A MENTAL-HEALTH MAZE

Children's mental-health care in Massachusetts has been fragmented and incomplete for years. Now it's time to act.

Some 111,700 children will experience a "serious emotional disturbance" during the 2005 to 2007 fiscal years, according to an estimate from the state Department of Mental Health. But getting mental-health care for children can be like walking through a maze of doors. Parents knock, but they're told to go to another door. Or worse, no one knocks, and untreated mental illnesses fester.

Some of these issues are being addressed by the Rosie D. lawsuit. In January, federal district court Judge Michael Ponsor ruled that Massachusetts had violated Medicaid laws by failing to provide home-based care for 15,000 children with psychiatric disabilities. This will lead to reforms for children covered by Medicaid. But the state needs sweeping change for all children.

"The time has come for bold vision and systemic change," a new report says. All children should get timely, first-class care. Anything less is unacceptable. Written by officials from the Massachusetts Society for the Prevention of Cruelty to Children and Children's Hospital Boston, the report calls for an interagency council that would have the governor's ear and that could enact sweeping change across agencies statewide. It's compelling work for Governor-elect Deval Patrick and the Legislature. The report sets the stage for a bill to be filed in January.

The bill would give responsibility for these issues to the Department of Mental Health, putting it in charge of setting statewide standards for care. The bill would increase staff and step up prevention. As with community policing, the strategy is to shift from a largely reactive system to one that can anticipate needs and meet them quickly.

With this new focus, the department could promote promising programs. One example is a Medicaid-funded program that lets pediatricians make phone calls to get psychiatric consultations about patients. Children's Hospital runs a similar call-for-help program in 15 schools that's popular with teachers. It's a resource that all the state's schools should have. The department could also better ensure quality across the board, so that children in foster care, those detained by the Department of Youth Services, and those with private insurance would all get good care.

The challenge is to reach children and families wherever they are: schools and doctors' offices, but also in their communities. It's a way to increase access and ease the stigma that keeps people from seeking help.

If there is no progress on children's mental-health care promptly, Massachusetts will have failed, and children will lose.

-Boston Globe Editorial, November 29, 2006

11/06