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A Leap in Mental Care for Children By Rosalynn Carter

This op-ed was published in the July 10, 2008, edition of the Boston Globe.

In the 31 years since I chaired the first presidential commission on mental health, medical science has made significant strides in the diagnosis, prevention, and treatment of mental illnesses. Living in recovery from a mental illness is now not only possible, but expected. Even children and adolescents diagnosed with mental disorders go on to lead healthy, productive lives.

Unfortunately, the nation's social systems for delivering mental healthcare have not kept pace with advances in medical science. There is much more information about how the brain interacts with risk factors for mental illnesses, resulting in effective, evidence-based treatments for depression, ADHD, and even psychosis. But too often these treatments do not reach the people who need them most.

This is especially true for children. National reports estimate that 20 percent of children suffer from mental health problems severe enough to inhibit their ability to learn. However, only one out of five of these children will receive the treatment they need, resulting in more than 50 percent dropping out of school. And suicide remains the third leading cause of death among young people.

Now there is an opportunity to make a dramatic leap forward in expanding access to mental healthcare for all children. At the federal level, Congress is on the cusp of passing landmark parity legislation that would restrict the ability of insurers to discriminate against individuals with mental health and addiction disorders. Although mental illnesses are every bit as real as heart disease or diabetes, insurers have capitalized on the stigma associated with them to limit access to care. The Paul Wellstone Mental Health and Addiction Equity Act would break down the false distinction between mental and physical illnesses and compel insurance companies to treat them equitably.

There are important advances being made at the state level in reforming systems of care. A recent report by Children's Hospital Boston and Massachusetts Society for the Prevention of Cruelty to Children paints a vivid picture of a fractured mental health system that prevents most children, adolescents, and families from getting the care they need.

That report has helped galvanize a large coalition of families, youth, advocates, and providers in support of "An Act Relative to Children's Mental Health" that would create a comprehensive and coordinated system of evidence-based mental health prevention, diagnosis, and treatment that is accessible to all children, adolescents, and families.

The legislation would help ensure the early identification of children with developmental and mental health problems by promoting screening by pediatricians. The earlier that signs of mental illness are identified, the more effective we are in treating the disease, preventing the emergence of more serious conditions, and helping children get back on a path of normal development.

The bill recognizes how vital schools are in reaching children with mental illnesses. By providing mental health consultation services to schools, the bill empowers educators to better understand what may be happening in their students' lives and to identify and respond to early signs of trouble.

It also is important that children are treated in a setting that is appropriate for the level of care they require. Too many children wind up in hospital psychiatric wards because there is no room in residential or community programs or because state agencies cannot agree on who should pay. This bill would facilitate children being moved into more appropriate settings where they could resume attending school and other activities.

There are also thousands of children in the care of state agencies. Currently, several agencies have overlapping responsibility for providing mental health services, which can lead to children receiving multiple and conflicting diagnoses and treatment plans. The Massachusetts bill would designate the Department of Mental Health as the lead agency in designing, delivering, and coordinating services for children.

Just as Massachusetts is the national leader in expanding health insurance coverage to all its citizens, the Massachusetts Legislature can create a model system of children's mental healthcare. This bill points the way toward a system that is comprehensive, collaborative, coordinated, and cost-effective. It would help children experience all the joys of childhood and reach their full potential.

Rosalynn Carter, former first lady, is chairwoman of the Mental Health Task Force at The Carter Center in Atlanta.

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