11/15/2012 06:18 pm ET Updated Dec 06, 2017

Smart Investment: Children's Mental Health

Six months ago, I marked Children's Mental Health Awareness Day by releasing a plan to improve children's mental health in the District. The crowd at Children's National Medical Center heard from Tonya Johnson. Her son Danzell had been skipping school, threatening her with harm and staying out all night. Ms. Johnson asked for help from her son's school, from the police, from the District's Department of Mental Health, and from community programs. Each time she was told that the mental health services Danzell needed weren't available. Finally, she was connected with Youth Villages, which provided Danzell with multisystemic therapy, an intense in-home program. Now Danzell is getting good grades and thinking about his future.


Danzell and his mother at the launch event for our plan to improve children's mental health in the District, hosted by Children's National Medical Center

Danzell went without help for months, because there is a paucity of appropriate, high quality mental health services in the District. Extrapolating from national data, there are at least 5,000 children in D.C. who have unaddressed mental health needs. But there are probably many more, because a large percentage of D.C.'s children face conditions that are known to trigger mental health concerns: living in poverty, witnessing violence, and having a parent who suffers from depression. We have more than 50 lawyers on staff at Children's Law Center. Every single one of them has worked with at least a dozen children who needed mental health care but weren't getting it. The great need for scarce services leads to a tremendous capacity deficit in D.C.

Increasing capacity requires a financial investment. Now that fiscal year 2012 is over and its funds are all accounted for, the mayor, his administration, and the council will turn their attention to making any needed adjustments to the FY2013 budget and planning for FY2014. Our plan to improve children's mental health in the District is ambitious but purposefully very practical and recognizes that budget resources are scarce. Many of our recommendations -- like streamlining the structure of children's mental health care -- don't require new money. But it will take some additional funds to create a better mental health system for our children. We want the city's decision makers to keep children's mental health in mind as they allocate D.C.'s dollars.

The first place the District should invest dollars is in scaling up successful pilot programs that are Medicaid funded. The federal government pays the District 70 cents for every dollar spent on these programs. The Department of Mental Health has brought several promising programs to the District, including the multisystemic therapy Danzell received. The program has a proven record of success -- it is what evaluators call an evidence-based practice. But demand exceeds supply. Danzell was lucky to get into the program -- and he was at great risk while he waited to get in.

School-based mental health programs are another good investment. Currently, such programs exist in roughly a quarter of D.C. public schools. Councilmember David Catania's South Capitol Street Tragedy Memorial Act, passed in March, requires the expansion of school-based programs to half of D.C.'s public schools by the 2014-2015 school year and all schools by the 2016-2017 school year. To meet that goal, money must be allocated in this budget cycle for FY2014.

Mental health services for children have the greatest impact when parents, therapists, pediatricians and social workers work together. Although the District's Medicaid program does not currently reimburse professionals for the time spent meeting and talking by phone, it could -- and the federal government would pick up 70 percent of the cost. In an encouraging step, the Department of Health Care Finance has outlined a plan to draw down this funding starting at the beginning of FY2014. The D.C. Council should hold them to this timeline.

Upfront investment in children's mental health will save the District money over time. Danzell was headed toward dropping out of school with the all-too-likely detour into juvenile delinquency and, as an adult, unemployment and homelessness. The cost to the District for every high school dropout is an estimated $300,000 over a lifetime -- and that doesn't factor in the human cost. For Danzell and all the children in D.C. who need these services, funding mental health programs and building capacity is a smart investment.