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Children’s Law Center grades the District’s progress in the past year in the 2013 Children’s Mental Health Report Card. The report card is based on goals outlined in last year’s plan, Improving the Children’s Mental Health System in the District of Columbia.
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Background on Children's Mental Health in the District
Children’s mental health is essential to their overall health, development and ability to learn. Nationally, 1 in 5 children has a diagnosable mental disorder and 1 in 10 has a serious mental health problem that is severe enough to impair how they function at home, school or in the community. Many mental disorders begin by the time a person is 14 and a large majority of them begin by the time a person is 24. Some children may need long-term treatment from a team of providers, with medication as part of their clinical intervention, while other children and families may need only short-term therapy.
According to the President’s New Freedom Commission on Mental Health, “no other illnesses damage so many children so seriously.” If children are not screened and treated, these childhood conditions may persist and lead to a cycle of school failure, poor employment opportunities and poverty. Children and youth with untreated mental health problems have more difficulties in school, more involvement with the criminal justice system, and fewer stable and long-term placements in the child welfare system than their peers.
Although mental health problems impact children from all types of families and at all economic levels, there are certain conditions which can increase the prevalence of mental health needs. Many of DC’s children are subject to the most significant of these conditions: living in poverty, witnessing violence or having a parent who has depression. There is a well-researched association between socioeconomic status and indices of both physical and mental health.
Often because of the trauma and turmoil in their lives, children and youth in the child welfare and juvenile justice systems have a higher percentage of mental health problems than children in the general population. Being the victim of abuse and neglect, being removed from one’s family or living in multiple foster homes can each separately lead to trauma-induced mental health problems; when experienced together, these traumas can greatly compound problems. Nationally, 50% of children in the child welfare system have mental health problems. In the juvenile justice system, 67% of youth have a diagnosable mental health disorder.
Nationally, 12.4% of children aged 6 to 17 who receive Medicaid have mental health conditions. Yet the District’s public mental health system is only serving—by the Department of Mental Health’s most recent count—5.48% of children in the District. This count includes all children receiving at least one mental health service, without taking into account whether children are receiving the correct treatment or all the services they need to truly improve their health and quality of life. Given that such a large percentage of the District’s children receive Medicaid—61%—the fact that there is such a large gap between the children who need services and those receiving them is particularly worrisome.
Children on Medicaid are legally entitled to a comprehensive range of support including emergency services, inpatient hospital care, outpatient physician visits, prescription medications and rehabilitation services. In addition to all of the services individually listed in the District’s Medicaid State Plan, children have a right to any services that are medically necessary based on the Early Periodic Screening, Diagnosis and Treatment (EPSDT) provision of federal Medicaid law (which is also referenced in DC’s Medicaid State Plan). However, this legal entitlement can only be fully realized by the District’s children when there is a complete array of services available. To be effective, these services must be high quality and well-coordinated. Providers must be willing to work in the District, and it must be easy for them to accept all forms of DC Medicaid. Recognizing that children live in families and communities, our treatment models must move beyond a child-only focus to more inclusive approaches that involve parents and other caregivers.
“The Children’s Law Center has been a real comfort to me. It’s fair to say that things really turned for the better for us because of the law center.”