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Globe Editorial

Help for mentally ill children

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June 25, 2008

IN THE universe of worries that parents of mentally ill children face, a needlessly vexing one is the inadequacy and unpredictability of care in hospital emergency rooms. Some children in psychiatric distress get stuck in emergency rooms for days because there are no available beds. Some children are sent home. Some are locked in rooms. And there is no central way — no one phone number or website — for emergency room staff to find beds. Instead, they call around to different psychiatric facilities.

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. Earlier this year, the American College of Emergency Physicians branded ‘‘boarding,’’ the warehousing of patients in emergency rooms, as a national problem of overcrowding.

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.

And that should be only one modest step in a larger overhaul of the state’s public and private mental health resources.

When treatment comes too late

Children who get tardy treatment or none at all end up straining the resources of their families, schools, and communities. In 2001, then-Surgeon General David Satcher issued a report saying that ‘‘the burden of suffering experienced by children with mental health needs and their families has created a health crisis...’’

Satcher called for a community health system — a grand vision of world-class care that would include prevention and early detection of mental illness. Frontline responders such as school teachers, daycare providers, and emergency room workers would be trained to respond to behavioral problems and mental illness. Schools could no longer duck the issue, as parents have sometimes found they do. Wide-ranging research would explore medical, ethical, and logistical issues. There would be better training for mental health professionals and multidisciplinary programs for healthcare professionals that would focus on children’s mental health.

Massachusetts is moving in this direction, thanks to the ‘‘Rosie D.’’ lawsuit. Filed in 2001, the suit claimed that the state had violated federal law by failing to provide early screening and diagnostic services. Judge Michael A. Ponsor called state efforts ‘‘woefully inadequate.’’

Now the state is implementing a court-approved remediation plan. The first step is under way: Pediatricians are screening Medicaid patients for behavioral and emotional problems. By Nov. 30, the state is supposed to develop a standardized way to assess children with mental health needs. And Nov. 30 is also the deadline for setting up a Web-based system to track care. By June 30, 2009, the state is supposed to have built a network of community service agencies to deliver care to Medicaid-covered children.

A tight deadline

But there are daunting challenges. June 2009 is a tight deadline. And there is a national shortage of children’s mental health professionals. To address this, state officials are reaching out to students in clinical programs, encouraging them to become mental health professionals. The state is also developing community college programs to train mental health paraprofessionals. These are sound moves, but they may not be enough to meet the immediate need.

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.

A vastly improved mental health system could provide the right care for children at the right time, freeing them and their families to live more productive lives.

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