A Perverse Limbo

A disturbing report by Congress's watchdog agency makes a start at documenting a difficult but little-known problem: Parents of children with serious mental-health problems are often driven to turn their children over to child-welfare authorities or the juvenile justice system to get the mental health care they need.

The General Accounting Office found that in 19 states and 30 large counties surveyed, more than 12,700 children - mostly teenage boys - were placed or detained in this way so they could receive mental-health treatment and care. But neither system is set up for this purpose. Child-welfare systems are meant to protect abused or neglected children, placing them in foster care if needed. Juvenile justice programs are aimed at rehabilitating children who have committed criminal or delinquent acts. Given the limitations of the study, the GAO notes, the number of children involved is probably much higher.

Parents of mentally disturbed children are forced to take such action for a number of reasons, the study found. Health insurance may not cover mental-health services; such services may not be available, especially in rural areas; red tape - including overlapping programs and complicated application processes - makes it difficult for parents to obtain services; and state and local officials often don't understand the system themselves and incorrectly advise parents about available programs.

The GAO also found that some state and local authorities are trying a number of innovative solutions to cope with the problem. Some are bundling programs to come up with the needed funding. Others are using less expensive providers, for example, nurses rather than psychiatrists to administer medicine. Kansas has created a single facility to house a full range of children's programs. Some states and counties are expanding the mental-health services available for children.

But no one really knows the scope of the problem. To find out, the GAO recommends that both the Justice and Health and Human Services Departments:

• Look into a tracking system to follow such children and the results of their placement in child-welfare and juvenile-justice systems.

• Work to better educate state and local officials on federal requirements regarding children with mental-health problems.

• Encourage states to evaluate their mental-health programs for children and find ways to share the results of those studies.

Parents of children with serious mental-health problems are often desperate. They shouldn't have to turn their children over to the county or state to get the help they need.

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