Running head: ISSUES IN CHILD MENTAL HEALTH POLICY 1 Analysis of the Issues in Child Mental Health Policy of the United States Problem Statement Two-thirds of the twenty percent of young people in the United States that suffer from mental disorders lack access to treatment that would improve their ability to get an education, complete it, and enjoy the various opportunities available in the country. The current situation of the management of the mental health problems of children and adolescents in the country requires a comprehensive policy to prevent its impact on the rise of juvenile crime rates, labor shortages, and other social problems. ISSUES IN CHILD MENTAL HEALTH POLICY 2 Annotated Bibliography Alegría, M., Green, J. G., McLaughlin, K. A., & Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the US. A William T. Grant Foundation Inequality Paper. In this article, the authors studied the increasing rate of inequality in mental health services in the context of the causes of the problem and effectiveness of current interventions to end specific disparities. Alegría, Green, McLaughlin, and Loder (2015) stated that despite the progress made in some areas of the health services industry in the country, young people with mental health problems from minority group still lack access to these services. They recommended that researchers and policymakers should endeavor to design and develop interventions that would contribute to improving the conditions of children and adolescents with mental problems. An evaluation of the integrity and value of this article showed that the authors’ extensive review of the literature and dependence on data and figures on topic enhanced its quality. It is this reason and several others including the quality of the content that would make it a valuable source of reference for the proposed paper. Bui, A. L., Dieleman, J. L., Hamavid, H., Birger, M., Chapin, A., Duber, H. C., ... & Murray, C. J. (2017). Spending on children’s personal health care in the United States, 1996-2013. JAMA Pediatrics, 171(2), 181-189. Health care spending in the United States has been a contentious issue because of the lack of information on the distribution of the cost to the various population groups. In this article, Bui and colleagues reported the findings of a review of aggregate health care spending from 1996 to 2013 in the country, which showed that spending on mental disorders for ISSUES IN CHILD MENTAL HEALTH POLICY 3 children was the second largest. The implication of this study is that despite this huge spending on ADHD for children, policymakers still have a long way to go regarding access to treatment and reduction of the impact of the condition on patients. This source is an important one for understanding the economic and financial dimension of the problems with the health policies in the country. Also, the validity and credibility of the data would enhance the quality of the recommendations proposed in the paper Cuellar, A. (2015). Preventing and treating child mental health problems. The Future of Children, 25(1), 111-134. Allison Cuellar wrote that the “policies and programs of the United States regarding the children with mental illnesses are fragmented and uncoordinated thereby making the benefits derivable from them unavailable. She argued that mechanisms of the treatment systems are not designed to be preventative or have long-term effects on the issues associated with the condition. Therefore, the rate of child mental health problems is increasing without effective strategies to reduce their impact on the quality of life of these patients. The reason for the selection of article as a reference for this paper is based on the various points and data used by Cuellar (2015) to support the information provided. Also, it is credible source since it relied on relevant and current literature to support the arguments presented in the article. Cummings, J. R., Wen, H., & Druss, B. G. (2013). Improving access to mental health services for youth in the United States. Jama, 309(6), 553-554. The need to critically examine the mental health treatment system in ways that would lead to policies that ensure increased access to them by communities with the right infrastructure is the focus of this article by Cummings, Wen, and Druss (2013). The authors argued that ISSUES IN CHILD MENTAL HEALTH POLICY 4 current gaps as evident from data from the 2008 mental survey are an indication that the nation needs to more regarding the infrastructure for community services as stipulated by the law. They concluded that a review of the implementation protocol is required to solve the problems of shortages of MH providers, stigmatization, and treatment centers for this demographics of health consumers. In my opinion, this article is a valuable source of information for understanding the factors responsible for the failure of the policies to achieve the desired impacts. It would enhance the quality of the proposed study in several ways. Fajardo-Bullón, F., Rasskin-Gutman, I., Felipe-Castaño, E., Ribeiro dos Santos, E. J., & León-del Barco, B. (2017). Analysis of Predictive Factors on Minors’ Mental Health According to the Spanish National Health Survey. Brain sciences, 7(10), 135. The authors of this article focused on the high incidence rate of children’s mental health problems through an analysis of the factors that result in these conditions. FajardoBullion et al. (2015) conducted this research on Spanish children through the examination of the social determinants of the conditions and their role in its exacerbation. The