Texas Star Alliance
Surging mental health care capacity for our highest needs children
Originally published in TribTalk here.
By Judge John Specia Jr., Meadows Mental Health Policy Institute, April 13, 2017
As someone whose career often focused on neglected children and troubled families, I am deeply grateful that this Legislature is investing so much brainpower and funding into improving the state’s foster care system. In fact, all three of the most recent Legislatures have sought to increase access to needed care for children in foster care and for youth in juvenile justice systems who have mental health issues. With the right care, these young people and their families can overcome their challenges and become productive, responsible citizens and neighbors — but only if they receive effective services early enough.
But we shouldn’t forget that the best thing we can do for children and families is to keep them out of the child protection and justice systems in the first place. Lawmakers should continue their important work of closing gaps in services for children in state custody, but we also urgently need broad-based prevention and intervention efforts across this great state to get help to families in need sooner.
Mental illness, or “severe emotional disturbance” as it is generally called in childhood, is more common among children and youth than many believe. In fact, the most rigorous research available shows definitively that approximately half of all mental illnesses begin by age 14. As many as one in five children manifest symptoms of a mental disorder in any year, most often in adolescence, where two in five children suffer from a diagnosable mental health or substance use condition. Most of these conditions start small and can be addressed through brief outpatient care, often in a pediatrician’s office. But a smaller percentage — about one in 50 children — suffer from mental health needs so severe that they risk having to leave their school or home because of the severity of their needs.
In Texas, children and youth with the most complex needs — over 95 percent — do not receive the intensive mental health care they need at all, let alone at the earliest point when they need it and when their needs are most readily addressed. Just like cancer, mental illness is far easier to treat in its earliest stage.
Instead, these children and their families are left on their own, most often until behaviors extreme enough to get noticed at school or by authorities. If the symptoms are left untreated until they become sufficiently disruptive, these children may wind up in special education, or enmeshed in the child welfare or juvenile justice systems. There’s a good chance they won’t receive the care they need in those systems. When national experts reviewed the care received by Texas children in foster care, they found about 4,000 children and youth with needs so severe they confounded attempts to safely place them, and most of these children needed a type or intensity of mental health care that was not available to them.
Fortunately, Texas lawmakers have the power to help these children and their families heal. Bills in the House and Senate, if enacted, would help increase the capacity of mental health service providers and expand mental health early intervention for children and families across our state.
• Senate Bill 74 by Sen. Jane Nelson and House Bill 1758 by Rep. Four Price streamline provider requirements for intensive mental health services for children served in the Medicaid system. This important legislation would encourage more providers to earn the credentials necessary to provide intensive case management and mental health services in the child welfare system for children and families with the highest needs. The vision is for child and family therapists to be able to work with children in foster care (and their foster families) where they live and need services, whether in the home or community.
• House Bill 1600 by Rep. Senfronia Thompson and Senate Bill 817 by Sen. Kirk Watson expand access to mental health screenings for children and youth over age 11 enrolled in Medicaid. Right now, Medicaid covers a single mental health screening once during adolescence, which is as nonsensical as only checking blood pressure or blood sugar once during the teen years. These bills would encourage, but not require, pediatricians, family practitioners, and other primary care providers to make mental health screenings part of a child’s annual well-child exam, helping young people find treatment before symptoms metastacize into the home and school.
From my experience on the bench and with the Department of Family Protective Services, I have seen too many children with serious mental health needs go undiagnosed and untreated until they were in crisis. I have also talked to many families who searched desperately for treatment for their children only to find that there was no available provider or that their insurance wouldn’t cover the needed care and they couldn’t afford to pay out-of-pocket. I have also seen parents who were children in the system. If left untreated, today’s children become tomorrow’s parents with the same untreated mental health issues, thus perpetuating the cycle. Far too often, the first time Texas children receive mental health screenings and care is when they’ve become part of “a system.” It’s a tragedy for those children and youth, their families and our state.
Mental illnesses are like any other health need. They must be identified and treated early for the best possible outcomes. These bills support vulnerable children and adolescents and their families, and they can help the next generation of Texans grow up healthier in body and mind.