Mentally Disabled Children Getting Inadequate Care

Federal action is needed to investigate and correct a range of systemic problems affecting people with mental illness, including the increased use of detention facilities for mentally ill juveniles, according to a report by the National Council on Disability (NCD) released last month.

As part of its annual recommendations, the independent federal agency urged more creativity in program design, more accountability in measuring the impact of civil-rights compliance for people with disabilities, and greater cross-agency coordination in managing disability programs.

`Disturbing Evidence' Found

The report found “disturbing evidence” that detention facilities are increasingly used in a “warehousing role” for juveniles with mental illness. According to the report, two-thirds of juvenile detention facilities are holding youth primarily because appropriate mental health services are unavailable, not because the youngsters have been accused of or determined to have committed offenses.

“It is something that has been a growing problem,” said Martin Gould, director of research and technology for NCD. “We noticed it this year in part because of some of the legislation introduced around the treatment of children and parents having to give up their custody of children with mental health needs so the children could receive the services that they required but the parents couldn't provide.”

The report said its findings were based in part on those of a 2004 Department of Justice report to Congress believed to be the first national study on the issue. Its data came from survey responses from juvenile detention facility administrators. The NCD report said the problem appeared to have developed unnoticed over many years.

The NCD report recommended that Congress hold hearings on “the causes, extent, and, most of all, the potential solutions to this problem, and that the administration make it a priority to ensure that effective and accountable measures are put in place for steadily reducing and eliminating the use of incarceration for non-delinquent children and youth deemed in need of mental health services.”

Gould said other related problems include the federal effort to prevent and stop child abuse and punish its perpetrators. It is unclear the extent to which disability— defined by federal law as, in part, a condition that places “substantial limitation” on a major life activity—adds to the risk of child neglect or abuse, according to the report, but anecdotal evidence suggests that it does. “And few could doubt that maltreatment in early life can contribute directly to the occurrence or severity of disability, through the effects of emotional or physical trauma,” according to the report.

The NCD Web site describes it as an independent federal agency that makes recommendations to the president and Congress to enhance the quality of life for Americans with disabilities and their families. NCD's purpose, in part, is to “promote policies, programs, practices, and procedures that guarantee equal opportunity for all individuals with disabilities, regardless of the nature or severity of the disability; and to empower individuals with disabilities to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society.”

Statistics Undercollected

Although federal programs are increasingly responding to the problem of neglect and abuse by including provisions to prevent these through legislation, such as the Indian Child Protection and Family Violence Protection Act of 2004, NCD researchers found that statistics required by several federal laws are undercollected and underreported.

For example, “There are children with mental health needs and mental health issues who are part of the foster-care system who are being abused but that information is not being reported to Congress,” Gould said.

A federal law, the Child Abuse Prevention and Treatment Act, requires states to report child-welfare statistics. The lack of information, however, limits the effectiveness of tracking reports by the Administration on Children, Youth and Families, which is charged with reporting to Congress on child maltreatment issues.

“Certainly, no one wishes to increase paperwork requirements borne by states, by local law enforcement or social services agencies, or by other entities,” said the report.

Gould said it is unclear why the data are not being provided, which was part of the reason that the NCD recommended that the secretary of Health and Human Services review existing data-collection requirements to ensure required data are collected or that alternatives are found.

“If there are children and youth with disabilities who are being affected negatively and that info is not being reported to Congress, then Congress or the executive branch can't be expected to respond to those [concerns],” Gould said.

The report found incremental progress in some areas, although gaps in necessary services and supports continue to leave many Americans with disabilities undereducated and unemployed.

The report called for new allocations of responsibility among federal, state, and private-sector partners, including consumers. New criteria for measuring program outcomes are also needed.

“National Disability Policy: A Progress Report, December 2003-December 2004” is posted at<www.ncd.gov/newsroom/publications/2005/progress_report.htm>.▪