The California Council of Community Mental Health Agencies, in collaboration with other statewide advocacy groups, recently released a report detailing the lack of service options for children and youth experiencing mental health crises across California. In nearly all 58 counties, youth have very limited access to any service options beyond hospital emergency rooms and distant or difficult to access psychiatric inpatient facilities.
The January 2015 report, “Kids in Crisis,” highlights the challenges that emergency rooms face in addressing the immediate and longer-term treatment needs of children and adolescents in psychiatric crisis. Because emergency rooms often lack staff with specialized psychiatric training, less than half of the young people seeking treatment there receive any type of mental health evaluation. Few are ever referred for outpatient treatment or follow-up.
Thus, many children in serious psychiatric distress not only go untreated but experience additional trauma that exacerbates their condition. To address this significant service gap, Assemblymember Das Williams has introduced Assembly Bill 741, designed to ensure that appropriate services for children and youth experiencing mental health crises are both available and accessible, and designed to meet their specific needs.
Examples of more effective and accessible services include the crisis services continuum available in Alameda County, where youth have access to mobile crisis teams, 23-hour crisis stabilization, and hospitalization/short-term crisis residential treatment.
As policy makers and advocates work to improve California’s system of crisis services for children and their families, it is worth considering lessons learned from implementing the settlement agreement for Katie A v Bonta, a landmark case in the state involving mental health guarantees for children who are in, or at risk of entering, foster care.
The implementation lessons applicable to efforts like AB 741 include the following:
- Broad systems change efforts could involve 58 individual counties and potentially hundreds of service providers and/or organizations. California should develop clear program implementation guidelines, supported by readily available training and technical assistance resources.
- California counties often lack adequate funding to develop new services, while non-profit organizations operate with little or no surplus revenue. It is critical that the state provide adequate funding to expand treatment options for children and youth in crisis.
- Within the context of the elements described above – thorough implementation guidelines, technical assistance, training, and adequate funding – the state should develop realistic and effective systems for holding counties and service providers accountable to stated outcomes.
The impact of the suffering and long-term cost of delayed or inadequate treatment for children in crisis cannot be overstated. Indeed, thousands of children and youth are brought to emergency rooms for mental health intervention across the country each day, putting them at risk of further traumatization. Thus, it is our responsibility to act expeditiously and thoughtfully to address this unmet need of our communities and of our children and their families.
Ken Berrick is Chief Executive Officer of Seneca Family of Agencies in Oakland, California. He is co-author of the book “Unconditional Care: Relationship-Based, Behavioral Intervention with Vulnerable Children and Families.”