War On Drugs Linked To Gaps In Mental Health Services For Children

Review These Books & Manuals On Relapse

 War On Drugs Linked To Gaps In Mental Health Services For Children 010709

On July 8, 2001 Carey Goldberg of the New York Times reported that many children are trapped in psychiatric hospitals because of a lack of community-based treatment services.  The problem is so widespread that it has prompted recent lawsuits demanding more outpatient treatment in states from New York to Idaho to California.  This is only one of the more visible indicators of a broader and deeper problem that is creating yawning gaps in the treatment of mental illness among the nation's children.  That problem is a national commitment to a War On Drugs Policy that diverts critical funding from treatment services to provide punishment on request to non-violent drug offenders while failing to provide treatment on request to children and adolescents in need of addiction and mental health services.  Here are some of the facts:

1.    Five to 10 percent of American children have serious mental health disorders

2.    Eighty percent of those children with mental health disorders don't get the treatment they need. (Source: Surgeon General's Report, January 2001) 

3.   Most states readily admit that community-based mental health services are inadequately funded and simply cannot meet the needs of all children seeking help. 

4.    The "kids in crisis",  those sufferring from full-blown psychiatric crises, wait for hours in emergency rooms for psychiatric assessment onlyt to be told no treatment resources are available.

5.    The "boarder kids" get stuck for days, weeks, or even months in pediatric wards because there is no place for them in a psychiatric ward or hospital.

6.   The "wait-listed kids," wait for months for outpatient therapy or case management sufferring from debilitating symptoms. 

7.    If children do get into intensive services they often become the "stuck kids" who are ready for discharge from psychiatric hospitals but cannot leave for lack of outside treatment programs. 

In Massachusetts alone children on the welfare system spent 15,796 days in October of 2000 of unnecessary time in hospitals.  This is more than 43 years and represents a 33 percent increase over the  the previous six months.  Although Massachusetts added $10 million to its mental health budget of $584.6 million last year to deal with the problem stuck kids, the problem persists.  

Analyzing The Problem

The problem with inadequate services for children and adolescents results from a complex chain of cause and effect that, surprisingly enough starts. with our nation's drug war policy.  Here's how it works.

1.    The nation declares a war on drugs and gives absolute top priority to arresting and incarcerating people who are addicted to drugs.  This results in a massive increase in criminal justice costs.  Being committed to "punishment on demand" communities fund the building of new prisons and the expansion of community probation and parole services.  Where does the money come from?

2.   To fund expanded criminal justice program made mecessary by the war on drugs deep cuts are made in community-based addiction, mental health, and dual disorder programs.

3.   This funding shift occurs when the nation is experiencing a sharp rise in juvenile psychiatric emergencies as a result of more children reaching adolescence and the tendency for more of those children to have serious psychiatric problems.

4.    To contain costs by lowering the number of people in treatment, managed care organizations in both the public and private sector have initiated gate-keeping practices that make it difficult to impossible for mentally ill children to receive proper treatment for adequate lengths of time in community-based settings.

5.   This excessive gate-keeping by managed care organizations results in a lack of available funding for community-based programs.

6.    In an effort to keep programs running, administrators are forced to make deep cuts in both the work-force and the salaries of professional staff.  This creates an over-worked and underpaid workforce.  

7.    The mental health treatment profession appears relatively unattractive and people seek other career alternatives.  

8.   This results is a shortage of properly trained child and adolescent treatment professionals in part due to low wages and salaries.

9.    Fewer kids get the treatment they need.  many end up having trouble in school, becoming delinquent, drinking abusively,  and using illicit drugs.  They can't get treatment, but if arrested they get punishment on request and end up doing time in jail and prison or being place under community correctional control.  Since treatment usually isn't provided, criminal recidivism is high/ 

What Happens To Parents & Children

Whatever the causes, the gaps in the system compound the pain of parents who are coping with their children's illnesses, and often result in making  the illnesses worse instead of better.  

