Child mental health policy

I N AN EFFORT TO highlight some of the proposed objectives for Healthy People 2010, this article will focus on one of the targeted areas: child mental health and mental disorders. In tracing the history of policy development in the area of child mental health services, the issues have by in large remained the same. Financing, access, quality, appropriateness of services, and service-system development have remained priority issues for clients, practitioners, and legislators alike. These issues differ little front the health policy issues that face all children. Although it is expected that most children will grow to be productive adults in our society, a significant number of children remain at risk of not meeting the challenges of the next century. For more than a decade, health care professionals have focused on children and families at risk. Research efforts have identified poverty as the factor most likely to put a person at risk for child abuse, teen pregnancy, drug abuse, and school failure. Given the dependent nature of children on their families, the status of family life in America today is an indicator of child well-being. The most notable trend putting youth at risk is the decline in the percentage of children living in a two-parent family (68%), with the greatest decline for African American youth (36%). For two-parent families, at least 76% have working parents (Federal Interagency Forum on Child and Family Statistics, 1999). Economic indicators, health and education indicators, as well as behavior and social indicators are also useful in monitoring the well-being of American children. Economic indicators impacting children have not changed since 1995. These include child poverty, secure parental employment, housing problems, and access to health care. In addition, the general health status of children, limitations in their level of activity, and immunizations have not improved, and the percentage of low birthweights has increased. Further, few behavioral and social environment indicators have changed. Cigarette smoking among young children and alcohol and illicit-drug use across all children and adolescents have not changed significantly since 1996. The percentage of young people who are victims of violent crimes has not declined, while the percentage of youth committing violent crimes has declined by 5% (Federal Interagency Forum on Child and Family Statistics, 1999). The consequences of combined risk factors are easily visible in American youth today. Newspapers are filled with stories of school shootings, child kidnappings, physical and sexual abuse, and serious neglect. It is estimated that 9.2 million youths are growing up with 4 or more risk factors, such as lack of health insurance, family below poverty level, and unemployed parents (Annie E. Casey Foundation, 1999). Most notable are neighborhood variables that exaggerate family vulnerabilities. As an example, poor city neighborhoods are most likely to have few community resources, the weakest schools, and high rates of violence, factors that discourage healthy family functioning. With this in mind, strategies designed to assist these youth and their families must be multidimensional. This means that they must address community, family, and economic factors that contribute to the vulnerable health status of the individual. There are approximately 13.5 million children and adolescents with mental or emotional disorders, with only one in five identified as needing treatment (American Association for Child and Adolescent Psychiatry [AACAP], 1999). Although