Washington’s Struggles to Treat Mentally Ill Youth Reflective of a National Dilemma

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Reports show many youth in Washington D.C. under the Medicaid umbrella are being left behind as their mental health disorders go untreated, leaving them at high risk for a run-in with the juvenile justice system. 

In the nation’s capital, Medicaid covers at least 18,629 youth who are in need of mental health care treatment, according to the Justice Policy Institute. More than half are not receiving help, as stigma and an ineffective treatment system stand in the way of children receiving care, the group found. But catching the problem early and treating it is crucial because children with untreated mental illnesses are at a higher risk for teenage pregnancy, poverty, poor performance in school, and none to intermittent employment.

Mental Health

All of these factors weigh into the equation of children winding up in a justice system that research shows only worsens the cycle. 

The problem, which is widespread in many urban areas, is prevalent in D.C. because of the location of the RTCs – or residential treatment centers, which are sometimes hundreds of miles away -- meaning parents can be separated from their children, with no visits, for months at a time, according to some experts.  

There are also states such as Florida and Utah where children who are sent away for treatment often land in centers that are close enough to home for families to visit regularly.  

Though there is real worry that mental health services are ineffective and unavailable, there is also hope in the field and academia that the system, so hobbled by bureaucracy, can lift up the neediest cases.

Half of all disorders begin at the age of 14, according to the National Institute of Mental Health. Disorders are caused by a number of factors such as genetics where an individual may be more susceptible to a disorder like schizophrenia or Alzheimer’s or environmental factors such as trauma, neglect, and violence. 

A City Divided 

Washington D.C. is split by the Anacostia River. While areas of wealth and politics characterize the west of the River, high unemployment rates and high child poverty rates characterize the east, which includes Wards 7 and 8. The problem is not isolated to this area but the disparity between the two locations point towards a wide gap between the rich and the poor in the nation’s capitol where Medicaid covers 61 percent of its children. 

According to the Justice Policy Institute, a Washington-based think tank, there is a correlation between factors that cause poor mental health and factors that cause youth to end up in the juvenile justice system. A recent report by the group shows that 40 percent of all juvenile arrests were made in Wards 7 and 8. 

Drug use, violence, parental neglect and poverty all lead to poor mental health and trauma. The result, according to the report, is that very high rates of youth in the juvenile justice system have diagnosable mental disorders. 

Take just Chicago and the surrounding area: According to a study of the Cook County Juvenile Detention Center, led by Linda Teplin, a Northwestern University Medical School professor, “66 percent of all males and 74 percent of all females met the diagnostic requirements for at least one mental health disorder.” 

What appears clear is that such high rates could have been averted said Rebecca Brink, the senior policy attorney at the Children’s Law Center, a nonprofit legal corporation based in Washington D.C.  “Kids who are getting in trouble with the law, kids who are not in preschool, families who are involved with untreated substance abuse and untreated mental health issues,” Brink said.  “That could’ve been averted earlier.” 

The perceived lack of children receiving treatment in D.C. is double edged: Not only is there a shortage of community-based services available for D.C. area children, the structure of mental health programs discourage families from seeking help for their children, according to Melissa Neal, the senior research assistant at the Justice Policy Institute. 

Oftentimes, children who are diagnosed with a mental disorder are placed in isolating residential treatment centers. The children are removed from their families, communities and are placed in facilities that are hundreds of miles outside of D.C. “It’s sort of in between a school and a hospital,” Brink said. “It’s less restricted than a hospital setting, but sort of more restricted than a school. Mental health services and educational services all in one place.”

Neal said parents will sometimes choose not to seek help for their children, fearing their child would be sent away.

“At least one of the theories we have is that parents are seeing the more severe treatment that they’re being provided and they’re saying, ‘My kid’s not that crazy, I don’t want them to be shipped off. My kid’s not that crazy so she’s fine,’” Neal said. 

The separation is difficult and according to the Children’s Law Center, research does not show that the RTCs are helping the children. If anything, the isolation these children are forced to face decreases their quality of life and gets in the way of the children’s recovery. When children return to their communities, they have difficulty applying what they learned at RTCs in their homes.  Ultimately, children show no improvement in their mental health, according to the Children’s Law Center.  

What’s missing now is mental health care in communities, reports show. And, the Justice Policy Institute reports that as of 2009, only one private pediatric psychiatry specialist was available in in D.C.’s Wards 7 and 8. Most of the specialists are located in Wards 2 and 3, far away from the areas where most of the at-risk children live. Even though Medicaid covers mental health care, researchers have found the location of these clinics is a major impediment. 

“Part of the problem is that folks are not in the right place,” Brink said. “Transportation is technically covered by Medicaid to get to and from appointments, [but] when you’re a single mom and you have several small children and you don’t have a car and you’re trying to get your kids to numerous different appointments spread out across the city…trying to get services located within the community in places where kids are already is a good thing.”  Another concern, Neal said, is providing culturally appropriate services to the children in the community. 

“[East of the Anacostia] really is a different world,” Neal said. “There is a really big disparity between a lot of the people that live in D.C. that work in the government and make these huge incomes, and these people in the Anacostia.” 

But perhaps the biggest barrier for some children to receive needed mental health care is the Medicaid program. In D.C., some 90 percent of Medicaid youth are a part of managed care organizations, which implement Medicaid. D.C. has three managed care organizations – Chartered, UnitedHealthCare Program, and Healthcare for Children with Special Needs.  

So it can be confusing, and Medicaid money is often spent on pilot programs that never fully mature or play out, which can be a waste of money, according to a recent report by the Children’s Law Center.  

Even with the walls to success, Brink and Neal both said they believe the issue can be properly addressed. 

“The question is not only about money, it’s about using the money we have more wisely,” Brink said. “Reallocating resources, better coordination, putting services where kids and families can better access them, and using our federal dollars more carefully.”  Neal backed that, adding that: “[We should] focus on community strength, not just focusing on weaknesses or risk factors, but ‘how can we empower the strengths that are already there?’ People within those communities really want change, they do want things to be better, and we want to support them as much as possible because they’re really going to make a difference.”

Photo by Joyce Lee.

Joyce Lee is a reporter for The Chicago Bureau