Dear Mr. President, Mr. Vice President and Members of Congress:

The National Federation of Families for Children’s Mental Health is a national family organization linking more than 130 chapters and state organizations focused on the issues of children and youth with emotional, behavioral, or mental health needs and their families.  The National Federation is the only national organization focused exclusively on the needs of children and youth with emotional, behavioral and mental disorders. It is also the only national organization in the country comprised of a majority of parents and other caregivers with the lived experience of raising children with mental health challenges. The National Federation thanks the Administration for involving us in the dialogue concerning mental health in America, and allowing us to inform the Vice President’s Task Force on Gun Violence Prevention, based upon our real life experience. The National Federation’s motto is that Children’s Mental Health Matters! We know that mental health is essential to overall health and wellbeing.  We know that mental illness in children and youth is real and treatable.  Children and youth with mental illness and their families deserve access to services and supports that embrace values of acceptance, dignity and social inclusion. We are concerned about the absence of mental health in our public health agenda.

The President’s plan, Now is the Time, aimed at protecting our children and our communities by reducing gun violence, states that “Today, less than half of children and adults with a diagnosable mental health problem receive the treatment they need”. We know this is true, but we must deal with the real issue that children who have mental health challenges and their parents cannot access services without fear of public scrutiny, bullying, discrimination and even institutionalization.  There is a serious lack of education in our society surrounding children’s mental health needs.  These are not “bad” or “violent” children and young adults.  These are youth who need treatment and parents who need support in getting help early.  These children, youth, and families need to know where to go, which treatment is best, and how to access community support.  The isolation parents feel because of their children’s behavior, due to mental illness, keeps them from reaching out or even knowing who to trust for help.  There should be national outrage at the number of young people who die each year by suicide and drug abuse, or the number of children with a mental health diagnosis that go untreated, and the lengths parents go to just trying to keep their children safe and out of trouble.  This has to change in our nation if we are to adequately address the need for an improved children’s mental health care system.

The President’s plan calls for us to make our schools safe. Making our schools safe is a number one priority, but the National Federation would like to offer a word of caution about increasing police presence in schools. As a nation, we must learn that “more” does not equate to “better”. In an effort to ensure that our schools are safe, we should first assess the effectiveness of current school resource officers, before placing more officers into schools.  Schools are still one of the safest places that exist for our children. Placing more officers in schools is a very reactive response.  We should be PROACTIVE, and work to prevent violence from reaching our schools in the first place.  Expending our resources to react to violence does nothing to prevent violence from occurring.

In many states, resource officers are not employees of the school but paid by state and local governments to enforce city and county laws. These officers tend to be familiar with conflict and crime, rather than social and emotional well-being. Many school officers are not trained to work with children who may have experienced trauma or have other social, emotional, or behavioral health needs.  Because officers are not trained to deal with the student population, they may often escalate a situation rather than deescalate or solve the problem. One solution seems to be getting training, such as Crisis Intervention Team training, to resource officers.  Perhaps we should mandate that school resource officers participate in Youth Mental Health First Aid trainings so that they will be able to recognize the signs of someone who may be experiencing a mental health crisis.  Resource officers could be extremely helpful and effective if they were appropriately trained to work with children, youth, and emerging adults.  As one parent put it, “The emphasis should be on proper training for these resource officers and effective engagement in the IEP process so that they learn how to handle the youth.”

Positive Behavioral interventions and Supports (PBIS) make a difference in schools and are much more affordable than increasing the presence of police officers. If there are funds available to hire more school personnel, perhaps we should consider hiring someone who will be able to provide social and emotional support to students, or at least provide a safe space where students are able to discuss their emotions and feel supported.

The President’s plan also calls for improving mental health services.  The report states that “three-quarters of mental illness appears by age 24”, yet less than half of children with diagnosable mental health problems receive treatment”.  The National Federation offers the following recommendations to the Administration:

1)      Increase Access to Mental Health Services

As President Obama said, “We are going to need to work on making access to mental health care as easy as access to a gun.” Today, less than half of children and adults with diagnosable mental health problems receive the treatment they need. While the vast majority of Americans with a mental illness are nonviolent, several recent mass shootings have highlighted how some cases of mental illness can develop into crisis situations if individuals do not receive proper treatment. We need  to do more than  just keep guns out  of the  hands of people with serious  mental  illness; we need  to identify mental  health  issues early and help individuals get the  treatment they  need  before these dangerous situations develop.

Recommendation:

Increase access by requiring that all CMS and HRSA federally funded health care providers serving children and adolescents institute a standard procedure focused to screen for mental, behavioral, developmental and substance use needs. This includes primary care and pediatric physicians, health centers, hospital emergency rooms, school nurses at all levels, day care centers, etc.

