Children and youth with serious mental illness improve most when served
through community-based services, according to data released by the Substance
Abuse and Mental Health Services Administration (SAMHSA).
Children and youth treated by so-called "systems of care" spend
less time in inpatient care, experience fewer arrests, make improvements in
their overall mental health, and do better in school than before entering the
care system, the agency said.
A system of care for children's mental health is a coordinated network of
community-based services and supports designed for minors with serious mental
health needs. The approach places the children and their families at the
center of a partnership with public and private organizations to tailor
services that build on a child's strengths. Such approaches are also tailored
to cultural and linguistic needs.
"These programs can have a significant mental health impact on
children," said SAMHSA Administrator Charles Curie, M.A., in presenting
the data at the U.S. Capitol last month. "Ultimately, these programs
Federal support for such mental health services is provided through the
SAMHSA-run Comprehensive Community Mental Health Services Program for Children
and Their Families. Since its 1992 authorization, the program has funded 121
programs that were designed to transform treatment and care for children with
mental illness and their families.
The following are key findings for patients treated by systems-of-care
Sandra Spencer, executive director of the Federation of Families for
Children's Mental Health, said such programs implement the second
recommendation of the 2002-03 President's New Freedom Commission on Mental
Health to provide family-driven care for children with mental illness.
Spencer, whose son was diagnosed with bipolar disorder at age 4, said the
systems of care approach, when instituted in her home-town of Greenville,
N.C., encouraged local mental health and educational officials to design a
treatment with the family. The use of systems of care changed the approach
from a problem that needed to be isolated to an illness that could be cured,
Michael Fitzpatrick, executive director of the National Alliance on Mental
Illness (NAMI), said one of the strengths of systems of care is the creation
of local facilities at which children who display problems can receive a
mental health evaluation.
"We need more of our communities to develop effective systems of
care, and this will take more funding," Fitzpatrick said at the
He and other supporters of systems of care emphasized the fiscal advantages
of the approach to mental health to the audience, which included members of
Congress and their staff members.
Local programs that used the approach reduced the average number of
per-child inpatient hospital days, which translated into an average savings of
$2,777 per child, according to the SAMHSA data.
The average reduction in number of arrests per child treated in systems of
care within the prior six months provided an average per-child savings of
Additionally, emotional and behavioral problems were reduced significantly
or remained stable for nearly 90 percent of children after 18 months in
systems of care.
The data suggested that systems of care save taxpayers money when compared
with the traditional mental health service delivery systems, said Curie.
He said SAMHSA aims to expand the program but noted that in the present
budget climate, funds for federal support of new programs will come only from
cuts in programs deemed less effective.
"We are confident that if we don't make the case for these programs,
then funding will not be increased," Curie told Psychiatric
The SAMHSA data appeared to echo somewhat previous findings about the
cost-effectiveness of the systems of care approach, including a January 2005
Psychiatric Services study. That report, "Public Costs of
Better Mental Health Services for Children and Adolescents," found that
reduced expenditures in other sectors that serve youth substantially offset
the costs of improved mental health services.
The SAMHSA data were released as part of the first National Children's
Mental Health Awareness Day session on Capitol Hill to introduce legislators
and their staffs to the issues and beneficiaries of children's mental health
services. The sponsoring partnership, which includes the Federation of
Families for Children's Mental Health, NAMI, National Mental Health
Association, and National Association of Social Workers, brought numerous
mental health professionals, medical professionals, and people who were
treated when they were children together to highlight efforts to reduce
dropout rates, substance abuse, suicide, and incarceration among youth with
Information about community-based systems of care is posted at<www.systemsofcare.samhsa.gov/>.▪