What she really needs, the mother said, are intensive home- and community-based services: counseling, case management, respite care, psychiatric rehabilitation. They are called wraparound services for the way they are supposed to enfold the family and child.
Without wraparound, an institution can become the only option for parents such as Rieck, she said. "We're not giving up our kids because we want to," said Rieck, 37. "We can't do anything else for them. They are hurting other people. They are hurting themselves. There is nothing we can do anymore."
Dawn Rieck worries about money on the way to visit her daughter Jessica at a facility in Leesburg. Son Anthony, 4, is in the back seat.
(Andrea Bruce Woodall -- The Washington Post)
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Maryland officials have recognized this desperation. They say the institutionalization of mentally ill and emotionally disturbed children is in many ways a failure -- bad for families and children and very expensive for the state.
In fiscal year 2004, Maryland spent more than $100 million placing about 3,000 mentally ill and emotionally disturbed children in hospitals and residential treatment centers, according to the state Mental Hygiene Administration.
Yet every dollar spent on services to help keep children with their families saves $10 in out-of-home placement costs, according to a report by the Governor's Office of Children, Youth and Families.
The District began offering a version of wraparound services in 2002. The Virginia General Assembly recently appropriated $1 million for a demonstration project providing wraparound-type services for 150 to 200 children.
And the budget proposal of Maryland Gov. Robert L. Ehrlich Jr. (R) included $1 million for two pilot wraparound programs expected to serve at least 200 children -- a minimum of 100 each in Montgomery County and Baltimore.
Some Maryland mental health advocates remain wary. The administration has cut about $15 million from a $42 million Medicaid program that was providing home- and community-based psychiatric rehabilitation and mentoring to more than 10,000 children, including Jessica. "The closest thing we had to wraparound they took away," said Cathy Surace of the Maryland Disability Law Center.
The impact of the cuts is a matter of debate, with an analysis expected next month. State officials have defended their decision, citing the program's ballooning costs and noting that spending on a broader array of therapy and rehabilitation services to mentally ill children held relatively stable last year.
For Jessica, the cuts meant losing a mentor who came to her home, usually twice weekly, in the afternoons. The mentor took her on outings to the library, shops and the recreation center -- places she enjoyed but had difficulty visiting without supervision. The visits helped, Rieck said, though they alone were not enough to save Jessica from her latest crisis.
