Help for Children with Mental Illness

Today’s Boston Globe has one of those feel-good editorials that calls for more of this and more of that aid for children in Massachusetts who have a mental illness. But their insight into this problem is limited, their solutions naive, and they inadvertently continue to promote the stigma attached to mental illness.

As the Globe’s Carey Goldberg reported recently, a dozen children faced such delays in recent weeks. Lisa Lambert, executive director of the nonprofit Parent/Professional Advocacy League, a mental health organization, says she has heard of 30 cases in the last six weeks. No state data are available.

These emergency room traffic jams are part of troubling national trends.

Troubling national trends indeed. Troubling national trends that have been going on for decades!

Mental illness care and treatment getting the short end of the stick in public health and financing is hardly new or news. It’s been going on since long before the era of John F. Kennedy, who suggested a comprehensive network and system of community mental health centers — affordable care for the middle class to help with mental health treatment. Sadly, his vision was only partially realized, and in the 1980s, Reagan’s administration worked hard to slash funding and support of this network. Which, not coincidentally, occurred during the drive to close large state hospitals that had for decades warehoused patients. The combination of these two actions resulted in the largest increase of homeless people who had mental illness in the history of the U.S.

Massachusetts ought to begin tackling this complex problem and take other steps to help families with mentally ill children. In the short term, the state Department of Mental Health could set up a website or a hotline to track psychiatric beds, so that children in distress can be placed rapidly.

Well, gee, yes, of course they should begin tackling this complex problem. But how and with what resources? It’s easy to stand on one’s soapbox and make proclamations that everyone can agree on. But it’s quite another to get down and dirty and make concrete suggestions on where funding and resources would come to “tackle” this problem. Setting up a hotline or website is one such suggestion, but really, if it were that easy, wouldn’t every state already have one? Tracking beds in hospitals isn’t as simple as looking a computer screen (which often has an inaccurate count) from hospital to hospital. It means, even in this day and age, actually going down to the wing and counting beds (or asking a nurse, who usually knows more about what’s going on than most everyone else).

When I was in school in South Florida, calling around looking for a psychiatric bed was also the routine when you needed to find hospitalization for your patient. Whether it was a child or adult didn’t matter — psychiatric hospital beds 15 years ago just as they are today are in short supply throughout the country. This is an industry-wide, national problem. Short-term fixes won’t address the larger issues. A website or hotline isn’t going to solve the underlying problem — a shortage of facilities that can help treat people who are in crisis and immediate need.

The editorial then goes on to talk about the Surgeon General’s mental health report of 2001, and a Massachusetts court ruling, also in 2001. That was seven years ago! Little has changed since the report or the ruling, because health and mental health concerns are not (and largely rarely are) government priorities.

“June 2009 is a tight deadline [for court-mandated changes in Massachusetts].”

It wouldn’t have been if the state had been working on the issue and pouring money and resources into it for the past eight years. And while it has made some minor inroads into addressing the concerns of the court, it really hasn’t had the resources to do much of anything. Year after year, state budgets give mental health in Massachusetts a short shrift. And Massachusetts is far from alone.

There is a ray of hope:

A children’s mental health bill on Beacon Hill would pour the foundation for a Satcher-like system for all the state’s children. Filed by Representative Ruth Balser, a Newton Democrat, and Senator Steven Tolman, a Brighton Democrat, the bill would promote widespread screening; move “stuck” children out of hospitals and into community programs; and extend insurance to cover “collateral services,” such as paying mental health providers to work with doctors and teachers, so that parents don’t have to be case managers.

Balser has also filed a mental health parity bill that would help establish better care for children and adults. It is scheduled to be debated in the House today.

I hope these bills are passed, as they would indeed lay such a foundation, but it seems like far too little, far too late. These are bills that should have been passed in 2002, six years ago.

Oh, and about that reinforcing the stigma thing…

People and children have a mental illness, they are not the sum of that illness. Just as someone might have cancer or liver disease, we don’t refer to children with cancer as “cancerous children,” nor do we refer to someone with liver disease “the liver-diseased man.” This is a subtle distinction, but an important one because by defining a child with a mental illness as a “mentally ill child,” we’re suggesting that is the most important defining feature of that individual. Individuals are people, not labels. By labeling large swaths of people in this manner, we de-humanize them and de-individualize them and keep a “them versus us” mentality alive. People with mental illness are not this homogeneous group of “those people.” They are us, we are them, and children deserve the same respect and individuality as adults.

Read the full editorial: Help for mentally ill children