Many wind up in custody, not treatment

How many of Michigan's children could be greatly helped by early, ample mental health care is anybody's guess. But experts agree the needs far outpace what's available. “There are many children who could benefit from mental health interventions who don't get it in a timely and appropriate manner,” said Patrick Barrie, who oversees mental health services at the Michigan Department of Community Health. But with no single entry route into the system, pervasive budget woes and insufficient insurance coverage, hundreds of Michigan children instead end up in detention facilities or as wards of the state. Thousands of others receive inadequate or no mental health care. Access to services is confusing, and eligibility requirements often discourage early intervention, meaning it often takes a crisis to get help.

Today as well as the next two Tuesdays, the Free Press will detail how children with schizophrenia, bipolar disorder, depression, anxiety and other mental illnesses succeed or fail in getting mental health services. Through the eyes of children who are in treatment, locked up or on the brink, we explore what it takes to get services, what's available and the impact on families when a child needs mental health care. The Michigan Department of Community Health (DCH) estimates that 545,000 of the 2.5 million children in Michigan in 2002 had a mental disorder, the most recent year for which data are available. Among children ages 9-17, the state estimated that between 66,000 and 120,000 have a serious emotional disturbance, which can include severe anxiety and schizophrenia. Barrie and other DCH officials concede that they don't have an exact count of how many children in Michigan have mental disorders, but they base their estimates on national mental illness prevalence rates and state statistics of how many children have accessed services.

The DCH, through county agencies, provides things such as therapy and case management to more than 28,000 children age 17 and younger who have been diagnosed with mental illnesses, and 1,192 others with developmental disabilities and mental disorders. An additional 25,000 children get short-term help from Medicaid, the federally funded program providing medical care for poor people and people with disabilities. But children with mental disorders also land in juvenile detention facilities, the foster care system, or receive some services through the public school system. No one tracks how many children get mental health services through these other means, nor is there a way to know how many parents pay for private help. But with treatment costing tens of thousands of dollars a year, children with enduring mental illness usually end up getting public assistance.

“There are a variety of systems dealing with children, and it creates the possibility of none of them doing as much as they could for these kids. When the other one doesn't step in, as often happens, then nobody's doing anything for these kids,” said Elizabeth Bauer, a member of the Michigan State Board of Education who also serves on the Michigan Mental Health Commission, appointed by Gov. Jennifer Granholm. All the dozens of mental health experts interviewed for this series agree that state and federal funding in the past five years has remained, at best, stagnant, while demands on the system have grown. DCH officials said funding for children's mental health care has been flat since 1998. In that year, the department spent about $2,569 for each Michigan child with a mental illness; in 2003, it was $4,167 — a negligible amount when one therapy session can cost more than $100, and residential treatment facilities typically cost in excess of $250,000 a year. The total DCH budget for children's services in 1998 was $111.7 million, and $122.5 million in 2003, said Judy Webb, director for DCH's division of quality management and planning. “We've seen a reduction in the numbers of people served, but an increase in the amount spent per person," Webb said. "We've been using our limited dollars for treating the more severely impaired population.”

Moreover, prevention programs for the state's children have been slashed. In 1999, DCH spent $11.3 million on prevention, but just $3.1 million in 2003. With funding shortages elsewhere, “prevention sort of goes on the back burner,” Webb said.

The Michigan Department of Education did not return requests for how many children with mental illness it serves, or how much is spent on special education for children with mental disorders.

The Family Independence Agency does not track how many children receive its mental health care, said FIA spokeswoman Maureen Sorbet. But she said, “Lots of our children, especially in juvenile justice and foster care, certainly receive those services,” such as therapy with a psychologist or psychiatrist. Meanwhile, state-run psychiatric hospitals for adolescents have dwindled from six in the late 1980s and early 1990s to just one today — Hawthorne Center in Northville, which has about 90 beds for long-term, institutional care. Experts pushed for more community-based services to end the warehousing of mentally ill children, but shuttering hospitals also was a cost-cutting measure. The DCH said those saved dollars went toward programs that help children get family counseling and other services while living at home, but experts say that didn't happen. Instead, many children who act out while awaiting placement in a health-care facility end up in juvenile detention, experts say.

“Incarceration not only sends a negative message about the child's worth, it has horrible consequences. Kids with mental illness or emotional disorders in these settings are very vulnerable to physical and sexual assaults, worsening of symptoms, and the suicide numbers are four times more than the general population of teens,” said Susan McParland, executive director of the Michigan Association for Children with Emotional Disorders. In some cases, parents who feel they have no other options are giving their children up, either by petitioning themselves on neglect charges or making their children wards of the court. Custody relinquishment to obtain mental health services for children is illegal. But according to a 2003 report by the U.S. General Accounting Office, at least 12,700 American families have done so, including at least 160 children in Oakland County and 400 in Wayne County. Advocates believe the numbers are much higher.

The state is aware of the problems facing children who are mentally ill. Since January, the governor's commission has been taking suggestions and discussing ways of improving care. The 33-member commission is meeting Sept. 20 to discuss a list of recommendations, which will be presented to Granholm by month's end. Advocates applaud the efforts as a start but say a national effort is needed to save children from further mental distress, interrupted family life and juvenile detention.

“The access to services for children with mental or emotional disorders ranges from bad to worse in this country. It's tearing families apart,” said Christopher Burley, deputy director of communications for the Bazelon Center for Mental Health Law, a Washington, D.C.-based advocacy organization for people with mental disabilities.

“Every day that policy-makers fail to act on this is another night that 2,000 kids across this country are going to bed in juvenile detention facilities because they can't find mental health services in the community.”

Laura Potts
31 August 2004

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