Here's what can happen to a parent:  

1.   A parent has problems with a serious mental health problem in child, such as uncontrollable acting out behavior in a fourteen year old boy caused by a bipolar mood disorder and a coexisting obsessive-compulsive disorder.  

2.    The parent calls the managed care gate-keeper who tells her to bring the child to an emergency room for evaluation. 

3.    After waiting for eight to nine hours to been seen in the emergency room the parent is told that there are no psychiatric adolescent beds available anywhere in the state for him. 

4.    The parent has to take the child home and manage the problem herself without medical assistance.  

5.    Because the mental health problem was never treated, it gets worse and a series of progressively more serious crisis situations occur over several months.  

6.     Finally the parent finds an inpatient treatment facility or their child gets arrested for violence, crime or drugs.  The child is admitted to a residential facility or a correctional program and can't get out because there is no available community-based treatment.  

7.    Eventually the kid is discharged back to the parents with no follow-up treatment available.  The mental illness flares up and the cycle starts again.

The Solution Is Obvious

The solution to the problem is obvious: more mental health services must be provided in communities, so that mentally ill children could live at home while still receiving intensive treatment and oversight by professionals.  

There are clinically effective models for community-based treatment based upon the concept of "wrap around services".  Wrap around services bring together all the agencies that normally deal with mentally ill children — including the juvenile justice system and child welfare offices — to collaborate in meeting the needs of each individual child.  Wrap around services often include staff members who spend extensive time in the child's home, and respite care when parents are at wit's end.

Wrap around programs have already proved themselves cutting hospitalizations and delinquency, and saving money.  The biggest obstacle to their implementation is lack of funding.

A Legal Solution

To get more funding may require a legal solution.  In May, a federal judge in Los Angeles ruled in favor of the plaintiffs, who represented more than 100 children in the state's mental hospitals and thousands in other locked facilities, in a class action lawsuit demanding wrap-around services.

In Massachusetts, the threat of a similar suit has been brewing; the state has been negotiating with patients' advocates, who sent notice of their intent to sue a month ago.  In New York, a class action lawsuit on behalf of hundreds of children that suit says are stuck in institutions is expected to begin litigation soon. At any time, the state has a waiting list of about 200 children who need residential treatment, the plaintiffs say, and has failed to create enough community services for them.

In Massachusetts, the threat of a similar suit has been brewing; the state has been negotiating with patients' advocates, who sent notice of their intent to sue a month ago.

Don't Forget The Bottom Line

Don't forget the real primary cause of the problem.  As a nation we are putting more emphasis on punishing non-violent drug users than providing treatment addicted and mentally ill kids.  Until we shift from a War On Drugs Policy that provides punishment on request to a Public Health Addiction Policy that provides treatment on request, we probably won't have the money to solve the problem and parents and their children will continue to needlessly suffer.

New York Times - July 9, 2001

Children Trapped 
By Gaps in Treatment of Mental Illness

By CAREY GOLDBERG

OSTON, July 8 — The 16-year-old girl had needed help, no question. She was throwing chairs, she was taking rides from strangers, she was acting suicidal. Finally, she ended up in a psychiatric hospital, where, her mother says, the staff effectively saved her life, stabilized her, worked on her bipolar disorder.

But once in, the girl could not get out. Not for months after the staff thought she was ready to go. No matter how she cried. She had joined the ranks of thousands of mentally ill children and teenagers in the country who, doctors, advocates and officials say, are trapped in psychiatric hospitals and in other institutions for lack of treatment programs outside.

The problem is so widespread that it has prompted recent lawsuits demanding more outpatient treatment in states from New York to Idaho to California. And experts say it is only one of the more visible indicators of a broader, deeper problem, yawning gaps in the treatment of mental illness among the nation's children.

