CHILDREN'S MENTAL HEALTH BARRIERS

Forum on Mind and Body Health

Stigma

Health Coverage

Identified Community Barriers

Forum on Mind and Body Health

On May 15, 2000, "A Regional Communities Forum on Mind and Body Health" was held in search of "Finding Collaborative Strategic Advantage." Over 120 people including community leaders, service providers, educators, and consumers of services from a myriad of organizations came together to discuss various issues. One of the issues discussed was the barriers experienced in our community surrounding children's mental health. Several key concerns or barriers were identified.

• Schools have no beneficial system for dealing with families or for education of children with mental health issues.
• Lack of services for co-morbid conditions.
• Childhood issues are more serious because they lead to other problems.
• Lack of mental health parity in services and dollars.
• More case management because of growing caseloads.
• Families suffer because children are being placed outside of our community and the transition process.
• Additional support is needed for families.
• Parents must be equipped and educated to understand and address the needs of children with mental health issues.
• Lack of research for children and families on mental health issues.
• Lack of consistency in the school districts relating to mental health issues.
• Challenge in coordination of mental health issues for children.
• Need more evidence based research and best practices.
• Difficulty in determining the services available and a lack of resources.
• The issues identified in our community are similar to those identified in the Surgeon General's Report on Mental Health. It is apparent that the issues facing our local area are similar to those around the country.

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Stigma

Stigma is an important barrier to understanding the issues of mental health, mental illness, and/or mental disorders. See the Adult Mental Health Assessment for a description of issues related to stigma.

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Health Coverage

The current health system has a tremendous impact upon all children. The results of a survey by the Brazelon Center for Mental Health Law (of all 50 states and the District of Columbia) are reported in Making Sense of Medicaid. This report details various barriers related to children's mental health services (About.Com News Center. (2000, January 11):

• Services focus more on the availability of clinics and residential care than on community-based services.
• Managed health plans have responsibility for outreach, identification, and screening; however, they regularly overlook the needs of children with mental illness.
• The availability of targeted case management and rehabilitation options that focus on enabling children with mental illness to live in the community are less available than other services.
• Medicaid fee-for-service is the primary financing mechanism for intensive services.

Over the past four years, two new benefit plans have become available through the public sector for children and adolescents with mental health and substance abuse problems. The plans offer increased opportunity for children and adolescents to receive mental health treatment. In 1996, an expanded benefit plan called State of Texas Access Reform (STAR) became available. STAR benefits provide inpatient/residential and outpatient coverage for eligible youth, i.e., those whose family's income is at or below 100% Federal Poverty Income Guideline (FPIG).

In mid-1999, the Children's Health Insurance Program (CHIP) was implemented to cover uninsured youngsters up to age 18. Current information reflects that 50.5 percent are Hispanic, 34.9 percent are Anglo and 14.6 percent are African-American. Enrollment efforts in Travis County were assisted through a generous donation from the private sector, the Dell Corporation. Children within 200% of FPIG are eligible for services. Included benefits are prevention and intervention services, screening, assessment and referral for mental health disorders, and hospital inpatient/residential services with some limitations and exclusions.

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Identified Community Barriers

• Parents often must relinquish custody of their children in order to receive behavioral health services they can't afford, their insurance won't cover or they are unable to access through any other means.
• Families need access to culturally competent providers and mental health professionals who are reflective of the diversity of the Travis County community.
• Mental health services are available at inconvenient locations or times to meet families' needs. Many parents may risk losing their jobs due to loss of productivity at the work place while managing their child's mental health needs. In addition, many families are unable to receive appropriate care due to waiting lists.
• The deinstitutionalization of youth out of inpatient hospitals coupled with the limited mental health coverage available through managed care plans has resulted in a lack of available community-based services to meet families' needs. As a result, many children with complex mental health needs become involved in the juvenile justice system.
• Need for Strength Based Family Focus Approach in the provision of services and supports to children with mental health needs and their families.
• Need for mental health parity in insurance benefit plans to ensure appropriate mental health treatment services are provided.

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