Children's Mental Health
Mental health problems affect 1 in 5 young people, but two-thirds of those who need treatment do not have access to it. Lack of access to supports can have a serious and lasting impact across all areas of a child’s life. Leaving children without support contributes to school drop-out, unemployment, and involvement with the juvenile or criminal justice system. In addition to loss of short- and long-term opportunities, there is also loss of life with suicide as the second leading cause of death for those ages 10 to 24.
We know that most people who will develop mental health disorders experience symptoms by age 14. Identifying these early signs and providing appropriate supports can improve the child’s life, mitigate worsening symptoms, and improve mental health in the future. What’s more, universal prevention programs are effective at addressing many negative outcomes, from bullying to absenteeism to depression, and improving positive outcomes, like increased connection among families, schools, and communities. The research on the effectiveness of prevention and early intervention shows that acting early improves the lives of children and their families now and has effects that can last for decades.
Waiting to address children’s mental health has serious financial costs and long-term effects on the lives of children and their families. Fortunately, laws and programs that prioritize acting early can prevent and mitigate the effects of mental health disorders. Mental Health America (MHA) supports the federal government’s work, in partnership with states and counties, to help children in both the short- and long-term, saving money and lives and empowering people to reach their full potential by investing in:
Prevention programs support the positive development of all children in their communities, across multiple areas including their health, in school, and at home. Prevention of mental health disorders begins with perinatal mental health, including access to services that support healthy development during pregnancy and focus on maternal—and paternal—mental health during and following pregnancy. But support should not stop when the baby is born. Strategies for effective prevention of mental health and substance use disorders in young people include strengthening families through parenting programs, promoting health through health care and other community programs, and supporting social and emotional learning into schools.
MHA calls for the following changes:
- Require screening for perinatal mood and anxiety disorders and follow-up care as part of cost effective health home and general medical and mental health integration in all health plans. Mental health professionals should be co-located within the settings where screening is preformed to provide immediate evaluation, diagnosis, and treatment of mothers with positive screening results. This approach will reduce barriers to care, improve compliance, and provide the best outcomes for mothers and infants. Where physical co-location is not feasible, virtual co-location by telehealth is a reasonable alternative.
- Invest in prevention and promotion, including setting aside resources for evidence-based prevention in mental health service programs (such as the federal mental health block grant program) and investment in proven prevention approaches by school systems. Investment in prevention and promotion also include focusing on workforce training, public education, continued research, and the development of state and local systems involving partnerships among families, schools, courts, healthcare providers, and local programs to create coordinated approaches that support healthy development.
- Develop state-based coalitions to design waiver proposals and approach the state Medicaid authority to seek a Section 1115 waiver of medical necessity and other criteria to permit group-based interventions, and petition the state for Medicare and Medicaid Services to consider long-term Medicaid and other government savings that result from the funding of evidence-based preventive services.
Early identification, accurate diagnosis, and effective treatment of mental health and substance abuse in school-aged people can alleviate enormous suffering and heartbreak and help young people to benefit from their education and to lead productive lives. Efforts to identify challenges early should involve all those who support and work with children and adolescents including teachers, primary care providers, mental health professionals, and school staff and administrators. With appropriate safeguards in place, screening in schools, in addition to screening in primary care, can help students get the supports they need to succeed in the community. The use of screening in schools can be a critical tool to increase compliance with federal requirements that schools identify and support students with disabilities. When combined with programs like school-wide positive based intervention and supports (SWPBIS), schools can focus on supporting students and improving school climate, while eliminating unfair disciplinary practices, including zero tolerance policies, that disproportionately impact students with mental health conditions.
MHA calls for the following changes:
- Advocates should actively engage with school districts to determine what efforts are underway to “screen” or promote early identification, and what programs are in place to provide appropriate services to young people with mental health or substance use conditions that prevent them from receiving full educational benefits from the general education program, as required by federal law. Getting and protecting required funding for screening and treatment is essential as schools face cutbacks.
- Schools should adopt proactive approaches like school-based positive behavioral intervention and support and “no eject, no reject” policies, and advocates should support school-based prevention services and legislation which transforms school discipline into a system of supports that furthers mental wellness.
- Advocates should demand that schools and school districts liberally construe their obligations under the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 to preclude the application of zero tolerance policies in cases where a mental health condition or a serious emotional disturbance allows or requires a reasonable accommodation
Children and families should have access to mental health and other support services that are trauma informed as needed, including longer-term support, regardless of how the child or family enters the service delivery system. Integrated and comprehensive treatment plans should involve the family and all service providers, including the school system, courts, child protection, health care, case managers, and the child mental health system. Services should include a full continuum of care, from talk therapies to school supports to residential treatment as needed. Making sure children and adolescents who are struggling get the help they need requires family engagement, and no family should have to relinquish custody to get supports for their child.
MHA calls for the following changes:
- Decision-makers and advocates should 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.
- Every state should follow the intent of the ACA and expand its Medicaid and CHIP programs to the limits provided by federal law, in addition to considering the PA, MA, or CO separate household models for disabled children who don’t qualify under ACA Medicaid expansion.
- Federal and state legislation and funding to improve oversight of residential treatment facilities is crucial. Federal and state governments should consider legislation to promote evidence-based practices, monitor outcomes, ban most use of seclusion and restraints, mandate licensure, training and continuing education, and requirement background checks of all treatment personnel.
To read our full position statements on children’s mental health, go to Children’s Issues.
To see a full list of our position statements, go to Position Statements.