Grading DC's Progress on Childhood Mental Illness

More D.C. kids getting treatment, but timeliness and quality still lacking

Latisha* was diagnosed with anxiety in her teens and her pediatrician grew concerned that she wasn't in school. She was growing increasingly anxious -- and housebound.

It turns out Latisha wasn't getting the help she needed to manage her illness. Despite being referred to a community mental health provider in D.C., high turnover meant that Latisha saw seven therapists over two years. Her condition worsened and she was about to drop out of high school.

Latisha's story illustrates how childhood mental illness that is left untreated can deny children an opportunity to live a happy, healthy, productive life -- and deny D.C. of their talent. It also can result in higher financial and social costs to the District if untreated mental illness results in the need for special education services, causes her to drop out of school, or lands a child in the juvenile justice system or prison.

Each year, Children's Law Center grades the District on its progress and failures in meeting the mental health needs of children like Latisha. On April 14, we released our third annual Children's Mental Health Report Card - with both good and bad news for the roughly 13,000 to 20,000 low-income children struggling with mental health issues in DC.

The good news for Latisha and thousands more children like her is that for the first time since we have issued our ratings, more D.C. children than ever are now getting help.

District agencies reached over 12,500 kids with mental health services last year -- about 30 percent more than in the previous year -- due in part to D.C.'s intense pressure on its Medicaid managed care organizations (MCOs) to a better job in this area.

There is also very good news when it comes to expanding the cadre of skilled professionals who can identify and treat childhood mental illness. D.C. is now requiring pediatricians across the city to screen for childhood mental illness during regular well-child visits -- ensuring that kids like Latisha can get diagnosed and treated earlier. The D.C. government also has launched a new effort to help pediatricians manage moderate mental illness through a network of on-call psychiatric professionals who can provide brief advice and referrals.

Despite this good progress, the District is still not moving forward in several critical areas.

Children are still waiting much too long to get help -- and the quality of the help they are getting is poor. If the goal of mental health treatment is to improve a child's health, it must be the right treatment, offered at the right time and proven to be effective.

In Latisha's case, her pediatrician eventually referred the family to Children's Law Center and we were able to get her into a therapeutic, school-based program to meet her needs. But that's not the case for far too many children.

Our 2015 Children's Mental Health Report Card also finds that DC has not made progress in improving care coordination. Very few children currently have case managers to ensure their families can navigate the complex network of providers, programs and services that comprise our mental health system. And, these entities often do not share information about progress as a child's treatment is handed off from one provider to another.

In addition, none of the government agencies that oversee children's mental health today has a clear picture of the many services being offered across the District -- whether it is the D.C. Department of Behavioral Health, the Department of Health Care Finance or other agencies that oversee mental health needs of children in foster care, the juvenile justice system or in our public schools.

These agencies need to do more to improve case management for individual children, identify and fill in gaps in services, ensure that families are connected to care, and standardize how they are tracking how many children are getting services.

D.C. has the chance for a fresh start with newly-elected Mayor Muriel Bowser. As a beginning, she has the opportunity to appoint a permanent director to lead the Department of Behavioral Health -- the lead mental health agency in DC. Her new appointee must be given the authority and responsibility to build a comprehensive and coordinated children's mental health system.

Until D.C.s mental health system can truly operate as a system, thousands of kids like Latisha will continue to fall through the cracks.

Ultimately, if not enough progress is made on childhood mental health, Mayor Bowser risks not making progress on homelessness, improving schools, public safety and in so many other areas she has on her agenda.

*We work hard to protect the confidentiality of our clients and have changed Latisha's name for this reason. All other details are true.