in legal writings, the Ohio lawyer has consistently argued to limit the scope and enforcement of the Americans with Disabilities Act and other civil rights laws. His nomination was approved 52-41 with seven Senators not voting.

• Find out how your senators voted on the Sutton nomination

States Underutilize Children’s Mental Health, Substance Abuse Screening Tools
The first study to assess behavioral health screening tool policies in the Medicaid programs of all 50 states found that many states are failing to adopt the most effective policies under their Medicaid programs to identify mental health or substance abuse problems in children. The study, conducted by the Bazelon Center for Mental Health Law, found that nearly half of the states do not have Medicaid policies in place to identify children with mental health and substance abuse issues. The study is published in the May issue of Psychiatric Services journal.

• Read more about the study
• Psychiatric Services website
  

New Publications

Power in Planning: Self Determination through Psychiatric Advance Directives
This pocket folder, released in March 2003, builds on the Bazelon Center's earlier work regarding advance psychiatric directives, assessing the utility of advance directives generally and the Bazelon Center's forms to prepare a psychiatric advance directive in particular.

No One’s Priority: The Plight of Children with Serious Mental Disorders in Medicaid Systems
This new report from the Bazelon Center examines parents' experiences in attempting to access mental health services for their Medicaid-eligible children.

Building Bridges: An Act to Reduce Recidivism by Improving Access to Benefits for Individuals with Psychiatric Disabilities upon Release from Incarceration
As the number of people with psychiatric disabilities in jails and prisons continues to rise, prison officials, state lawmakers and mental health advocates have become increasingly concerned about the effect of this trend on inmates, staff and state budgets. Building Bridges offers states a strategy to reduce recidivism and help recently released inmates with psychiatric disabilities successfully transition to community life.