researchers concluded that the design of health policies and programs should integrate the care systems used for children from poor occupational and health backgrounds. Also, the instruments used for the conduct of the project were standardized and universal thereby making the findings as credible as possible. It is this reason and several others that influenced the decision for the inclusion of this article as one of the references for the research paper/ Garland, A. F., Haine-Schlagel, R., Brookman-Frazee, L., Baker-Ericzen, M., Trask, E., & Fawley-King, K. (2013). Improving community-based mental health care for ISSUES IN CHILD MENTAL HEALTH POLICY 5 children: Translating knowledge into action. Administration and Policy in Mental Health and Mental Health Services Research, 40(1), 6-22. In this article, Garland et al. (2013) conducted a selective review with the objective to highlight and synthesize existing knowledge on the measures required by the public health system of the United States to ensure that its strategies are achieving the desired results. The result of the study is a multi-level framework that can lead to improvement of treatment targets and evidence-based practices. They concluded that community-based mental health care for children and their families is an imperative that should be considered by policymakers and stakeholders in the development of policies and programs. This reference is credible one for the formulation of recommendations for the determination of measures that can lead to resolution of the issues that surround children mental health. Harper G. (2012). Child and adolescent mental health policy. In Rey JM (ed), IACAPAP eTextbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Harper (2012) wrote that the “public policy for children mental health should address the disparities that could prevent the children from attaining their full potential in life circumstances, endowment, and services. He argued that the most appropriate measures for understanding the sources of the problem include the consequences of the disparate endowment, life circumstances, and effectiveness of the interventions. Although these approaches are included in most of the policies and programs used for managing the issues of child and adolescent mental health, the results of the treatment systems have yielded minimal benefits. While the credibility and integrity of the information contained ISSUES IN CHILD MENTAL HEALTH POLICY 6 in this article can be ascertained, its primary purpose for the research paper is to contribute to the evidence used to support the viewpoints of the author. Kutcher, S., & McDougall, A. (2009). Problems with access to adolescent mental health care can lead to dealings with the criminal justice system. Paediatrics & child health, 14(1), 15-18. Kutcher, S., & McDougall, A. (2009) examined the issue of mental disorders in young people from the dimension of its role in the increasing rate of juvenile crimes in this article. The scholar noted that the failure of the public health system to provide the required services for dealing with this problem in the youth population is responsible for the over 70% of young offenders that have mental disorders. They concluded that a combination of social, legal, and medical interventions is urgently needed to address the problem. An analysis of the quality and relevance of the information in this article to the credibility and integrity of the research paper showed that the authors’ extensive review of the literature on the connection between mental illness and potential for crime is the reason for its inclusion in the list of references. Also, the capacity of the content to provide insights to both the short- and long-term impact of mental illness in children is an added value. McMorrow, S. (2010). State mental health systems for children: A review of the literature and available data sources. This analytical review of the literature and data sources on the performance of state governments in the management of healthcare policies and programs for children’ s mental health showed huge gaps in the various elements of the initiatives. McMorrow (2010) noted that “children are clearly not immune to the challenges of mental illness and they share many of the difficulties of their adult counterparts in accessing effective services.” Therefore, ISSUES IN CHILD MENTAL HEALTH POLICY 7 he concluded that despite belonging to the vulnerable population, these children need better healthcare, educational, and social outcomes to succeed as adults. A measure of the integrity and value of this article showed that the authors’ extensive review of the literature and dependence on data and figures on topic enhanced its quality. It is this reason and several others including the quality of the content that would make it a valuable source of reference for the proposed paper. Primer, A. (2011). Mental health financing in the United States. Kaiser Commission on Medicaid and the Uninsured In this report, Primer (2011) stated that the complexity of the system used for the management of the various funding sources for mental health and substance abuse services in the United States is the leading cause of the challenges experienced by policymakers in formulating efficient policies. The authors conducted a detailed examination of the issues through an analysis of the mechanisms used for funding the system. Furthermore, the report concluded that the best approach for resolving the policy problems in financing mental health care services all levels in the country is through a