Mental Health

Children’s mental health is essential to children’s overall health, development, and ability to learn. Children and youth with untreated mental health problems have more problems in school, more involvement with the criminal justice system, and fewer stable and longer-term placements in the child welfare system than children with other disabilities.

Many low-income children and children involved with the child welfare system experience mental health problems. Living in poverty, witnessing violence, being the victim of abuse and neglect, and being removed from one’s family are difficult events which can lead to a variety of mental health problems. Children, youth and families in the child welfare system frequently require services and interventions to reduce maltreatment, stabilize children and address trauma.

One in five children in the U.S. has a diagnosable mental disorder and one in 10 suffers from a serious mental health problem that impairs how they function at home, school or in the community. Poor children have more mental health problems than other children. Nationally, the prevalence of “severe emotional disturbance” (a term used to describe child with serious mental health problem) among poor children (aged 6-17) on Medicaid is 13.5%.

Children and youth in the child welfare and juvenile justice systems have a higher percentage of mental health problems than child in the general population. Fifty percent of children and youth in the child welfare system have mental health problem. Sixty seven to 70% of youth in the juvenile justice system have a diagnosable mental health disorder.

Nationally, approximately 70% children and adolescents in need of treatment do not receive mental health services. In fiscal year 2006, DC’s Child and Family Services Agency (CFSA) reported that only 35% of its child clients received some form of mental and behavioral health service. In fiscal year 2008, the Department of Mental Health (DMH) provided specialty mental health services to only 3.5% of the children enrolled in Medicaid.

Commonly diagnosed mental illnesses in children served by CFSA include:

• Attention-deficit hyperactivity disorder
• Depression
• Anti-Social Disorder
• Adjustment Disorder
• Post Traumatic Stress Disorder
• Mental Retardation
• Borderline Intellectual Functioning
• Conduct Disorder
• Bipolar Disorder
• Mood Disorder
• Physical or Sexual Abuse
• Attachment Disorder

In recent decades, mental health service delivery has shifted from institutional care (hospitals and residential facilities) to systems of care that are designed to provide culturally competent, family-centered, community-based services. The goal is for each child to have an individualized, coordinated treatment plan which utilizes a variety of treatment models and services to support the child in his or her home and community. Common mental health services and treatment for children include:

• Diagnostic evaluations and psychological testing
• Crisis stabilization
• In-home family stabilization services and parent training services
• Individual, group and family therapy
• Psychiatric treatment and medication management
• Substance abuse treatment
• Acute in-patient hospitalization
• Short or long-term residential treatment
• A variety of evidence-based specific therapy models, including:
o Cognitive behavioral therapy (CBT) and trauma-focused CBT
o Functional family therapy

The child mental health system in DC is fragmented and it is often quite difficult for children to get the treatment they need. Children with mental health problems receive services through a complicated variety of agencies and providers, including:

• Public (Medicaid) or private health insurance
• School system
o some children with mental illness are deemed eligible for special education services based on an emotional disability. 
• DC agencies, including the CFSA and DMH
o Within these agencies mental health services are provided through a range of private agencies, community-based organizations and networks of individual clinicians.

Useful Resources:

• DC Department of Mental Health
• U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Child and Adolescent Mental Health Information Center
• National Alliance on Mental Illness
• National Center for Children in Poverty, Children’s Mental Health: Facts for Policymakers
• Embry Howell, The Urban Institute, Access to Children’s Mental Health Services under Medicaid and SCHIP (August 2004)