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March 30, 2015

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A chain of neglect

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My son Tim has a serious mental illness. Whenever a tragedy highlights the need for better mental health services, I wonder if policy leaders will finally enact some of the measures that would most make a difference for Tim. And for children who today are experiencing what he did years ago.

I’m usually disappointed.

Tim has had a bad outcome. He is homeless. It could be worse; he is still alive. Many are not.

Bad outcomes are the result of a chain of neglect of mental illness that lengthens over decades. We are not, however, helpless in the face of this chain. We have so many policy tools available to break it. We just need to get started.

Here are three places we could begin:

1. Requiring behavioral health screening for all children. This would break the chain at its beginning, when the earliest symptoms of illness first start to appear.

2. Changing special education rules to make them more responsive to mental illness. This would break the chain at its middle, when symptoms of the disease can change the trajectory of a child’s life.

3. Redirecting funding from prisons to community mental health services. This would break the chain at its end.

Periodic behavioral health screening should be as common a part of well-child exams as immunizations. It should be a mandatory covered service in Medicaid and SCHIP (State Children’s Health Insurance Program). Every private insurer should be required to cover it, too.

Serious mental illnesses are childhood diseases. Half begin before the age of 14. If we screened every child at least once every five years, early detection could lead to effective treatment.

What it could save in dollars alone are direct medical costs that today rival those of cancer. It could also save lives, because serious mental illnesses take more than 25 years from life expectancy — 10 more than all cancers combined.

Also, not every child who is suspended or withdrawn from school has a mental illness; but every child with a mental illness has probably been suspended or withdrawn from school at least once.

Removing a child from school who is already isolated from peers should only be used as a last resort.

I would mandate that a meeting with a mediation planning and placement team be scheduled within 10 days whenever a school or a parent wants a special education student removed for behavioral reasons for at least five consecutive days. The state must be a third party to this mediation. The purpose would be to develop a new individualized education program, known as an IEP, with additional services with the input of a child’s regular health and mental health providers. If there are none, then health and behavioral health evaluations should be done, with the state picking up the cost.

If any two parties agree to the additional services, then these should automatically become part of the IEP, with the state picking up the additional cost. If the parents are not one of the parties in agreement, they can still have the right to go to due process.

And if the child isn’t already receiving special education services, then perhaps the same event should trigger an eligibility determination — because he probably needs them.

Finally, I would increase funding for community mental health services, while decreasing our reliance on incarceration to warehouse people with mental illnesses. Jails are now the largest mental health providers in the nation.

Recently, Tim sat for four months in one, waiting for a treatment bed to open. Does anyone believe that not having that bed available saved a dime?

This is a problem everywhere. States have cut $4.6 billion from mental health budgets in the past four years.

If policymakers do their accounting honestly, they must acknowledge that we have gained nothing from these cuts in the short term, nor will we gain in the long term. Mental illnesses didn’t just disappear, and the cost has been too dear.

We are not helpless in the face of tragedy. But we are accountable.

Paul Gionfriddo lives in Florida and writes the blog Our Health Policy Matters. He wrote this for the Hartford Courant.

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  1. This is a subject, a crisis, in our American healthcare and educational system that few ever want to be associated with, let alone talk about it. Yet, mental illness continues to not only pervade in our society, but it continues to grow virtually unchecked.

    As a citizen, parent, and educator, I have witnessed our American policymakers do little but CUT funding, over the past decades of my life. As an educator, I have seen children who needed care never receive it, and go on into their lives, bumped and buised about, never realizing their full potential, nor a very happy life.

    Our government needs to address this adject failure of a mental health care system, which includes childhood screening, monitoring, and treatment. Our society is only as strong as our weakest link in it.

    Blessings and Peace,