A decade after West Virginia officials drafted a plan to connect much of the state’s mentally ill population with home and community-based services, the state hasn’t fulfilled its obligation to its youngest members, instead relegating them to psychiatric hospitals and other government facilities, a Department of Justice report determined.
An investigation released this week has found that, as of last December, more than 1,000 children with mental health conditions were living in residential treatment facilities — accounting for 25 percent of all youngsters in the custody of West Virginia’s Department of Health and Human Resources. That figure stands 10 percentage points above the national average. According to the report, state officials have placed more than 70 percent of children between the ages of 12 and 17 in these facilities, which cost taxpayers in West Virginia $67.5 million in fiscal year 2012.
“The state has needlessly segregated thousands of children far from family and other people important in their lives,” the report concluded. “With adequate services, the State could successfully treat these children in their homes and communities. The systemic failure to develop critical in-home and community-based mental health services also places children with mental health conditions who currently live in the community at risk of unnecessary institutionalization.”
The National Alliance on Mental Illness says that home-based mental health care — defined as resources based in a child’s home or community — helps youth and family members mold individual treatment plans in accordance with the child’s needs. Key players in this framework include family members, service providers, teachers, neighbors, and extended family. In previous surveys, families who used these types of services cited changes in their child’s behavior including improved school attendance and performance, positive peer and familial relationships, decreased substance abuse, and better control of one’s emotions — all factors that experts say pave the way for less involvement with law enforcement and the juvenile justice system.
In its 30-page report, the Justice Departments asserts that West Virginia could be pursuing more cost-effective methods of treatment and housing. The federal agency said the state could meet its obligation to mentally disabled youth — as outlined in the Americans with Disabilities Act — by eliminating unnecessary residential placements and cutting down on the time that children with mental disabilities are required to stay in facilities. The report also implored state health officials to expand in-home and community services for mentally ill children, particularly those with Medicaid who have limited access to services.
West Virginia has tried to move that direction recently. For example, state health officials launched support programs for pregnant women that help parents improve child-rearing skills. Through a federal waiver awarded to the state Bureau for Children and Families, West Virginia has also funded in-home mental health services for some children. Officials in the Justice Department’s civil rights division said that state government cooperation shows signs of change.
If West Virginia does go further in improving access to consistent, home-based mental health services, some advocates say that would involve cutting youth incarceration and bolstering other social service agencies that interact with affected populations. Right now, the state confines juveniles at a rate 42 percent higher than the national average, with youth as young as 10 in its detention centers and group homes. In the mountainous state, community therapy and substance abuse treatment programs are as far as 70 miles outside of one’s community, sometimes leaving judges little choice but to send youngsters to state facilities.
The issue goes further. In its policy report, child mental health organization KIDS COUNT said a dearth of social workers and family connections in the child foster care system preclude youth with mental disabilities who enter the juvenile justice system from living in the community. Even with funding for residential care, a weak case management system often keeps youngsters in government facilities for weeks and months on end. The welfare of children who identify as LGBT counted as another area of concern for advocates who pointed out that members of that population may have been exposed to trauma that goes unaddressed.
“There is a lack of substance abuse services, a lack of counseling, a lack of ability to have in-home services to maintain kids in the family,” Alan Moats, a judge in West Virginia’s Barbour County, told Slate last year. “So many times I will remove a child and place him in a facility, if they’re on the verge of doing bad things or getting into drugs. When they have structure, they thrive.”
Experts estimate that placing troubled youth in home-based programs would save West Virginia up to $70,000 per child.
If West Virginia officials need guidance in changing their policies, they can look to other states that have made headway in addressing these problems. At least eight states have banned youth incarceration for status offenses, misdemeanors, and some low-level felonies. Ohio’s government-funded RECLAIM program provides family therapy and substance abuse treatment to juvenile offenders. Georgia has always stepped up to the plate, allocating $1.6 million to grants that will help nonprofit and for-profit health care providers treat young people in the rural parts of the state.
The nudge from the federal government may help, too. This Department of Justice report follows a similar investigation examining some of the same issues with youth in Oregon. That investigation brought forth a 2012 plan to implement statewide mental health reform.