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Position Statement 42: Services For Children With Mental Health Conditions And Their Families

Policy

Mental Health America (“MHA”) is committed to the principle that mental health is an essential part of a child’s overall well-being.  All children should have right to live in healthy communities, free from violence and discrimination, with access to high-quality primary and mental health care and healthy food,  good educational opportunities and other resources necessary for children to grow and thrive.  Children and families should have access to mental health and other support services that are trauma informed.[1]  Services should include promotion of mental health, prevention of mental illnesses and substance use, early identification, treatment, and long-term support, as needed, regardless of how the child or family enters the service delivery system.

Treating the whole person through the integration of mental and primary health care, actively involving the family, and ensuring access to an array of culturally and linguistically appropriate services saves lives, reduces negative health outcomes, and results in long-term cost savings. Most importantly, it improves the quality of life for both the child and his/her family. Effective mental health treatment must be child- and family-centered. MHA urges decision makers at the federal, state, and local levels to safeguard access to quality services that are developmentally, culturally, and linguistically appropriate to meet the mental health needs of all children and families in this country.

MHA supports the following principles concerning the treatment of children’s mental health conditions:

  • Mental health is central to the health and well-being of children and their families.  Children deserve the opportunity to have emotional and mental conditions identified early so they may receive proper services and supports to avoid losing years that are critical to their healthy development… years that can never be reclaimed.
  • Children should be routinely screened in schools, faith-based institutions, sports programs, and other child serving settings for adverse childhood experiences.
  • Early assessment should be conducted by qualified professionals to develop appropriate intervention strategies that are least restrictive and address problems before they escalate.
  • All assessments should be conducted in a culturally and linguistically appropriate manner that involves the family at all levels of the decision-making process. Services are more effective when they are culturally competent in approach and delivery.[2]
  • When use of medication is deemed clinically appropriate, it should be part of an integrated and comprehensive treatment plan that uses a broader systemic, holistic approach. Treatment works best when it is carefully planned with the family and all service providers, including the school system, courts, child protection, health care, case managers and the child mental health system.

Background

MHA’s commitment to a larger treatment regime to address children’s mental health needs is based on the following:

  • Serious emotional distress and mental health conditions are real. Empirical research in neuroscience and the behavioral sciences is advancing our understanding of the etiology of these health conditions.[3]
  • Serious mental health conditions are heavily influenced by the mother-child relationship. An infant’s brain makes as many at 1.8 million neural connections per second.[4] The way in which these connections are formed is highly influenced by human relationships. When a mother or caregiver attributes meaning to her/his behavior, she helps her infant to develop a secure sense of her/himself.  This security helps the baby to regulate her/himself in the face of adversity.  Training in how to work with mothers and their babies to cope with maternal mental illness is essential.  But devoting time and attention to parent-child relationships is an excellent model for preventive mental health care even if the mother is healthy and has a healthy lifestyle. [5] It is shameful to blame mothers, but it is important to assist them.
  • A focus on prevention and early intervention efforts could greatly reduce the number of children experiencing serious mental health conditions. Providing resources early in the process will help contain escalating costs once the problem becomes severe, when more expensive services may be required. One way to ensure that our health system meets children’s mental health needs is to move toward a community health system that balances health promotion, disease prevention, early detection and universal access to care.[6]
  • One in nine children has a mental disorder which resulted in severe impairment, but fewer than half will receive care for that illness[7]  Half of all individuals who have a serious mental health condition during their lifetime report that the onset of the problem occurred by age 14 years and three fourths by age 24 years.[8]
  • There is substantial and growing evidence that childhood maltreatment, including exposure to violence and other traumatic events is associated with an increased likelihood of mental health conditions, including PTSD and depression.[9]  Untreated childhood abuse has been associated with a plethora of psychological and physical symptoms, and these problems can persist for years.[10]  Adults with a history of adverse childhood experiences have a lower overall health status with higher use of health services and negative educational and occupational outcomes and difficulties in interpersonal relationships, especially intimate ones.[11]  This evidence supports a renewed commitment to providing to all children an environment free from violence and trauma.
  • Psychotropic medications are highly effective in the treatment of many psychiatric symptoms in children and adolescents when disorders are appropriately diagnosed and medications appropriately prescribed as part of an integrated and comprehensive treatment plan. In treating ADHD, for example, more than 200 studies show that medication can produce beneficial results.[12]
  • Although the most research suggests that there is not compelling evidence of widespread over-medication or misuse of psychotropic medications in children in adolescents in the US,[13] there is evidence of the growing use of anti-psychotic medications among children under five and among Medicaid recipients and particularly minorities.[14]  This may reflect the unwillingness of Medicaid to pay for the therapy needed to identify and treat the underlying causes, including traumatic experiences, of behavioral problems among indigent children.
  • Almost 45%  of students with a mental health condition 14 years or older drop out of school, the highest dropout rate for any disability group.[15]
  • Suicide remains a serious public health concern and is the third leading cause of death in young people between the ages of 10 and 24. More youth and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.[16]
  • The state child welfare officials and county juvenile justice officials who responded to a 2003 GAO survey estimated that over 12,700 children entered the child welfare or juvenile justice systems in order to receive mental health services in fiscal year 2001. Of these children, about 3,700 entered the child welfare system. [17]
  • Seventy percent of youth involved in state and local juvenile justice systems suffer from mental health conditions, with at least twenty percent experiencing symptoms so severe that their ability to function is significantly impaired.[18]
  •  Schools offer an ideal foundation to address prevention, early-intervention, positive development, and regular communication with families. Under federal law, schools are major providers of mental health services. Children spend at least six hours in this environment, and schools have a responsibility to see that all of children’s mental health needs are met.[19]
  • There is growing evidence of the strong correlation between mental health conditions and childhood obesity.  That evidence suggests both that untreated mental health conditions contribute to obesity and that obesity leads to an increased risk for serious mental health conditions.[20]

Call to Action

MHA challenges decision-makers to:

  • Dedicate resources to study and fund best and promising practices that are focused on prevention and early intervention for children and young adults with mental health conditions.
  • Provide resources to develop, implement, and evaluate programs that focus on culturally and linguistically diverse populations to insure proper care for all children and families.
  • Insure that all mental health and prevention services are informed by our growing knowledge of the substantial role that childhood trauma plays in causing and exacerbating mental illnesses;
  • Recognize the correlation between mental health conditions and childhood obesity and develop comprehensive and integrated services to address these serious conditions;
  • Provide resources to conduct research specifically designed to assess the appropriateness of a use of medications with children. Address the underlying ethical and medical problems associated with developing and testing medications for children. Require that appropriate and discrete labeling of medication for children be developed by the Food and Drug Administration (FDA); and
  • Create a system of care in which mental health services are provided by individuals or teams that are trained to integrate knowledge about human behavior and development from biological, familial, social and cultural perspectives with scientific, humanistic and collaborative approaches to service delivery and the promotion of mental health.

Effective Period

The MHA Board of Directors approved this policy on March 8, 2014. It is reviewed as required by the MHA Public Policy Committee.

Expiration: December 31, 2019.



[1] According to SAMHSA’s website, “Most individuals seeking public behavioral health services and many other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to mental health and co-occurring disorders such as chronic health conditions, substance abuse, eating disorders, and HIV/AIDS, as well as contact with the criminal justice system.

When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.” http://www.samhsa.gov/nctic/trauma.asp

 

[3] U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General, Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health (1999).

[4] Board on Children, Youth and Families, National Research Council and Institute of Medicine, From Neurons to Neighborhoods: The Science of Early Childhood Development, Committee on Integrating the Science of Early Childhood Development, National Academy Press (2000).

