Minnesota’s Mental Health System for Children Needs Overhaul, Report Finds

Minnesota's mental health care system for children is "fractured," often provides care "too late" and "forces" parents to fight for treatment that is "guaranteed by law," a report on the public and private system for treating the state's estimated 72,000 children with mental illnesses found, the Minneapolis Star-Tribune reports. According to the "scathing report" conducted by the Citizens League, Minnesota's mental health program needs to undergo a complete system redesign. The report noted that 10 years after the state enacted the Children's Mental Health Act, which guaranteed "appropriate, consistent care" for children with mental illness, the "mission remains utterly unfulfilled." In addition, the report "sharply criticized" the state Department of Human Services, which commissioned the study, for not using the existing medical screening program operated through the state's public insurance programs, as only 6% of eligible children receive the medical check-ups. The report noted, "This is an ideal opportunity to screen 305,000 ... children and provide early intervention for those exhibiting signs of mental illness. And it is going to waste." Glennis Edwall, director of the children's mental health division at the DHS, said agency officials are "aware" of the problems but do not see DHS' mission as managing a statewide system of children's mental health care. Rather, DHS functions as a "safety-net" agency offering programs and services for those unable to afford treatment. "DHS has never been in the prevention business in any way," she said, adding, "But in terms of a safety net for kids and their families, that is DHS' responsibility."

Recommendations
To develop a more comprehensive and continuous system, the report suggested that the state award the Minnesota Health Department, a public health agency separate from DHS, the authority and finances to design a "public-health approach" to mental health, creating public education campaigns and screening programs to "identify children who need care." The review adds that without state leadership, citizens will "pay the price" through "drastically" lower graduation rates for children with mental illnesses, higher medical costs, drug abuse and an "increasing rate of teen suicide." While officials from both the state health department and DHS agree that "some government body must assume responsibility for children's mental health care," they do not necessarily support shifting oversight to MDH. According to the Star-Tribune, officials from both agencies are working together to revamp the system (Marcotty, Minneapolis Star-Tribune, 4/11). The report is available at http://www.citizensleague.net/studies/mental-health/children/report.htm.

First in the Union?
In other Minnesota children's health news, a Star-Tribune editorial is supporting a trial period for a bill that would "broaden the reach of public insurance programs" to make the state the first to offer universal coverage for children. Noting that the bill, sponsored by state Sen. Roger Moe (DFL), is moving through the state Senate but faces opposition in the Republican-controlled House, the editorial says the plan would reduce long term health care costs by offering "good preventive medicine" and remove some "roadblocks" to accessing care through the state's existing public health insurance programs, such as the state's six-month re-enrollment requirement for Medicaid. In addition, the bill would cap premiums at 5% of income and eliminate the payments for the poorest families. However, as the plan would cost $35 million annually, the editorial says Republicans are right to "ask hard questions" about the proposal. As Health Department surveys indicate the state programs have "room for improvement," the editorial says funds may be better spent by supporting neighborhood public clinics than by enrolling more children in "big insurance plans." Therefore, the editorial says the plan "should be phased in or tested, with the state measuring whether children actually get better health care in six months or a year after enrolling" (Minneapolis Star-Tribune, 4/8).