Inadequate State Children’s Mental Health Structure Hampers Opportunities for Improved Care, Study Says

Survey of State Mental Health Directors Points to Workforce,
Accessibility and Stigma concerns

WASHINGTON–(BUSINESS WIRE)–State agencies charged with the treatment of children who have mental
health and substance abuse conditions are missing out on opportunities
to improve care. They are unable to capitalize on chances to advance
prevention, care coordination and integration with primary care,
according to a national survey of state agency directors, being released

The 48 children’s mental health directors (from 46 states, one
territory, and Washington, DC) surveyed offered an uneven picture of
poorly organized state agency structures.

The first of its kind, the findings from the “National Survey of
Children’s Mental Health Directors: Current Status and Future
Directions,” are published in the latest issue of The Journal
of Behavioral Health Services & Research (JBHS&R)
is published by the National Council for Behavioral Health, an
association of 2,800 mental health and addiction providers, and Springer.

“The directors we surveyed are concerned that children’s services are
thought of as an ‘afterthought’ and often driven by adult behavioral
health services,” said study author Dr. Mario Hernandez, PhD with the
University of South Florida (USF) in Tampa.

Survey respondents reported concerns related to three main areas:

Workforce capacity– there is a scarcity of “highly qualified
providers, overall workforce shortages and insufficient state supported
technical assistance to the workforce.” According to the study, “without
sufficient financing or opportunities for career advancement it is
difficult to keep qualified workers in the public sector.”

Accessibility and availability of services– the workforce
shortage has resulted in a dearth of services. Interestingly,
Medicaid-eligible families “have access to a broader array of children’s
mental health services and supports than privately insured families.”
The out-of-pocket costs for people covered by private insurance make
obtaining mental health services “prohibitive.”

Stigma/lack of public awareness– “stigma of mental illness is
still alive and well,” and children are affected because the “shame and
responsibility felt by parents often prevents early identification and
treatment.” The directors urged increased public awareness and
understanding about mental illnesses as a key factor to increasing
access to services.

The state children’s mental health directors surveyed by the USF team
also cited a lack of data and quality assurance systems, interagency
collaboration and coordination as concerns affecting the quality of
children’s mental health services.

“What’s lamentable is that more attention and money is given to adult,
than children’s, services. As a result, there’s scant attention to early
intervention when we know that works well for kids,” Dr. Hernandez added.

ACA Implementation
Poorly organized state children’s mental
health offices have created a dichotomy when it comes to implementation
of the Affordable Care Act (ACA).

A substantial majority of the directors (81%) perceives significant
opportunities to improve accessibility and availability of services
through reform in two notable areas: expansion of Medicaid eligibility,
and inclusion of mental health services as an Essential Health Benefit
on private health insurance plans.

Directors also see opportunities for greater integration of behavioral
health and primary care such as the training of pediatricians on how to
identify mental health conditions in their young patients, and including
behavioral health consultants within pediatric offices.

Yet, for all the promise of not only the ACA, but also the Mental Health
Parity and Addiction Equity Act, barriers to progress remain due to
political and cultural resistance to reform.

The country is essentially split when it comes to states planning for
implementation of the ACA, and those that are not. One hundred percent
of directors in the east and 91% of those in the west are planning for
implementation. Directors in the midwest and south (42% and 39%,
respectively) however, are not making such plans. The result is that
only about two-thirds (67%) of directors are planning to leverage the
law’s benefits.

“The stark reality is that at a time when one half of American youth
experience a mental health disorder, 50-70% of which never receive
services, children in some states will have a mental health safety net,
and many will not,” Dr. Hernandez said.

The survey of state children’s mental health
directors resulted from 17 online, closed and open-ended questions
administered by Qualtrics, a web-based survey program. USF
utilized The National Association of State Mental Health Program
Directors’ established regions to identify the mental health directors
of all 50 states, 1 U.S. territory, and Washington, D.C. The survey was
administered between September 2013 and March 2014.

The Journal of Behavioral Health Services and Research (JBHS&R)
is a quarterly, peer-reviewed, multidisciplinary journal that publishes
articles on the organization, financing, delivery, and outcomes of
behavioral health (including mental health, alcohol, and drug abuse)
services. It is the official publication of the National Council for
Behavioral Health. To learn more about JBHS&R, visit

The National Council for Behavioral Health is the unifying
voice of America’s mental health and addictions treatment organizations.
Together with 2,800 member organizations, serving 10 million adults,
children and families living with mental illnesses and addictions, the
National Council is committed to all Americans having access to
comprehensive, high-quality care that affords every opportunity for
recovery. The National Council was instrumental in bringing Mental
Health First Aid to the USA and more than 500,000 individuals have been
trained. In 2014, the National Council merged with the State
Associations of Addiction Services (SAAS). To learn more about the
National Council, visit


National Council for Behavioral Health
Aaron Cohen, 301-633-6773