2)      Integration of behavioral health and primary health care

HRSA states that behavioral health and physical health are inter-related and providing behavioral health care in a primary medical care setting can reduce stigma and discrimination, be cost effective and lead to improved patient outcomes.  Nearly 70 percent of HRSA-supported health centers provide mental health counseling and treatment; almost 40 percent provide substance abuse counseling and treatment; and close to 20 percent offer 24-hour crisis intervention services.  About 4,000 mental/behavioral health providers work in health centers.

Recommendation: 

a.       HRSA to establish policy and appropriate funding to provide timely access to needed mental health/behavioral services in 100% of health care centers.  To achieve parity, access to mental health care should be compulsory.

b.      HRSA to prioritize development of additional strategies to accelerate integration of behavioral health and primary health within existing programs.

c.       Integrated funding grants to stipulate collaboration with public mental health agencies and community based organizations representative of diverse racial/ethnic populations.

3)      Mental Health Parity and the Affordable Care Act

The Affordable Care Act will provide one of the largest expansions of mental health coverage in a generation by extending health coverage to 30 million Americans, including an estimated 6 to 10 million people with mental illness. The Affordable Care Act will also make sure that Americans can get the mental health treatment they need by ensuring that insurance plans cover mental health benefits at parity with other benefits.

Recommendation: 

a.       Essential health care coverage benefits must include an array of effective mental health services and supports appropriate for the needs of children, adolescents and their families.

b.      Prioritize development of core set of Child and Adolescent Quality Measures focused on preventive and integrated mental health and primary care

c.       Reporting on Child Health Care measures should not be optional for States.

The National Federation is pleased to see that the President’s plan will “launch a national conversation to increase understanding about mental health.” A national conversation about children’s mental health cannot be delayed and families must have a primary role in the discussion. This includes youth, young adults and family members with lived experience, who share their experiences of accessing mental health services, provide realistic lived views of how the system works and how it can be improved. Parents and caregivers play a principal role in the mental well-being of their children. They are the constant and lifelong supporters of their children. Families will be able to contribute to the conversation about their support needs and the need to break down the misunderstanding and stigma in society.  The time for a national conversation is now and parents and caregivers must be at the table.

The National Federation also recommends that a series of executive orders be put in place that address the need for including parents and support programs for parents in any mental health treatments for children.  Parent support assists parents to engage productively with service providers and community organizations. Using parent support reduces the use of high cost residential programs, produces better clinical results and increases school attendance for the children.  Lastly, it provides information and support for parents so they can “get back to work” rather than stay home to protect their child.  Some examples of executive orders that can help with this are:

In SAMHSA, add the language in Systems of Care Expansion Implementation Cooperative Agreements to include Parent Support Provider services to the types of activities designed to implement, expand, operate, and sustain systems of care.

• In CMS, identify the use of Parent Support as an allowable category of service whenever services are provided to a child with behavioral disorders
• In Maternal Child Health, require the use of Parent Support Providers in order to do outreach and follow-up with children at risk of emotional or mental health challenges.
• In Education, under IDEA and Part B, require the coordination or contract with the local family organization that represents/assists in parent support for children with behavioral health concerns.
• Establish an Interagency Children’s Mental Health Coordinating Committee, similar to the autism coordination committee established under 42 USC 280i-2, to coordinate the administration of programs in Education, HHS (including CMS), NIH and MIMH, with the input of experts in children’s mental health, including at least one representative of a family organization that provides Parent Support services, a national family organization with statewide chapters, and a youth organization with experience with youth support.
• Form a Children’s Mental Health Commission to review and expand on the New Freedom Initiative executed by President George W. Bush in February 2001. The final report, Achieving the Promise: Transforming Mental Health Care in America, was issued in July 2003.  Ten years later, there is still much to be done.  This Commission would provide an opportunity to bring together youth, parents, researchers, service providers and other expert stakeholders.  This Commission would have the experience, knowledge and data that could identify, address, and create solutions to today’s concerns related to safety in our schools and communities and improving mental health care for our children. The National Federation of Families for Children’s Mental Health, since 1989, has been the nation’s leading voice in children’s mental health.  Two of the members on President Bush’s New Freedom Commission were a part of our organization’s constituent base.  Through our organization’s work and partnerships, we stand prepared to respond and participate in the formation and work of a New Commission.

Lastly, it is the hope of the National Federation of Families for Children’s Mental Health that this Administration joins forces with our organization and others to educate the country about mental health. As this Administration moves forward with the plan to protect our children, we urge the President to make improving mental health care a part of every Address to the Union and the focus of any health care discussion by the White House. It is vital that the National Federation of Families for Children’s Mental Health continue to serve as a resource to the Administration as we bring the authentic voice of those living this experience.

Sincerely,

Sandra Spencer,

CEO, National Federation of Families for Children’s Mental Health