President Obama unveiled new policies on Wednesday aimed at limiting gun violence, in the wake of the Newtown tragedy. It includes 23 specific Executive Actions. But only four of them have anything to do with increasing mental health care in this country. And the dollar amounts attached to each of those are paltry.
As the executive director of a nonprofit organization which works with at-risk teenagers and young adults, and with 32 years of experience in this field in three different states, I can tell you that the mental health system in this country is grossly underfunded and absolutely porous. And the president and his team should be paying particular attention to one aspect of the system that is indisputably broken, which those in my field call "The Cliff."
No, this is not the fiscal cliff we have all heard about endlessly the last few months. This is a very different cliff, which refers to the tragic situation of children receiving care and services in the mental health system but, when they turn 18, "age out" because they are now classified as adults. Logic would dictate that such individuals are then picked up and served by the adult mental health system, but that is very often not the case. The "bar" to receive mental health care suddenly jumps higher. The diagnosable and verifiable mental illness that a person had while under age 18 may not be considered serious enough to render him or her eligible for the adult system. Or their IQ may be a bit too high. In either event, the 18-year-old is suddenly left with nothing.
This is devastating for the 18-year-old and it is devastating for parents. I carry in my briefcase the testimony of parents whom I heard at a state hearing almost 10 years ago. They talked about the services and care their son received throughout high school, but, "All of this ended when he moved from youth services to adult services... Our son, and apparently many other kids like him, are being denied because of the way the current statutes are written for people like him."
In Vermont, where I work, the Department of Mental Health periodically produces a chart entitled, "Age of Individuals Served, Community Mental Health Programs." It is a bar graph showing the number of individuals receiving mental health care by age, starting at birth and going through age 95. This chart always shows the same thing: it slopes sharply upward through the teenage years, peaking around age 16-17, with almost 800 individuals receiving care at that age, and then sloping sharply downward, so that by age 19-20 there are less than 300 receiving care, a decrease of 63 percent. That is why we call this chart "The Cliff."
That is the scenario in Vermont, and to find out if it is indicative of the rest of the country I called Dr. Hewitt "Rusty" Clark, who is widely recognized as the national expert on this issue. He is the director of the National Network on Youth Transitions and co-author of the seminal work on this subject, "Transition of Youth and Young Adult with Emotional or Behavioral Difficulties," published in 2009. Dr. Clark confirmed for me that what we are experiencing in Vermont is very much the norm for the other 49 states. His book provides ample, overwhelming evidence regarding, "The complexities involved in traversing the huge chasm between child-serving and adult-serving systems," and that, "typically, child and adult serving agencies are fragmented across eligibility requirements, service delivery methods, and philosophies of service." His book makes another relevant point, that it is not only mental health care that comes to an abrupt halt at age 18. Depending on the state, there are disruptions in Special Education services at or around that age, services provided by the Juvenile Justice system, and the Child Welfare system.
So where are these young people ending up, and how are they faring? One nonprofit mental health director once tried to convince me that the chart showing the sudden drop-off of people served by the mental health system at age 18 was proof that the system was working, that these individuals were simply moving on to happy, successful and productive lives. "Go to our homeless shelters and prisons," I responded. "You are much more likely to find them there." And the data on that is overwhelming. The federal Substance Abuse and Mental Health Services Administration reports that 20 to 25 percent of the homeless population in the United States suffers from some form of serious mental illness. According to the Bureau for Justice Statistics, 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of jail inmates are suffering from mental illness.
Adam Lanza was age 20 when he took the lives of 20 children and six adults. It is hard for me not to wonder if he fit into that category of someone who did receive mental health care up until the age of 18, but then aged out and received nothing. If so, it's another example of a policy and practice which is misguided, inhumane and dangerous. And if this is not the case for Adam Lanza, it is still something extremely important for President Obama to fix in our country's very broken mental health system.
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