Mental Health: A Report by the Surgeon General

Children needing services are identified under the auspices of five distinct types of service sectors: schools, juvenile justice, child welfare, general health, and mental health agencies. These agencies are mostly publicly supported, each with different mandates to serve various groups and to provide somewhat varied levels of services. Many of these agencies arose historically for another purpose, only to recognize later that mental disorders cause, contribute to, or are effects of the problem being addressed. In the past, these sectors operated somewhat autonomously, with little ongoing interaction. Catalyzed by the NMHA’s Invisible Children’s Project (NMHA, 1987, 1993), the combined impetus of Federal policies and managed care more recently has begun to forge their integration.

Two recent review articles examined the characteristics of children served in public systems. Based on an appraisal of six prior studies, it was concluded that, in addition to emotional and behavioral functioning, these young people have problems in life domains such as intellectual and educational performance and social and adaptive behavior (Friedman et al., 1996b). Frequently, such children and their families have contact not only with the mental health system, but also with special education, child welfare, and juvenile justice (Landrum et al., l995; Duchnowski et al., l998; Greenbaum et al., l998; Quinn & Epstein, l998).

It is estimated that in a 1-year period more than 700,000 children nationwide are in out-of-home placements, mostly under the supervision of either the child welfare or to some extent the juvenile justice system (Glisson, 1996). Also, during the 1996–1997 school year more than 400,000 emotionally disturbed children and youths between the ages of 6 and 21 were served in the public schools nationwide (U.S. Department of Education, 1997). This is just under 1 percent of the school enrollment for ages 6 to 17, and 8.5 percent of all children with disabilities receiving any kind of special education service (Oswald & Coutinho, l995; U.S. Department of Education, 1997). These figures and percentages have remained relatively constant since national data were first collected about 20 years ago, although there are great variations between states. For example, in 1992–1993, 0.4 percent of school-enrolled children in Mississippi were identified as having a serious emotional disturbance compared with 2.08 percent in Connecticut (Coker et al., l998).

In addition to children with a serious emotional disturbance served by the special education system, children served by child welfare and juvenile justice systems also have need for mental health services (Friedman & Kutash, l986; Cohen et al., l990; Greenbaum et al., 1991, l998; Otto et al., l992; Glisson, 1996; Claussen et al., 1998), because they are much more likely to have emotional and behavioral disorders than is the general population (Duchnowski et al., 1998; Quinn & Epstein, 1998). Thus, the emphasis on interagency community-based systems of care is warranted and essential (see Integrated System Model).

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