Georgia's failed children's mental health system
Atlanta Journal-Constitution articles highlight the need for major reform
A record number of child suicides. Children whose parents can’t get them the residential treatment they need for serious mental illness. Kids stuck in emergency rooms because there are no treatment facilities for them. These are some of the major issues facing Georgia’s system for treating children with mental illness, as my fellow Duke Chronicle alum Carrie Teegardin is writing about in a series of articles out this past week in the Atlanta Journal-Constitution. I’d add to that list of issues children abandoned to foster care because their parents can’t get them the treatment they need. I highly recommend you read the series.
There are solutions to this problem. I’d point out three possibilities right here:
Getting rid of the “Institution for Mental Disease” (IMD) exclusion from Medicaid, which severely limits Medicaid funding for residential mental health treatment other than that provided in a hospital.
Children and youth under 21 can receive mental health treatment paid for by Medicaid only in a specialized, short-stay hospital. As a result, there are few residential mental health treatment facilities for children and youth. The problem is baked-in to the Medicaid law. As a recent article explains it:
“When Medicaid was established in 1965, it explicitly prohibited states from receiving Medicaid payments for Institutions of Mental Disease (IMDs), which the law defines as “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.”
At the time, the intention behind the IMD exclusion was to disincentivize institutionalization of mentally ill individuals, following widespread outrage over patient abuse in the asylum system, and replace it with a system of community mental health care.
Such a system never materialized and the exclusion has made it difficult for patients to access mental health care nationwide, which in turn has led many severely mentally ill individuals into homelessness.”
For adults, the IMD exclusion completely prohibits facilities of more than 16 beds from billing Medicaid for mental health treatment. In my opinion, along with the rights to refuse treatment that our courts have created over the past 50 years, it’s a major reason there are so many seriously mentally ill homeless folks on the street.
Congress needs to get rid of the IMD exclusion. With Medicaid available to cover treatment, the free market will help create more treatment facilities. There are administrative ways to get around the IMD exclusion, as well. For children or adults, the federal Medicaid authorities have in states such as Montana authorized waivers from the IMD exclusion. Georgia’s Department of Community Health should apply for one.
Expanding the mental health services provided by Medicaid
Georgia’s Medicaid plan doesn’t fully cover the wide range of mental health services that children need. The Department of Community Health, our Medicaid agency, should work to expand those Medicaid-covered services to include high-fidelity wraparound (currently available from limited providers), therapeutic foster care, behavioral aides, targeted case management, and other intensive services that can keep a child at home and out of crisis.
Creating an intensive care coordination benefit.
In addition to adding more services to the Medicaid Plan, the State should consider obtaining other Medicaid waivers — such as the 1915 home and community-based services option or the 1115 demonstration waiver — to create a specialized benefit package for children with very high mental health needs. States such as Wyoming have successfully obtained such a waiver, and it would complement the new “Multi Agency Team for Children” with complex needs that was revived by HB 1013 in the last legislative session.
Those are just a few suggestions. I’m hearing that our General Assembly will focus on reforming children’s mental health this upcoming session. Keep your fingers crossed.
What ideas are we missing? If you have suggestions on improving mental health treatment for Georgia’s children, let me know!
In other news:
Here’s an op-ed I missed from this past summer that asks whether it’s ethical to put pictures of children free for adoption out there on the Internet for anyone to look at.
Michigan expanded its definition of “relative” to include fictive kin and is requiring children’s court attorneys to go through trauma-informed training.
Don’t scare the children! You might lose your job.
GREAT ARTICLE.