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Why is Children's Mental Health Important?
Much attention is directed toward the fact that many children are having
difficulties in school and at home, from emotional and behavioral outbursts,
violence and crime, alcohol or other drug abuse, and family discord. There
are also concerns by families who suffer through the frustration of missing
work to meet with teachers, continual behavioral problems at home, and parents
concerned that their children are not getting the attention they need because
educators are dealing with other children with emotional and behavioral problems.
Nationwide, it is estimated that six to nine million children and adolescents
are not getting the help they need (Stephenson, 2000, October 25). Without
care, mental health problems in children can lead to more serious mental
disorders, involvement with the juvenile justice system, loss of custody
or placement outside the home, parental frustration, and other destructive
behaviors, including violence toward others and suicide.
On May 21, 2000, the Austin American-Statesman printed a headline, A
child dies. A family mourns. And a question echoes in the sadness: Who
failed Caitlin? The article outlined some chilling questions asked
by a mother after the suicide of her sixth grade daughter. What if the
parents had done something different? What if mental health professionals
knew more about dealing with children? What if the managed care process
had not been as complicated? What if the school system had done more?
In the end, Caitlin's mother said, "If I was going to blame Caitlin's death
on something, I would blame it on stigma associated with mental illness.
It kept me from being willing to look at what was really going on with
her" (Bonnin, 2000).
Children's mental health must be addressed because (Children's Partnership,
2000):
- Twenty percent of children will need mental health care services during
their life.
- Ten percent of children will suffer from serious emotional disturbances.
- Research shows that two-thirds of children do not receive the care
they need.
- In 1998, Travis County had a 1.0 suicide rate per 100,000 between
the ages of 5-14. In this age group, 14 children and adolescents committed
suicide (Epigram TX).
Children's mental health is important as a cross-cutting issue that impacts
the Community Action Network issue areas. Many of these issues are reviewed
in the Adult Mental Health section of this report. The following issues are
more specific to children's mental health and further reveal the importance
of this issue area for our community.
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Basic Needs
The Community Action Network's Basic Needs Report defines basic needs
as "emergency
food, clothing and housing (rent, mortgage, utility) assistance." (Community
Action Network [CAN], 1999, August). The report indicates that Travis County's
economic growth has continued strongly yet the need for basic needs assistance
has not gone away. According to the Census Bureau estimates released in
1999, 12.9 percent of Travis County population lived at or below the poverty
level
in 1995. This translates to approximately 87,177 residents of Travis County
living below the federal poverty income guideline ($16,700/year for a family
of four).
According to the State Data Center population estimates for 1999 in Travis
County, almost 20 percent (Table 7-17) of children and adolescents live at
or below the U.S. poverty standard.
Due to the high cost of living, many of the area wage earners can be classified
as "working poor" because their wages fail to cover the basics of housing,
childcare, food, and health care. The upward economic trends show no signs
of leveling. This will continue to raise the cost of living and further widen
the gap between poor and wealthy. Race, socio-economic status, and social
class will continue to be factors in improved health and social well being.
In an Austin American-Statesman's editorial article on January 6, 2000, Elliot
Naishtat, Democratic state representative, wrote, "People who are poor struggle
to meet basic needs" (Naishtat, 2000, January 6).
The Austin Travis County Mental Health Mental Retardation Center,
the largest provider in the Travis County area that provides services
to children and adolescents with severe and persistent mental illness,
reports serving 543 children in the priority population. The Texas
Department of Mental Health Mental Retardation defines priority population
for mental health services as:
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"Over 90% of the children served
with mental illness by the Austin Travis County Mental Health Mental
Retardation Center live below the federal poverty income guideline."
- Austin Travis County Mental
Health Mental Retardation Center
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Children and adolescents under the age of 18 years with a diagnosis of mental
illness who exhibit serious emotional, behavioral, and mental disorders and
who have a serious functional impairment; or are at risk of disruption of
a preferred living or child care environment due to psychiatric symptoms;
or are enrolled in a school system's special education program because of
a serious emotional disturbance. Almost 80 percent of the children and adolescents
are in families that make less than $16,000 (see Table 7-18) a year and it
is estimated that over 90 percent live below the federal poverty income guideline
level.
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Children and Adolescents and the
Juvenile Justice System
In Texas, there is a growing awareness that a significant percentage of
youth in the juvenile justice system have mental health needs. Media attention,
in Texas and across the country, during the past year has sharpened public
interest. Nationally, studies indicate that most youth in the juvenile system
have at least one diagnosis (conduct disorder being most prevalent) while
at least 20 percent have serious mental health disorders (L. Southern, personal
communication, November 14, 2000). Data indicates that 35 percent of those
receiving community services in Texas in fiscal year 1999 had involvement
in the juvenile system or were considered at high risk of involvement based
on specific risk factors versus 20 percent of youth in other states. Interviews
and surveys of local probation officers indicate referrals for mental health
treatment for juveniles is at an all time high and steadily rising. Increasing
numbers of referrals for mental health services have strained the system.
