Mentally Ill Youth Do Best In Community Care Settings

Children and youth with serious mental illness improve most when served through community-based services, according to data released by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Children and youth treated by so-called “systems of care” spend less time in inpatient care, experience fewer arrests, make improvements in their overall mental health, and do better in school than before entering the care system, the agency said.

A system of care for children's mental health is a coordinated network of community-based services and supports designed for minors with serious mental health needs. The approach places the children and their families at the center of a partnership with public and private organizations to tailor services that build on a child's strengths. Such approaches are also tailored to cultural and linguistic needs.

“These programs can have a significant mental health impact on children,” said SAMHSA Administrator Charles Curie, M.A., in presenting the data at the U.S. Capitol last month. “Ultimately, these programs change lives.”

Federal support for such mental health services is provided through the SAMHSA-run Comprehensive Community Mental Health Services Program for Children and Their Families. Since its 1992 authorization, the program has funded 121 programs that were designed to transform treatment and care for children with mental illness and their families.

The following are key findings for patients treated by systems-of-care programs:

Sandra Spencer, executive director of the Federation of Families for Children's Mental Health, said such programs implement the second recommendation of the 2002-03 President's New Freedom Commission on Mental Health to provide family-driven care for children with mental illness.

Spencer, whose son was diagnosed with bipolar disorder at age 4, said the systems of care approach, when instituted in her home-town of Greenville, N.C., encouraged local mental health and educational officials to design a treatment with the family. The use of systems of care changed the approach from a problem that needed to be isolated to an illness that could be cured, she said.

Michael Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI), said one of the strengths of systems of care is the creation of local facilities at which children who display problems can receive a mental health evaluation.

“We need more of our communities to develop effective systems of care, and this will take more funding,” Fitzpatrick said at the briefing.

He and other supporters of systems of care emphasized the fiscal advantages of the approach to mental health to the audience, which included members of Congress and their staff members.

Local programs that used the approach reduced the average number of per-child inpatient hospital days, which translated into an average savings of $2,777 per child, according to the SAMHSA data.

The average reduction in number of arrests per child treated in systems of care within the prior six months provided an average per-child savings of $784.

Additionally, emotional and behavioral problems were reduced significantly or remained stable for nearly 90 percent of children after 18 months in systems of care.

The data suggested that systems of care save taxpayers money when compared with the traditional mental health service delivery systems, said Curie.

He said SAMHSA aims to expand the program but noted that in the present budget climate, funds for federal support of new programs will come only from cuts in programs deemed less effective.

“We are confident that if we don't make the case for these programs, then funding will not be increased,” Curie told Psychiatric News.

The SAMHSA data appeared to echo somewhat previous findings about the cost-effectiveness of the systems of care approach, including a January 2005 Psychiatric Services study. That report, “Public Costs of Better Mental Health Services for Children and Adolescents,” found that reduced expenditures in other sectors that serve youth substantially offset the costs of improved mental health services.

The SAMHSA data were released as part of the first National Children's Mental Health Awareness Day session on Capitol Hill to introduce legislators and their staffs to the issues and beneficiaries of children's mental health services. The sponsoring partnership, which includes the Federation of Families for Children's Mental Health, NAMI, National Mental Health Association, and National Association of Social Workers, brought numerous mental health professionals, medical professionals, and people who were treated when they were children together to highlight efforts to reduce dropout rates, substance abuse, suicide, and incarceration among youth with mental illness.

Information about community-based systems of care is posted at<www.systemsofcare.samhsa.gov/>.▪