Five to 10 percent of American children have serious mental health disorders, federal officials say. About 60 to 70 percent who have mental health disorders do not get the treatment they need, said Gary De Carolis, chief of the child, adolescent and family branch of the federal Center for Mental Health Services. But a surgeon general's report released in January offered an even higher estimate, 80 percent.

Experts say it is unclear how many children are not only under- treated but actually trapped in the mental health system, victims in large part of poor record-keeping and differences in the process from state to state. The National Mental Health Association is working to quantify "unmet need" in 13 states and is struggling with variances in data collection and systems, said Maril Olson, the association's director of child welfare.

"I don't know of any states that would say, `We are doing really great,' " Ms. Olson said. "Every state would say `We don't have enough funding, we don't have enough services.' "

Here in Massachusetts, advocates and doctors have been documenting several aspects of what they call the "stuck kid" problem.

There are the children who must wait for hours in emergency rooms while in full-blown psychiatric crises. There are the "boarder kids," children stuck for days or weeks — or in extreme cases, months — in pediatric wards because there is no place for them in a psychiatric ward or hospital.

There are the "wait-listed kids," waiting months for outpatient therapy or case management. And there are the "stuck kids" themselves, usually about 100 of them at any time in the state, according to official figures, who are ready for discharge from psychiatric hospitals but cannot leave for lack of outside treatment programs.

Dr. Josh Sharfstein, a Massachusetts pediatrician who has documented the state's "stuck kid" problem among children cared for by the child welfare system here, found that from last October to March, stuck patients spent 15,796 days — or more than 43 years — of unnecessary time in hospitals, 33 percent longer than in the previous six months.

"The systems to take care of the most severely mentally ill kids are completely broken," Dr. Sharfstein said. "If you have a heart ailment in Massachusetts, you're going to get excellent care, but if you're a child with mental illness you could have the best insurance and wind up spending three days in the emergency room."

Massachusetts has more psychiatrists and social workers per person than any other state and is second in the number of psychologists, said the state's mental health commissioner, Marylou Sudders. "Stuck kids" are a high priority for the whole administration, Ms. Sudders said, and the state added $10 million to its mental health budget of $584.6 million last year to deal with the problem. And yet it persists.

Ms. Sudders attributed the problem to an overall crisis in mental health treatment, and she cited these other factors: a staffing shortage so severe that the state can actually operate only 8 of 10 beds for mentally ill children it has the money for; a shortage in psychiatric wards; and a boomlet in the state's adolescent population.

Whether caused by demographics or other societal shifts, a sharp rise in juvenile psychiatric emergencies has been reported in many states, including Connecticut and New York.

Mental health advocates also mention the effect of managed care on mentally ill children. Private managed care, experts say, tends to reduce coverage for mental health, and parents often wait too long before seeking help. In some states, managed care programs for children covered by public money have so cut the amount of treatment received that state governments have abandoned the programs.

Whatever the causes, the gaps in the system compound the pain of parents who are coping with their children's illnesses, and often, experts say, exacerbate the illnesses themselves.

"If a child has appendicitis or a diabetic condition, you're going to get them in to the hospital that day," said Pamela Sepe, a registered nurse and a mother of four, including a 14- year-old son who has bipolar disorder and obsessive-compulsive disorder. "It's just so sad, because they have an illness too, but it just affects a different area."

When her son had a recent crisis and began flying out of control, Ms. Sepe took him to the emergency room, as his doctor had instructed her, only to be told after nine hours of waiting that there were no psychiatric adolescent beds anywhere in the state for him. She had to take him home.

Most children and teenagers stuck in psychiatric hospitals tend to be wards of the state, many unable to return home. But Ms. Sudders said the problem extended to children covered by private insurance.

When the children covered by public money get stuck in psychiatric hospitals, parents and experts say, that backs up the whole system.

"All along the spectrum there is bottlenecking or a logjam," said Lisa Lambert, assistant director of the Parent/Professional Advocacy League, which advocates for mentally ill children. "It's all connected."