complete modification of the complex systems that cater for the resources used for the most vulnerable individuals. While the credibility and integrity of the information contained in this article can be ascertained, its primary purpose for the research paper is to contribute to the evidence used to support the viewpoints of the author. ISSUES IN CHILD MENTAL HEALTH POLICY 8 References Alegría, M., Green, J. G., McLaughlin, K. A., & Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the US. A William T. Grant Foundation Inequality Paper. Bui, A. L., Dieleman, J. L., Hamavid, H., Birger, M., Chapin, A., Duber, H. C., ... & Murray, C. J. (2017). Spending on children’s personal health care in the United States, 19962013. JAMA pediatrics, 171(2), 181-189. Cuellar, A. (2015). Preventing and treating child mental health problems. The Future of Children, 25(1), 111-134. Cummings, J. R., Wen, H., & Druss, B. G. (2013). Improving access to mental health services for youth in the United States. Jama, 309(6), 553-554. Fajardo-Bullón, F., Rasskin-Gutman, I., Felipe-Castaño, E., Ribeiro dos Santos, E. J., & Leóndel Barco, B. (2017). Analysis of Predictive Factors on Minors’ Mental Health According to the Spanish National Health Survey. Brain sciences, 7(10), 135. Garland, A. F., Haine-Schlagel, R., Brookman-Frazee, L., Baker-Ericzen, M., Trask, E., & Fawley-King, K. (2013). Improving community-based mental health care for children: Translating knowledge into action. Administration and Policy in Mental Health and Mental Health Services Research, 40(1), 6-22. Harper G. (2012). Child and adolescent mental health policy. In Rey JM (ed), IACAPAP eTextbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. ISSUES IN CHILD MENTAL HEALTH POLICY 9 Kutcher, S., & McDougall, A. (2009). Problems with access to adolescent mental health care can lead to dealings with the criminal justice system. Paediatrics & child health, 14(1), 1518. McMorrow, S. (2010). State mental health systems for children: A review of the literature and available data sources. Primer, A. (2011). Mental health financing in the United States. Kaiser Commission on Medicaid and the Uninsured. ISSUES IN CHILD MENTAL HEALTH POLICY 10 BACKGROUND AND LANDSCAPE Youth mental health is a crucial part of the health of the United States general population. As important as health gets, especially for the young people, there is a conspicuous lack of policy to allow access to health services at affordable rates in the country. According to Harper (2012), 17-20% of the youth in the country develop mental health issues at some point in their lives. Furthermore, 70% of mental disorders develop before the age of 25. This makes the youth and children the most vulnerable groups when it comes to mental health issues in the country. Therefore, it is evident that the lack of elaborate policies governing their treatment and access to care jeopardizes the future of the youth in the country. The high levels of mental health issues developing among the youth make it necessary to look into policies that will ensure that the youth is considered in the development of preventive and treatment initiatives addressing mental health. The effects of mental illnesses on any particular subset of a population are devastating. If left untreated, mental disorders can affect all aspects of health including emotional well-being and social development. The adverse effects on the developmental needs of children bar the children from reaching their social goals and thus curtails their abilities to interact socially with others. The results of such developmental retardation include stigmatization, social isolation, and could even be depressive to the youth. On the contrary, addressing the issues of mental illnesses early in life, a significant reduction of emotional and behavioral problems, functional impairment, and contact with law enforcement are realized (Harper, 2012). There is a huge gap between individual organizational efforts and the policy implementation on a national level. Therefore, policy development to address youth mental issues is necessary to allow the affected population to access the required care. ISSUES IN CHILD MENTAL HEALTH POLICY 11 The percentage of the youth seeking out-patient mental health services in the U.S has been on the constant increase. Between 1996 and 1998, 9.2% of youth in the country sought outpatient mental health services. This number increased to 13.3% between 2010 and 2012. The increase in number of youths with less severe or no impairment at all was the highest, but those with the severe ailments formed the bulk of those seeking outpatient care. From this information, it is evident that the number of youth who are seeking mental health care is constantly increasing. That goes to show that there is an emerging need to put policies and initiatives in place to solve the issue at hand. Further, according to Primer (2011), there is a complicated system for the management of mental health funding in the U.S. This system has limited the ability of policy-makers to come up with effective policies that could be utilized. The number of children experiencing mental disorders in the country is very high. Similarly, over 70% of young offenders who are incarcerated have mental health problems. In 2010, approximately 70800 young offenders were in incarceration. Doing the math, it is evident that mental health disparities may be blamed for the increased number of young offenders. Garland et al. (2013) discovered that there is a huge lack of child-dedicated mental health facilities and