Planting the seeds for an effective public mental health system
By Vivian Wong
Today is Earth Day, a day when communities come together to recycle, plant trees, and promote more eco-friendly daily routines—all in the name of protecting our environment. But what about protecting and strengthening our young minds?
Currently, more than 14 million children and adolescents live with a diagnosable mental health disorder. Mental health hospitalizations for kids have been increasing drastically, 80 percent higher in 2010 than in 1997, according to a study by the UCSF Benioff Children’s Hospital. In fact, nearly one in ten children who are hospitalized have a primary diagnosis of a mental health condition.
Due to this startling trend as well as tragic experiences like that of Virginia Senator Creigh Deed’s and his son, lawmakers have been focusing their efforts towards increasing psychiatric beds in hospitals throughout the country. While such resources can be integral for people living with mental illness in crisis, they do not address the greater issues that exist within our current mental health system. For transformative change to happen, we need to cultivate more sustainable solutions for mental healthcare that improve outcomes for young people long-term.
A Polarized System, With Few Options
Historically, the public mental health system has operated in a polarized fashion. At one end, youth living with mental illness are offered basic treatment options such as “couch therapy” and medication management. If those interventions are unsuccessful, as they often are, youth are either hospitalized or institutionalized in long-term treatment facilities or end up in juvenile hall. Public mental health systems offer limited, if any, options in between these two extremes. Over the last two decades, however, there has been a shift towards prioritizing development of intensive community and home based services and supports delivered through a more efficient and effective approach known as Wraparound.
Wraparound –A Sustainable, Long Term Strategy to Care
Wraparound is a method used to develop and deliver individualized behavioral health services and supports. These services are identified and implemented through a team-planning process that engages individuals who have stake in the well-being of the child, such as family members, service providers, and teachers. Through this process, the team identifies treatment goals and creates a comprehensive and coordinated plan of care, known as a Wraparound Plan, to achieve those goals.
Wraparound plans are highly individualized and focus on home and community-based services that emphasize the strengths of the child and his or her family. They involve a range of therapeutic interventions—formal and informal—that may include in-home behavioral support services, crisis planning and intervention, parent coaching and education, individual, family and group therapy, medication management, among other community-based services and supports. For example, if a young person’s mentor and football coach believes that playing football helps him manage stress, the Wraparound strategy respects that feedback and may incorporate it into the plan. Because Wraparound utilizes an integrated team that reflects each individual child’s world, everyone involved is inherently committed to the long-term success of the child.
How Do Wraparound Services Actually Improve Outcomes for Youth?
Wraparound is a more effective approach to serving children with unmet mental health needs. Studies have found that youth who receive Wraparound services are less likely to end up in psychiatric hospitals, residential treatment facilities, and juvenile detention centers as compared to those who are served within an institutional setting. Wraparound services are also linked to improved outcomes in school, fewer run-ins with law enforcement, and reduced suicide-related risk factors.
Not only are community-based services effective at improving outcomes for youth, but they’re cost-efficient, too. Mental health advocacy organizations such as the Bazelon Center and NAMI caution policymakers about the increasing use of hospitalization, citing high associated costs to both the admitted child and society at large. According to NAMI, experts tend to agree that at least 20 percent of the total cost of inpatient and residential services could be saved if Wraparound programs and intensive community-based services are available within public mental health systems. Another recent report found an average annual savings of $40,000 per child among State Medicaid agencies who provided youth with home and community-based services. Thus, these services provide a less costly alternative to hospitalization, and create an opportunity for reinvestment in expanding preventative care.
Sowing the Seeds for a Sustainable Mental Health System
In an ideal public mental health system, young people living with mental illness in crisis can receive hospital care without delay and mounting financial cost. However, this is just one aspect of a well functioning and sustainable system. If we channeled more attention towards community-based services, we could prevent many youth from getting to the point of needing hospital care in the first place.
Efforts are already underway to increase access to Wraparound for young people with serious unmet mental health needs. These efforts have resulted in significant reforms in several states, [See Katie A. (CA), J.K. (AZ), and Rosie D. (MA)] which have improved access to individualized, comprehensive, and community-based services. In the spirit of Earth Day, we as a stakeholder community should sow the seeds of a sustainable mental healthcare system for youth and prioritize Wraparound services.
- Reinvesting in the Community: A Family Guide to Expanding Home and Community-Based Mental Health Services and Supports by NAMI