NAMI E-News April 21, 2003 Vol.03-21
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Federal Report Confirms NAMI Call to Action to Help "Families on the Brink"
Arlington, VA - In a report to three leading Members of Congress, the
General Accounting Office (GAO) has confirmed that states and counties force
parents to give up custody of tens of thousands of children and adolescents
with mental illnesses (biologically-based brain disorders) in order to secure
necessary treatment-even though child welfare and juvenile justice systems are
not primarily designed to provide mental healthcare.
The report supports the landmark study Families on the Brink: The Impact of
Ignoring Children with Serious Mental Illness, published in 1999 by the
National Alliance for the Mentally Ill (NAMI), in which 20% of families
surveyed reported having to give up custody of children to the state in
exchange for adequate treatment.
The GAO report comes in response to the leadership of three key Members of
Congress pressing for closer scrutiny and reform of a system in shambles: U.S.
Senator Susan Collins (R-Maine) and U.S. Representatives Pete Stark (D-
California) and Patrick Kennedy (D-Rhode Island).
"Every parent in America should be grateful to Senator Collins and
Representatives Stark and Kennedy for insisting on this very important, first
federal look at a system that forces families to be torn apart in order to get
the help they need," said Darcy Gruttadaro, national director of NAMI's Child
& Adolescent Action Center.
"Mental illness may strike any family. No one is immune. It is not the fault
of either the parents or the child. No parent should ever have to confront
this kind of choice."
Based on estimates provided by 12 states and 32 counties, the GAO found that
more than 12,700 children were placed in the child welfare or juvenile justice
systems in 2001 for mental health treatment-even though none had been abused
or neglected or committed a delinquent act-because necessary services were not
available in their home communities.
Parents from all financial levels may be forced to make the heart-wrenching
decision to give up parental rights in exchange for help, but the federal
government picks up most of the tab for residential care for children from
low- income families. In many cases, the cost runs as high as $250,000 per
year for a single child.
No formal or comprehensive federal or state system exists to track these
custody relinquishments, In fact, the GAO report admits that figures available
from 2001 understate the problem. Of the states from which the GAO could not
obtain estimates, five have the greatest populations of children in the
nation.
Of those states that did provide estimates, Michigan, Connecticut, Montana,
Washington and Rhode Island reported the most children placed into the child
welfare system-with numbers ranging from 425 to 1100. Counties reporting the
highest estimates of children placed in the juvenile justice system were Pima,
Arizona; Miami-Dade, Florida; Middlesex, New Jersey; Prince William, Virginia;
Lake, Indiana; and Philadelphia, Pennsylvania-with numbers ranging from 500 to
1,750.
"Most child welfare and juvenile justice workers are not trained to understand
or handle healthcare for children and teens with mental illnesses," Gruttadaro
said. "Even worse, the juvenile justice system is hardly a therapeutic
environment. In fact, that kind of environment often makes mental illnesses
worse."
"The tragic reality is that as a nation we abandon and neglect families with
children with mental illnesses-driving them into the wrong systems. Those
systems that do exist to serve children and adolescents with mental illnesses
struggle with inadequate funding or budget cuts. They are fragmented and
overly bureaucratic. Families in crisis are left on their own to navigate
multiple, complex systems that do not work well."
"The system is not family-friendly. It overwhelms families who often require
immediate, intensive assistance. As the GAO report indicates, living with a
child with a serious mental illness without appropriate treatment or services-
without any support-strains a family’s ability to function," Gruttadaro said.
NAMI families long have raised concerns underscored by the report:
*Teachers often do not understand basic facts about mental illnesses and are
unprepared to teach children with them effectively. School officials often
blame parents for a child’s mental illness and fail to follow federal
standards for special education.
*Numerous barriers to treatment and services exist: discriminatory caps on
mental health insurance coverage, lack of qualification for Medicaid, and a
profound shortage of mental health specialists for children.
In response to the GAO report, NAMI specified legislation pending in Congress
which can make a difference in reversing the "moral, economic and political
scandal" of child custody relinquishment-as well as provisions in one bill
that threaten to make it worse.
*The Paul Wellstone Mental Health Equitable Treatment Act of 2003 (S. 486 and
H.R. 953) - to end insurance discrimination in health insurance against
children and adults with mental illnesses.