The stuck patients also burden the psychiatric hospitals, taking up beds needed by others while the hospitals lose money because the state does not usually pay full rates when a patient's stay is no longer considered clinically necessary.

For all the problem's complexity, there seems to be a consensus about the solution: more mental health services must be provided in communities, so that mentally ill children could live at home while still receiving intensive treatment and oversight by professionals.

The federal Center for Mental Health Services has been giving tens of millions of dollars in grants each year to encourage such programs for several years, and they now exist in 67 communities, Mr. De Carolis said.

The programs bring together all the agencies that normally deal with mentally ill children — including the juvenile justice system and child welfare offices — to make them collaborate rather than try to stick each other with the bills for a child's care.

They generally create interagency teams and strive for "wrap-around" treatment — wrapping the services around the child instead of making the child negotiate a maze of agencies. They often include staff members who can spend extensive time in the child's home, and respite care when parents are at wit's end.

The programs have already proved themselves, Mr. De Carolis said, cutting hospitalizations and delinquency, and saving money. But they often meet some resistance. A therapist used to 50-minute hours, he said, might balk when told to go into schools and homes and act as part of the community; so might the director of a 140-bed treatment center when the emphasis shifts to intensive at-home services.

Lawsuits around the country on behalf of children stuck in the system generally demand — and have often received — more of such wrap- around services.

In May, a federal judge in Los Angeles ruled in favor of the plaintiffs, who represented more than 100 children in the state's mental hospitals and thousands in other locked facilities, in a class action lawsuit demanding wrap-around services.

In New York, a class action lawsuit on behalf of hundreds of children that suit says are stuck in institutions is expected to begin litigation soon. At any time, the state has a waiting list of about 200 children who need residential treatment, the plaintiffs say, and has failed to create enough community services for them.

With waits of 6 to 12 months, "Children are really suffering," said Nancy Rosenbloom, staff lawyer at the Legal Aid Society, which is bringing the suit. "There are children at home getting no services; children in foster care not getting mental health services; children in the hospital who don't need to be in the hospital; and children in jails and prisons who are there because judges feel they need some kind of residential care."

In Massachusetts, the threat of a similar suit has been brewing; the state has been negotiating with patients' advocates, who sent notice of their intent to sue a month ago.

Compared with other states, "Massachusetts has tons of group homes," said Steven Schwartz, executive director of the Center for Public Representation, which would bring the suit. "We have more hospital beds than most states. What we don't have is home-based support that allows people to leave hospitals for home. That's why we have this problem of stuck kids."

And the real number of stuck children in Massachusetts alone is probably in the thousands, Mr. Schwartz said, if those stuck in state hospitals and other facilities, not only private hospitals, are counted.

As for the 16-year-old girl with the bipolar disorder, she needlessly spent about four months in the hospital, crying to her mother on the phone, "You've got to get me out of here!" She finally did get out of the hospital last week, but not to go to a residential treatment program. She simply went home, despite her mother's misgivings. "I finally had to get her out myself," her mother said. "She would still have been there."

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982.  CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster's College in St. Louis, Missouri.  He is a Senior Certified Addiction Counselor In Illinois.  He is a prolific author who has published numerous books, pamphlets and articles.  Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant.  He has presented lectures and conducted workshops in the U.S., Canada, and Europe.  

For books, audio, and video tapes written and recommended by Terry Gorski contact: Herald House - Independence Press, P.O. Box 390 Independence, MO 64055.  Telephone: 816-521-3015 0r 1-800-767-8181.  His publication website is www.relapse.org.

Home - What's New - Site Map - Search Gorski's Site - Articles - Book Reviews

Mission & Vision - Training & Consultation Services - Publications - Links

Daily News Review  -  Addiction Databases  - Leading Addiction Websites

GORSKI-CENAPS Clinical Model --- Research-Based Best Practice Principles

Terry Gorski and Other Members of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related To Recovery, Relapse Prevention, & Relapse Early Intervention