April 1st, 2013

Report: Mental health care for children lacking

According to a government report, requested by U.S. Sen. Tom Harkin (D-Iowa), Rep. Rosa DeLauro (D-Conn.), and Rep. Lucille Roybal-Allard (D-Calif.), children’s mental health care is lacking and several issues must be addressed.

The findings of the Government Accountability Office (GAO), a nonpartisan “watchdog” agency of the U.S. Congress, include:

  • Eighteen percent of foster children were taking psychotropic medications – including 48 percent of foster children who lived in group homes or residential treatment centers – as compared to 6.2 percent of non-institutionalized children in Medicaid nation-wide and 4.8 percent of privately insured children.
  • Thirty percent of foster children who may have needed mental health services did not receive them in the previous 12 months. Outside of foster care most children whose emotions or behavior indicated a potential need for a mental health service did not receive any services within the same year.
  • Many children who took psychotropic medication did not receive other mental health services (such as psychosocial therapy or counseling), despite the fact that experts find that medication alone is rarely adequate treatment for children with complex mental health needs.
  • GAO recommended in 2011 that the Centers for Medicare and Medicaid (CMS) identify options for collecting data from state Medicaid programs about whether children in Medicaid receive the services for which they are referred. Findings in this report underscore the continued importance of CMS’s monitoring of children’s receipt of mental health services and the need for continued research in this area.

“Clearly we must do a better job ensuring that all children have access to comprehensive mental health care,” DeLauro says. “The needs of kids in Medicaid and foster care are every bit as urgent as their peers and we cannot allow them to fall through the cracks.”

DeLauro says she found it troubling that there is not even the necessary data to evaluate some of the important questions GAO is trying to answer.

“Congress must do better and I will continue to work with my colleagues to make sure we are addressing the health concerns of all our children,” she says.

Edward Schork Ph.D., a child, adolescent and family psychologist in Greenwich, Conn., says the country’s mental health system is seriously underserved in regard to children in general and not just what has been reported by the GAO.

“Among all American youth, psychological disorders in childhood and adolescence are highly prevalent, substantially under-diagnosed, and seriously under treated,” Schork says.

For example, he refers to the recent National Health and Nutrition Examination Survey study by the Centers for Disease Control that documented that 13 percent of 3,042 American children between the ages of eight and 15 years had a diagnosable DSM-IV psychological disorder during the previous 12 months.

“And only half of these children had been taken to a mental health professional for treatment,” he says.

“These findings are gravely concerning from the viewpoint of children’s and families’ current suffering and disruption, lost potential in the child’s eventual development and lost opportunity to intervene before youth problems lead to serious adult disorders and dysfunction,” Schork says.

He says more research and programmatic initiatives are needed in the areas of primary prevention, early intervention and overcoming obstacles to accessing and providing services to children.

Obstacles include under-identification and under-referral by schools, agencies and families; shrinking child clinician reimbursement by private and public insurances; failure of the CPT system to reimburse non-M.D. child clinicians for time spent on consultative visits and phone work with school and other health care professionals; and the fact that disturbed youth frequently “slip through the cracks” or whose families have a difficult time accessing, paying for or getting legal standing to commit their child to residential treatments.

By Greg Hitchcock

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