BBAís reform road map
BY KRISTEN LOMBARDI
Ever since 1999, when state officials warned that demand for psychiatric beds for youth under 18 with acute mental illness had reached "near-crisis proportions," the stateís collapsing system of childrenís mental-health services has made banner headlines (see "Disorderly Conduct," News and Features, July 7, 2000). Yet despite media attention, the stateís fractious, multilevel mental-health system remains plagued by an urgent need for beds and a host of other problems.
Now, the Boston Bar Association (BBA) is throwing its weight behind the cause. Last week, the BBA released a 16-page report outlining the sorry state of mental-health services for Massachusetts children and offering five practical steps to address the systemís persistent problems. The study lays out a road map for making small, feasible improvements within the next 12 months.
Boston attorney Michael Blau, who heads the 64-person task force of lawyers, state administrators, legislators, and advocates that authored the report, considers the issue of childrenís mental-health care "one of the most socially worthy." The BBA, he explains, decided to examine the matter in 1999 mainly because the systemic problems have persisted for so long.
"These were truly intractable issues," Blau adds, "and theyíre having a profound effect on families." Blau and his fellow attorneys also saw the opportunity to advocate for what he calls a "vulnerable constituency." Mentally ill kids donít have much of a political voice on Beacon Hill. "By the BBA wading into the fray," he says, "itís given added visibility and importance to this situation."
Of the reportís five recommendations, one in particular cuts to the crux of the matter. Right now a plethora of state agencies ó from the Department of Mental Health to the Department of Youth Services and the Department of Social Services ó provides programs for mentally ill children. Yet they donít collaborate effectively, if at all.
"Itís ad hoc and scattershot," says Joshua Greenberg, a BBA task-force co-chair and director of the Boston-based advocacy group Health Care for All. Each agency has its own separate jurisdiction; thereís no centralized case manager helping a child. The BBA report calls for state departments to develop protocols defining who is responsible for what services. The policies, Greenberg says, "would create a more coherent system of care for kids."
Another recommendation that would offer direct benefits to children and families involves the creation of a guide to childrenís mental-health services. The how-to book would be designed as a reference tool for parents, pediatricians, school officials, and emergency-room physicians ó in short, anyone who might deal with a mentally ill child.
The final three recommendations ó to develop measures to hold the system accountable; to study how to connect mental-health services to pediatric clinics; and to draft legislation for collecting annual data ó arenít likely to have an immediate effect. But they are crucial first steps toward revamping the system. Notes Greenberg, "We tried to frame achievable goals that can be acted upon in the short term. An awful lot of time has been spent discussing the problems. These steps are ways to move forward."
Even if the task force implements its five steps this year, as it expects to do, the problems afflicting mental-health care for children wonít magically disappear. After all, the task force canít overhaul the entire state mental-health system overnight. Says Blau, "It will take a sustained effort to make any progress. We expect to be there."
A full copy of the BBA Childrenís Mental Health Task Force report is available on the BBA Web site at www.bostonbar.org/gr/adhoc/cmhreport2002.pdf
Issue Date: January 24 - 31, 2002
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