If you’re ready for a crash course in mental health, read Alison Cuellar’s article in the new volume of Future of Children “Policies to Promote Child Health.” She introduces us to internalizing and externalizing conditions that children experience, as well as the trajectories and outcomes that can accompany them. She also describes prevention programs, and interventions from academic, juvenile justice, and medical and social service angles.
Unfortunately, well intended programs and interventions often come with an unintended consequence. Cuellar argues that due, in part, to differing funding structures of schools, health care providers, and juvenile justice programs, there is an inherent lack of integration among treatment providers; thus, children sometimes fall through the cracks. For example, health insurance might not pay for anything beyond direct professional services provided to a child; whereas parent education or family treatment might be necessary but not be covered. Another example would be programs funded by the Substance Abuse and Mental Health Services Administration—while there might be more flexible funding available for intervention and prevention initiatives through this funder than health insurance, funding is limited to particular communities and settings; thus excluding children not found in these areas.
I’ll be frank in saying that there isn’t an easy method to defragment a complicated system of service delivery. Cuellar concludes that we need to identify ways to overcome fragmentation between services. Volume editors Currie and Reichman call on governments to follow the lead of businesses and make use of the vast amount of data available to them to “create an integrated portrait of child health or to target policies to those who have the most to gain from them.”
In a blog post last year, I wrote about how the Affordable Care Act was a step in the right direction to allow for a more integrated health care system and that there were existing initiatives, such as the patient-centered medical home model, that encourage coordination among providers. Perhaps future policies and practices will encourage coordination among mental health services, thereby improving child mental health.
We often assume that low household income causes children’s food insecurity. But the Future of Children’s recent research report highlights a number of additional factors that contribute to food insecurity. One notable risk factor is a caregiver who faces mental or physical health problems.
The latest research shows that even when we account for income level, caregivers’ health is still central to children’s food security. For example, a recent paper in the Journal of Children and Poverty found that mothers in food-secure families had better overall health and were less likely to report substance use compared with mothers in food-insecure households. Craig Gunderson and James Ziliak‘s Future of Children report cites a number of health factors that can contribute to children’s food insecurity, including parental depression, parental drug use, or living with an adult with a disability.
What can we do to help children in these situations? The authors point out that the effect of caregiver’s mental and physical health on family food security raises concerns about families’ ability to navigate the welfare system. A caregiver’s health problems may also be exacerbated by lack of access to services. While the authors argue that improved access to services could improve food security, they also state that we need further research on how policy makers can create more accessible systems. The authors offer one suggestion to address the risk factor of substance use: ensuring that mothers who seek substance use treatment are enrolled in SNAP and WIC, if they are eligible. Perhaps a similar idea could be implemented in other contexts where caregivers receive medical or mental health treatment.
As more researchers explore the relationship between food security and health, new policy possibilities may come to light. However, the research highlighted in the Future of Children report makes us aware that health contributes to food security, and low income is not the only indicator of risk. In following blog posts, we will explore additional factors that influence food security. To learn more about health and food insecurity, see the Future of Children‘s Fall 2014 research report.
A youth diagnosed with bipolar disorder and accused of breaking and entering approaches the court. The judge faces a choice: place him in underfunded mental health care in the community, where he may not receive the treatment he needs, or put him in the juvenile justice system, where he may be adversely affected by the criminality surrounding him. The New York Times recently profiled one such youth, Daniel, who has been in juvenile detention for two years because authorities felt he would receive better treatment there than in his home in Ohio. The Future of Children examined this topic in a recent volume on Juvenile Justice. The volume’s article on mental health found that youth would benefit from better evaluation of mental disorders and from more cooperation between mental health and correctional agencies.
Currently, many systems operate independently to help at-risk youth. Juvenile justice, mental health, education, and child protection institutions all treat youth separately, despite these issues’ interconnectedness. For instance, half to two-thirds of children in juvenile justice custody meet criteria for mental disorders – two-thirds of these for at least two disorders. Both institutional limitations and a lack of standards prevent court authorities from determining which youth would benefit most from community-based treatment, which might be harmed from exposure to prisons, and which pose safety risks to society that necessitate their isolation. This leaves the juvenile justice system to handle many youth who might respond better to mental health treatment outside of detention.
Mitigation of these issues begins with evaluating and sorting criminally detained youth using evidence-based methods that have recently become available. Those deemed not to be dangerous but who have long-term mental health needs, particularly those charged with lesser crimes, should be directed to proven community-based treatment programs. Not only have some of these programs been shown to help improve mental health, but they also reduce recidivism and anti-social behaviors. Youth with mental health disorders that are sentenced to detention should also receive better mental health treatment. Detention centers can partner with community groups to bring professionals into detention centers and offer specialized services to youth with severe difficulties.
Everyone benefits from collaboration between juvenile justice facilities and community mental health programs: courts can direct youth to appropriate services, the community is safer as recidivism declines, and troubled youth receive the treatment they need in order to adjust to a healthful lifestyle.