*The Family Opportunity Act of 2003 (S. 622) - to allow states to expand
Medicaid coverage to low and middle-income families, which are the ones most
often forced to give up custody of children to states in exchange for
treatment.
*The Child Healthcare Crisis Relief Act (H.R. 1359) - to address the national
shortage of children's mental health specialists.
*Revisions to the Individuals with Disabilities Education Act (IDEA) within a
reauthorization bill (H.R. 1350)-which NAMI opposes-that would eliminate
rights of students with disabilities under existing law to receive free and
appropriate public education.
President Bush's "New Freedom" Commission on Mental Health is scheduled to
make recommendations soon to reform the nation's overall mental health system.
NAMI pointed to the Department of Health & Human Services (HHS), Department of
Justice (DOJ) and Department of Education (DOE) as holding many of the keys to
resolve the child custody issue.
"The problem is a national tragedy." Gruttadaro said. "It is a national
scandal. Federal leadership is needed to build a system that can provide
appropriate treatment for children with mental illnesses. No child should be
left behind. No parents should ever be forced to abandon their children to get
the help they desperately need."
To view the Chicago Tribune article please click the link below or cut and
paste the entire link into your web browser:
http://www.chicagotribune.com/news/nationworld/chi-0304210080apr21,1,2897272.story?coll=chi%2Dnewsnationworld%2Dhed
You will be asked to fill out a short form to register for a FREE user
account before being able to access the full article online.
For the full GAO report click the following link or cut and paste it into
your browser:
http://www.gao.gov/cgi-bin/getrpt?GAO-03-397
CMHS Consumer Affairs E-News April 24, 2003 Vol. 03-27
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GAO ISSUES REPORT ON CHILD WELFARE AND JUVENILE JUSTICE
Recent news articles in over 30 states describe the difficulty many parents
have in accessing mental health services for their children, and some parents
choose to place their children in the child welfare or juvenile justice
systems in order to obtain the services they need. The United States General
Accounting Office (GAO) was asked to determine:
(1) the number and characteristics of children voluntarily placed in the
child welfare and juvenile justice systems to receive mental health services,
(2) the factors that influence such placements, and
(3) promising state and local practices that may reduce the need for child
welfare and juvenile justice placements.
What GAO Found
Child welfare directors in 19 states and juvenile justice officials in 30
counties estimated that in fiscal year 2001 parents placed over 12,700
children into the child welfare or juvenile justice systems so that these
children could receive mental health services. Nationwide, this number is
likely higher because many state child welfare directors did not provide data
and GAO had limited coverage of county juvenile justice officials.
Neither the child welfare nor the juvenile justice system was designed to
serve children who have not been abused or neglected, or who have not
committed a delinquent act. According to officials in the 6 states GAO
visited, limitations of both public and private health insurance, inadequate
supplies of mental health services, limited availability of services through
mental health agencies and schools, and difficulties meeting eligibility rules
for services influence such placements. Despite guidance issued by the various
federal agencies with responsibilities for serving children with mental
illness, misunderstandings among state and local officials regarding the roles
of the various agencies that provide such services pose additional challenges
to parents seeking such services for their children.
Officials in the states GAO visited identified practices that they believe may
reduce the need for some child welfare or juvenile justice placements. These
included finding new ways to reduce the cost of or to fund mental health
services, improving access to mental health services, and expanding the array
of available services. Few of these practices have been rigorously evaluated.
What GAO Recommends
Federal Agencies Could Play a Stronger Role in Helping States Reduce the
Number of Children Placed Solely to Obtain Mental Health Services The
Departments of Health and Human Services (HHS) and Justice (DOJ) should
consider the feasibility of tracking children placed by their parents in the
child welfare and juvenile justice systems to obtain mental health services.
HHS, DOJ, and the Department of Education (Education) should develop an
interagency working group to identify the causes of the misunderstandings at
the state and local levels and create an action plan to address those causes.
These agencies should also continue to encourage states to evaluate the
programs that the states fund or initiate and determine the most effective
means of disseminating the results of these and other available studies.
To view the full report, including the scope and methodology, click on the
link below. For more information, contact
Cornelia Ashby at (202) 512-8403
or ashbyc@gao.gov.
http://www.gao.gov/cgi-bin/getrpt?GAO-03-397
Last Updated on
04/14/04
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