policies in the country. Essentially, this leaves the youth vulnerable. To show the gap that exists in youth mental health care, suicide is the third leading cause of death among the youth, and 90% of those who die by suicide have underlying mental issues. This goes to show that there is an acute need for attention to the issue. Several factors have to be considered when it comes to developing policies addressing the youth and mental health. The leading factor is the financial approach to the development of elaborate policies addressing children and youth mental issues. The Congressional committees on finances are the main players in the factor of financial approach. The mental health policies ISSUES IN CHILD MENTAL HEALTH POLICY 12 have to be handled from the national government perspective which forms the foundation for deploying initiatives funded by the Federal Government. The number one determinant of the efficiency of any policies that could be formulated and initiatives is the funding of those initiatives. More investment in preventive care is required to ensure that the less severe cases are diagnosed early in life and managed to allow the leading of a normal life and reduction in disruptive behavior. The financial factor also has to consider the affordability of the care to different subsets in the society. The other category of factors to consider when developing such policies is the social factors that affect the possible formulation and implementation of the policies. The first social issue that is significantly affecting the health of the youth in the country is the racial minority access to care. According to Lau et al. (2012), health disparities across racial identities are amplified among the youth with the majority of Latino youth lacking personal doctors and African-American youth lacking access to particular medication in the past. This evidence serves as just the tip of the iceberg when the overall disparities in access to healthcare are reviewed. Therefore, this guides to the need for the presentation of initiatives to ensure the equality of access to mental health policies. This approach would allow racial minorities to access care at the same level with majorities and close the gap between the quality of care provided to the two sides. Another social factor to consider when developing mental health policies for children and the youth is the family relationships and the care provided to children. Garland et al. (2013) advance that one issue that mostly contributes to or worsens mental disorders in children is family instability. This refers to the lack of parental guidance or depression arising from family problems. This issue might affect the health of the children adversely. Therefore, there is the ISSUES IN CHILD MENTAL HEALTH POLICY 13 need to consider this factor when developing policies. Without preempting what could be done, the policies must ensure stable care for youths that may be undergoing treatment for mental issues. The approach is aimed at ensuring that the cases of recidivism are minimized. Family relationships also affect the access to health care and medication. Away from social and economic factors, it is necessary to consider the political approach to such policies. Political approach to health care issues essentially involves the political factions in the Congress regarding various policies. Here, the politicians who are situated in the Congress are the leaders of the policy-making process. With the political disagreements on various healthcare issues including the Affordable Care Act repeal attempts, political divisions may cloud the process of policy-making. Therefore, in the development of policies, the numbers on either side of the political divide matter. Policy presentation in the House and adoption mainly depends on the political duel existing among the legislators. Therefore, the bottom line in presenting policies that must be approved by the Congress is to ensure that the policies are acceptable by the majority. On the contrary, this may jeopardize the credibility and efficiency of the policies including slowing their adoption. Statistics show that mental health care for children is underfunded. According to Primer (2011), the spending for mental healthcare is easily diverted to other healthcare spending needs due to the complexity of the system to source and account for funding. This shows a financial factor to consider. Regarding the social factors involving racial disparities, Lau et al. (2012) found out that racial minorities were three times less likely to access mental health care than nonHispanic whites in the U.S. these factors point towards the need to evaluate the methods that policy development could be adopted to address children mental health care. ISSUES IN CHILD MENTAL HEALTH POLICY 14 References Garland, A. F., Haine-Schlagel, R., Brookman-Frazee, L., Baker-Ericzen, M., Trask, E., & Fawley-King, K. (2013). Improving community-based mental health care for children: Translating knowledge into action. Administration and Policy in Mental Health and Mental Health Services Research, 40(1), 6-22. Harper G. (2012). Child and adolescent mental health policy. In Rey JM (ed), IACAPAP eTextbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Lau, M., Lin, H., & Flores, G. (2012). Racial/ethnic disparities in health and health care among US adolescents. Health services research, 47(5), 2031-2059. Primer, A. (2011). Mental health financing in the United States. Kaiser Commission on Medicaid and the Uninsured.
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