New England States Fare Badly in Nationwide Survey of State Practices in Placing Children in Juvenile Justice and Child Welfare Systems to Receive Basic Mental Health Services: The Practice of Putting Parents in a Position of Needing to Relinquish Custody to Receive Services for Their Children is Criticized.

On July 17, 2003, the United States General Accounting Office released a report on states’ practice of requiring parents to surrender custody of their children to the state to be able to obtain mental health services for them in the juvenile justice and child welfare systems. The report was based on a survey of states by the General Accounting Office, initiated at the behest of Senators Susan Collins (ME), and Joseph Lieberman (CT), of the Senate Committee on Governmental Affairs. Of the six New England states, only Connecticut, Rhode Island and Vermont responded to the survey.

The report found that of the 19 states responding to the survey, in 2001, parents placed over 12,700 children – mostly adolescent males – into the child welfare or juvenile justice systems so these children could receive mental health services otherwise unattainable through their parents’ health insurance policies.

Maine’s practice of requiring parents to surrender custody was highlighted in Barbara Walsh’s “Castaway Children” series in the Portland Press Herald in August, 2002. The NEJDC presented Ms. Walsh with its first annual media award in November, 2002. The state of Maine did not respond to the survey.

Since the report was published, Senators Susan Collins (ME) and Mark Pryor (AR) have sponsored legislation which would provide $55 million in federal matching grant funds for states to improve their mental health care treatment systems for children. The legislation was prompted by a series of hearings before the Senate Governmental Affairs Committee at which witnesses testified to the nationwide practice of parents relinquishing custody of their children to foster parents so the children may receive federally supported mental health care through Medicaid.

Senator Collins’ legislation would give states money enabling them to:

• Expand public health insurance programs to cover mental health treatment for eligible children and families;
• Provide outreach and public education programs, and provide training and professional development for those in the field;
• Help develop a system for tracking the number of children who enter the welfare and juvenile justice systems to receive care (most states do not have such a system); and,
• Provide wraparound services for family advocates.

Senator Collins is also working to establish an interagency task force to examine the issues surrounding mental health care services for children.

For more information, go to http://collins.senate.gov

Summary of the United States General Accounting Office Report on Child Welfare and Juvenile Justice: Several Factors Influence the Placement of Children Solely to Obtain Mental Health Services

A recent survey of 19 states and 30 counties found that in 2001, over 12,700 children – primarily male adolescents with multiple mental health issues - were placed into the child welfare or juvenile justice systems for the primary purpose of obtaining mental health services. Neither system is designed to serve children with such mental health needs and the study found that most children did not receive the services their parents had been promised they would receive if the state assumed custody.

The GAO based its findings on news articles from 30 states and mental health advocacy organizations which reported that parents are put in situations where they must agree to surrender custody of their children to ensure they receive the mental health services they need. The primary factors that influenced parents’ decision to place their children in the child welfare or juvenile justice systems were: limitations in health insurance coverage, shortages of mental health services in many localities, difficulties in accessing services through mental health agencies, eligibility requirements for services provided by different agencies and programs and misunderstandings among state and local officials and service providers regarding the responsibilities of various agencies to meet children’s mental health needs.

Juvenile justice officials reported that some children are placed in the system solely to obtain mental health services inaccessible in other ways. Children so placed are not tracked; no database distinguishes between children placed in juvenile justice systems to receive mental health services from children who have been charged with delinquent behavior and who may also have mental health problems. This lack of tracking leads to a lack of knowledge regarding the extent and outcomes of the mental health placements. State welfare officials told the GAO that many of the children placed were violent and had tried to hurt either themselves or others.

Another concern regarding placement surrounds monetary issues. Mental health treatment can be very expensive and most families rely on insurance to help cover the costs of these services. Most private health insurance plans offer different coverage for mental health services than for physical health services. Although the federal government passed the Mental Health Parity Act (“MHPA”) to reduce restrictions on coverage by some employer-sponsored group plans, some restrictions still exist, such as limits imposed on the number of reimbursable treatments. Furthermore, the federal government set certain requirements for Medicaid eligibility, despite Medicaid’s history of providing comprehensive health insurance for children from low-income families.

Officials from child-serving agencies interviewed in the report identified expansion of the number and range of community-based services as a means to improving treatment for children with a mental illness, which would also avoid the need to push parents to surrender custody. Community based mental health programs would also reduce states’ reliance on hospitalization and residential care for children for whom no intervention had been made early enough. Examples of such programs include: early intervention, diversion, transitional services and crisis intervention. Family support services and encouragement of parental involvement were also viewed as means to improve states’ treatment of children. Although states and counties are implementing practices that may reduce the need for parents to place their children with child welfare or juvenile justice agencies, the G.A.O. concluded that all agencies must work together with parents to meet the needs of children with severe mental illness, and to assess the quality and quantity of mental health services for children.