Mental health services for Washington’s poorest kids is lacking, study says

At least 5,000 of the District’s poorest children are not receiving necessary mental health treatment, according to a study released Tuesday by an advocacy group that describes the city as in the throes of “a children’s mental health crisis.”

Even when parents seek out treatment for the children, the report stated, families must navigate a complex and inadequate social services system, often resulting in delayed and low-quality treatment. A lack of providers has led to lengthy waits for families who need immediate care. The region’s best providers have settled elsewhere in the area, where they can make more money, according to the second annual report by the Children’s Law Center, which attempts to assess how well the District is caring for the city’s 96,000 children insured by Medicaid.

The study noted that nationally, 12.6 percent of such children are thought to have mental health issues, according to a widely accepted estimate from the Urban Institute. In the District, however, only 6.8 percent of children — some 7,000 — were treated for mental health conditions.

Based on the national estimate, the District would have more than 5,000 children who need help but are not receiving it. And those estimates are conservative, said Judith Sandalow, the law center’s executive director.

“Between the number of children living in poverty and the level of trauma that comes with the violence some of these children witness, the number [of children in need] is probably much higher,” Sandalow said.

Sandalow said the report was created to get officials to acknowledge “that we have a children’s mental health crisis and we need to act.” The report itemizes a host of mental health needs, summing up the city as a place that is making improvements but still sorely lacking.

National studies have shown that children who aren’t treated for mental health issues are more likely to drop out of school, get involved in crime and commit suicide.

The city doesn’t identify how much it spends on children’s mental health in its budget, but funding for mental health services in the District has been described as “negligible,” according to a 2013 report from the city’s Department of Health Care Finance.

That department received $2.7 billion last year. The current budget proposal ups its allocation by 6 percent, partially to address the need for better mental health care for children.

City officials, who have not yet received the full report, said the department is actively trying to connect children and families with mental health services. “Our goal it to make sure that mental health treatment is available to every child and family that needs it,” Phyllis Jones, spokeswoman for the city’s Department of Behavioral Health, wrote in a statement.

By law, every child on Medicaid is entitled to screening and treatment for behavioral health issues. In the District, four “managed care organizations” coordinate treatment and services, functioning much like an HMO. They help to arrange payment through nonprofit groups and other agencies that provide therapy, rehabilitation and other services.

The report acknowledged that the District has made some strides in streamlining bureaucracy in this area, by making it easier for therapists and social workers to get credentialed and paying providers more. The District is also adopting a screening tool for pediatricians, who might be unaware of the best ways to fulfill their legal obligation to check up on patients mental health.

Problems remain. There is no Web site or call center listing all of the available providers. Although providers are supposed to book appointments within a week, the average wait time is 22 days.

The city’s consumer services report in 2013 found that about 30 percent of responders found their experience below adequate.

The city also graded service providers on a five-star rating system. Of the 10 agencies that serve children, the highest score any agency got was a three — and only one agency met that standard.

“For a long time, D.C. has been an unpleasant place for mental health providers to work,” Sandalow said, adding, “payments used to be late, and we weren’t paying enough. And that’s slowly being fixed.”

Robert Samuels writes for the Post’s social issues team. In Maryland, he focuses on issues affecting low-income children and families. He also covers life in the District.
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