Children with even the most severe mental disorders can live at home, achieve in school, and flourish as adults. What they need to succeed are supportive services that:
- Are provided primarily in the family’s home and community
- Are available when needed, including after-school, in the evenings, and on weekends;
- Give children the opportunity to practice life skills and make positive choices while engaged in community activities;
- Engage children in activities that interest them;
- Strengthen the family’s and child’s network of social support; and
- Are designed around the goals of the family and child.
The Bazelon Center advocates for systems of care that deliver such services. Typically, these systems rely on a single plan of care developed by a team that includes the family and child, service providers, and representatives of all the public systems with a role in planning mental health services for the child, including the school, foster care, and juvenile justice systems. The family and child play a strong role, helping guide the team’s understanding of the child’s needs (“assessment”) and the interventions that would meet those needs (“service planning”). The highly individualized service plan that emerges is built on the strengths of the family and the child. A case manager helps coordinate the delivery of an array of community-based services and supports that are identified in the individualized plan. Services delivered in this fashion are sometimes referred to as “wraparound services” or “intensive home-based services.”
Mounting evidence demonstrates the effectiveness of systems of care. These systems have been found to produce sustainable improvements in mental health and school achievement and reduce hospitalization and criminal justice involvement.
While many communities have begun to build systems of care, they often receive too little funding and serve far fewer children than is necessary. One reason is that too many public dollars are invested in residential treatment. Despite a virtual consensus among experts that residential treatment is an archaic and ineffective approach, nearly a quarter of national spending on children’s mental health goes to this form of institutional care. It is time to stop this misguided investment and instead invest in building a foundation of supportive services that allows children with mental disorders to thrive in their communities.