 

[5] Fonagy, P, “The Human Genome and Interpersonal World: The Role of Early Mother-Infant Interaction in Creating an Interpersonal Interpretive Mechanism,” Bulletin of Meninger Clinic 65:427-48 (2001).

 

[6]  Cooper, Janice L. and Masi, Rachel. “Facts for Policymakers", National Center for Children in Poverty, Columbia University (2006).

[7] Merikangas, et al., “Prevalence and Treatment of Mental Disorders Among US Children in the 2001-2004 National Health and Nutrition Survey,” Pediatrics 125:75-81 (2001).

[8] Kessler, Ronald C., Patricia Berglund, Olga Demler, Robert Jin, Kathleen R. Merikangas, and Ellen E. Walters. “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Health conditions in the National Comorbidity Survey Replication.” Archives of General Psychiatry 62:593-602 (2005).

[9] The Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic have been conducting a multi-year study involving over 17,000 children.  The results of this ongoing study, referred to as the Adverse Childhood Experiences Study (ACES) are available at:  http://www.cdc.gov/ace/index.htm

 

[10] Self-reported physical abuse rates range from 10 to 31% for men and 6 to 40% for women.  Childhood sexual abuse rates range from 3 to 29% in men and 7 to 36% in women. Id.

 

[11] Id.

 

[12]Pruitt, David, ed., Your Adolescent:  Emotional, Behavioral, and Cognitive Development from Early Adolescence through the Teen Years. (American Academy of Child and Adolescent Psychiatry, HarperCollins, 2000)

[13] “Medication Use in US Youth with Mental Disorders” Merikangas, et al., JAMA Pediatrics 167(2):141-48 (2013), http://www.ncbi.nlm.nih.gov/pubmed/23403911.  

 

[14]  “Trends in Antipsychotic Drug Use By Very Young, Privately Insured Children” Olfson, et al., Journal of the American Academy Of Child & Adolescent Psychiatry 49 (1):13-23 (2010); Verdier & Zlatinov, “Trends and Patterns in the Use of Prescription Drugs Among Medicaid Beneficiaries: 1999 to 2009,” Mathematica Policy Research Medicaid Policy Brief 17 (March 2013), www.mathematica-mpr.com; “U.S. Probes Use of Antipsychotic Drugs on Children” Lagnado, L. The Wall Street Journal (August 11,2013);  “Use of Antipsychotic Drugs Up Sharply Among Poor Children in Kentucky” Musgrave, B., Lexington Herald Leader (October 9, 2012) http://www.kentucky.com/2012/10/09/2365969/use-of-antipsychotic-drugs-up.html.

 

 

[15]  U.S. Department of Education, 30th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, Washington, D.C. (2008), http://www2.ed.gov/about/reports/annual/osep/2008/parts-b-c/index.html?exp=6,  Table 16, p 67.

[16] National Adolescent Health Information Center, Fact Sheet on Suicide: Adolescents & Young Adults, University of California, San Francisco (2006).

[17] Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services (GAO-03-397, April 21, 2003).

[18] Skowyra, Kathleen, and Joseph J. Cocozza, A Blueprint for Change: Improving the System Response to Youth with Mental Health Needs in the Juvenile Justice System, National Center for Mental Health and Juvenile Justice, Research and Program Brief (June 2006).

[19] Rones, Michelle, and Hoagwood, Kimberly, “School-Based Mental Health Services: A Research Review,” Clinical Child and Family Psychology Review 3(4):223-41(2000); Individuals with Disabilities Education Act, 20 U.S.C. §1400, et seq.

[20] Russell-Mayhew, et al., “Mental Health, Wellness and Childhood Overweight/Obesity,” Journal of Obesity Online (6/24/2012)  www.ncbi.nim.nih.gov/pmc/articles/PMC33388583/Schwartz, M.B. & Brownell, K.D., “Actions Necessary to Prevent Childhood Obesity: Creating the Climate for Change,” J Law Med Ethics. 35(1):78-89 (2007).

 

 

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