Taking John

A. Talbott,

Editor: M.D.

Editorial

Board:

C. Bell, M.D. Campbell, M.D. Maryjane R. England, M.D. Robert 0. Friedel, M.D. Jeffrey L Geller, M.D., MPH. Stuart L. Keill, M.D. Steven M. Mirin, M.D. Jose M. Santiago, M.D. James H. Shore, M.D. Miles F. Shore, M.D. George M. Simpson, M.D. Leonard I. Stein, M.D. Gail M. Barton, M.D., ex officio Carl

Magda

Interdisciplinary Advisory Board: Suzanne Dworak-Peck, A.C.S.W. Susan B. Fine, MA., O.T.R. Laurie M. Flynn Mary E. Johnson, M.A.LS. Frances Palmer, MS., O.T.R.IL. Sheldon Silk, MS. Gary R. VandenBos, Ph.D. Review Editor: S. Kesselman, M.D. Scarsdale, N.Y. 10583

Book

I 30 Garth

Martin Suite 501,

Road,

Contributing Editors: M.D., Audiovisual Overview Paul M.D., Law & Psychiatry Leona L Bachrach, Ph.D., The Chronic Patient Gene D. Cohen, M.D., Ph.D., Practical Geriatrics Wendy Davis, MEd., DSM-lVin Progress Richard Frances, M.D., Akohol & Drug Abuse James Randolph Hillard, M.D., Enuryency Psychiatry Samuel W. Perry III, M.D., Treatment Planning Carl Salzman, M.D., Psychopharmacology Steven S. Sharfstein, M.D., Economic Grand Rounds Kathleen Kannenberg, MA., O.T.R., James M. Karls, D.S.W., Sandra1lley, RN., MN., Gary R.VandenBos,Ph.D., Ian Alger, S. Appelbaurn,

Interdisciplinary

Update

Editorial Consultants: Leona L. Bachrach, Ph.D.

John 0. Lipkin, M.D. Theodore W. Lorei, M.S.W. Sally Webster,

Cover Art Consultant: Ph.D., New York City

Editorial Staff: 202-682-6070 Teddye Clayton, Managing Editor Betty Cochran, Assistant Managing Editor Joanne Wagner, Senior Assistant Editor Constance Grant Gartner, Assistant Editor Nancy C. Van Gorden, Production Editor Joyce S. Ailstock, Administrative Assistant Carolyn Rice, Secretary

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Frey, Director, Periodicals Advertising Production Beth Prester, Circulation Coleman Young, Fulfillment Elizabeth Flynn, Promotion

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Ronald

Hospital

K Street,

NW.,

and

Mental

Health

Care

for

Children

and

Adolescents

Children and adolescents in the U.S. suffer from fragmented, illogical, inefficient, and inadequate mental health care. Progress made under the community mental health movement is eroding. In the private sector, benefits are shrinking, and ever more restrictions are applied. The inadequacy ofpediatric identification and referral ofchildren with psychiatric disorders has been amply documented. Although virtually every mental health professional would agree that at times psychiatric hospitalization is the best option, far too many youth are hospitalized because of lack of outpatient or other alternative programs, insurance benefits that limit reimbursement to a hospital setting, or the eagerness of investor-owned hospitals to fill a surplus of beds. In rural areas, the lack ofaccessible child and adolescent mental health professionals often results in referral to a regional inpatient unit for an evaluation that should have been done on an outpatient basis. In the absence ofaftercare services, gains made during hospitalization are lost, or children who could have been returned to their families are placed in an institution. Except in the few states that require coverage for a continuum ofcare, insurance reimbursement patterns have blocked the development of innovative community-based day treatment services. We can no longer afford the financial and human costs offailing to care for mentally ill youth and their families. We desperately need a rational, integrated system of mental health care delivery, beginning with education of pediatricians and school and social service personnel to identify and refer children and adolescents. An efficient and responsive evaluation system and a full range of treatment services tailored to the needs ofeach child and family must be available. Necessary components include outpatient services, day, evening, and summer treatment programs, homeand school-based evaluation and treatment, respite placements, crisis intervention teams, and residential treatment facilities, as well as both shortand long-term hospital units. Coordination among mental health professionals, special educators, social welfare agencies, child protective services, and the juvenile justice system is essential. Most frustrating is the fact that cost-effective and clinically sound models already exist; examples are the Child and Adolescent Service System Program ofthe National Institute ofMental Health and the Robert Wood Johnson Foundation Mental Health Services Program for Youth. We must abandon parochial interests, interdisciplinary and interagency squabbling, and the practice of making excessive profits from the mental health care industry. We must educate policymakers if we are to turn the current crisis in health care into an opportunity to create the integrated and accessible system of services that our youth deserve.-MINA K. DULCAN, M.D., chiefofchild and adolescent psychiatry andassociateprofessor ofpsychiatry, Emory University School ofMedicine, Atlanta “

“

Classified

Michael Roy 202-682-6124 Washington, D.C. 20005

American Psychiatric Association: Joseph T. English, M.D., President John S. Mcln#{231}yre,M.D., President-Elect A. Shellow, M.D., Speaker. APA Assembly Melvin Sabshin, M.D., Medical Director

and Community

Providing

Issue

Psychiatry

Hospital published facilities keeping research advance

December

and Community Psychiatry, established monthly by the American Psychiatric and agencies concerned with the care with the association’s objectives to improve and professional education in mental the standards of all mental health services

1992

Vol.

43

No.

in 1950 by Daniel Blain, M.D., Association for staffmembers of mentally disabled persons, care and treatment, to promote health and related fields, and and facilities.

is of in to

‘ 169

12

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