Parents of adolescents with serious emotional, behavioral or mental problems
report that, at times, it has been recommended to them to have their children
charged with criminal offenses in order to access court ordered care (L.
Southern, personal communication, November 14, 2000).
Critical issues common to Texas and other states were identified in a state
report (L. Southern, personal communication, November 14, 2000):
- Recent laws are emphasizing prosecution of juveniles as adults even
though the 1999 report of the Coalition of Juvenile Justice to Congress
indicated that rehabilitation programs are more successful than severe
punishment.
- Financial resources that cover mental health treatment are limited
because many children are uninsured and the Texas Department of Mental
Health Mental
Retardation's contracted children services do not meet demand.
- Treatment availability for youth with emotional and mental disorders
is limited. Screening for mental health problems in the juvenile
justice system is lacking, as are community-based intensive treatments
and support
options. These deficits result in an over-reliance on residential
treatment, prevention activities, continuity of care system, and specific
cross training
to mental health and juvenile justice professionals.
- Collaboration between the mental health and juvenile justice systems
is problematic due to different missions, the mental health system's
limited legal authority to mandate treatment, lack of shared responsibility,
varying
philosophy regarding parental involvement, integrated funding, and
lack of best practices guidelines.
Young offenders with mental health disorders bring a unique set of challenges
into the justice system. Continued collaboration between juvenile justice
authorities, mental health professionals, public agencies, families, and
advocates is needed. National Community Mental Health Services for Children
and their Families, including the SAMHSA site in Travis County, provide research
to determine the nature and prevalence of mental health and substance abuse
disorders among youth in the juvenile system (Faenzo and Seigfried, 1998,
October/November).
In Travis County, the Juvenile Probation Department Substance Abuse Services
Division provides screening, assessment, and treatment of juveniles with
substance abuse problems. As Table 7-19 reflects, there is a growing number
of youth being referred with mental health issues. The number of referrals
has nearly doubled between 1999 and 2000.
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Parents Relinquishing Custody of their
Children with Mental Illness
The tragic story of parents relinquishing custody of their children with
mental illness is becoming a common occurrence. Parents of children with
physical ailments would never consider giving up custody of their children
in order to get appropriate health care. However, many parents of children
with mental disorders are left with the only choice of seeking appropriate
mental health treatment by relinquishing custody. The reason stems from limited
healthcare plans inadequately covering mental health treatment and there
are misunderstandings about federal special education and child welfare laws.
Many parents discover treatment is needed only after their child enters the
child welfare or juvenile justice systems. The Brazelon Center for Mental
Health Law recommends the following (Giliberti and Schulzinger, 2000):
- Federal entitlements need to be clarified and enforced.
- Medicaid eligibility needs to be expanded to include a full array
of services.
- Legislative action to prevent custody relinquishment.
- A comprehensive mental health system of care is functioning in
the community.
Travis County must examine the tragedy of parents who face the decision
of relinquishing custody of their children in order to obtain appropriate
treatment. Continued research is recommended to determine the depth
and scope of this issue in Travis County.
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"Lindy has dual diagnoses: serious
emotional disturbance and developmental disabilities. The only
appropriate facility in her area refuses to accept Medicaid payment,
and will only take private payment at $99.25 per day or a state
allotment for child welfare children. Her mother, Perri J., has
been told to file a 'willful neglect and abandonment' petition
with the juvenile court to have Lindy placed at an appropriate
facility. Perri doesn't want to give up custody of Lindy, but doesn't
know where else to turn."
-Brazelon Center for Mental Health
Law
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Co-occurring Mental Health Disorders and
Substance Abuse
Comorbid mental and addictive disorders are especially challenging with
children and adolescents. Alan Leshner, Director The National Institute
on Drug Abuse states, "There is a unique disconnect between the scientific facts
and the public's perception about mental and addictive disorders -- a big
difference between reality and perception" (About The Human Internet, 1998).
These co-occurring disorders complicate the treatment process. It is often
difficult to diagnosis the disorders because it takes time to separate one
from the other. In addition, traditional treatment often focuses on one disorder
or the other but seldom recognizes the "interacting effects" one has on
the other (Hatfield, 1993).
The highest rates of co-occurring substance abuse and mental disorders in
youth are in the 15 to 24 year-old age group (USDHHS, 1999). Children and
adolescents diagnosed with conduct problems, oppositional-defiant disorder,
and attention deficit/hyperactivity disorder appear to be at special risk.
Children and adolescents often do not begin abusing substances until after
the onset of a mental disorder (USDHHS, 2000).
The outlook on treating co-occurring mental health and substance abuse
disorders is improving. Dual-diagnosis programs that address both issues
are increasing
and are identified as "best practice" programs (USDHHS, 2000).
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Description of Children's Mental Health Home
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Children's Mental Health Home Page
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