· Mental illness affects one in every five young people at any given time. To reduce the risk for developing disabilities, all these children should be identified and receive the help they need to develop normally.
· One in ten Alaskan young people experience emotional problems so severe that their functioning is impaired.
· In 1992, an estimated two-thirds of Alaskan young people with mental health problems were not getting the help they needed.
· Many of the children under 18 with a serious emotional disturbance who receive mental health services may be receiving inappropriate services.
· Between 14,000 and 15,000 Alaskan young people experience serious emotional disorders, but only 5,500 receive treatment.
· Alaska has one of the highest rates of substantiated cases of child abuse and neglect in the nation.
· Alaska's teen suicide rate is the fourth highest in the nation.
· In the past ten years, arrests of Alaskan juveniles for violent crimes have increased 268 percent.
Members of the Alaska Mental Health Board, parents, advocates, providers and representatives of state agencies came together to write A Shared Vision II, Children and Youth Services section, with a sense of commitment and energy to produce a plan that not only provides philosophical guidance but actual strategies to achieve goals. Participants in this process acknowledge that to date we have not formed a unified vision of where we would like to be in five years; however, we are more aware of the steps we need to take to get there and are committed to expanding the system of care and improving and extending access for families and children to quality mental health care in Alaska.
Nationally, research into the causes and treatment of mental disorders has been advancing rapidly since 1980. These advances are attributed to the synergy of multi-disciplinary research which has resulted in the rapid development of new research techniques and technologies. This research has produced a better understanding of the complex interaction between the brain, endocrine and immune systems and the complex role in brain development of interactions between genetics, the biological systems, behavior, and the environment. Biology modifies behavior and behavior modifies biology.
While a very complex series of interactions is involved in brain development and the development of mental disorders, this also opens many points at which interventions can interrupt the development of mental disorders. The Institute of Medicine recommends adopting risk reduction programs that include universal preventive interventions for the whole population, including preconception and prenatal care, immunizations, and protection from heavy metals and head injury; selective prevention interventions targeted to individuals or population subgroups whose risk of developing mental disorders is significantly higher than average (Headstart and Healthy Families, for example); and indicated preventive interventions targeted to high risk individuals who are identified as having minimal, but detectable, symptoms or biological markers. Alaska lacks well developed programs for universal and selective preventive interventions.
The American Academy of Child and Adolescent Psychiatry has age appropriate screening tools for use in schools for children age three to eighteen and guidelines for identifying infants and toddlers with mental health needs. Federal laws (Individuals with Disabilities Education Act) require schools to identify all students with mental disabilities and to encourage the treatment of infants and toddlers prior to occurrence of developmental delays. While risk reduction programs have proven cost effective, states need incentives to change their existing programs. To help pay for new programs, the federal share of Medicaid has been increased. The National Governor's Association co-sponsors the "I am Your Child" campaign to focus public attention on the importance of the early childhood years in reducing the risks of mental disorders. The challenge facing state agencies and planning boards is to translate the science of prevention into cost effective programs.
More effective tools are now available for early identification and treatment programs. The American Academy of Pediatrics has developed the DSM-PC to help family physicians and other primary care providers identify children who should be referred to professionals trained in the diagnosis and treatment of childhood mental and emotional disorders. Additionally, age appropriate screening tools have been developed to help pre-school and school teachers and parents identify children who need further assessment by mental health professionals. Early intervention programs greatly improve outcomes for children. Of special note is the progress reported in reducing life-long disabilities among people who are treated for schizophrenia within six months of onset.
The federal Center for Mental Health Services (CMHS) was established to focus services research on more effective treatment programs, especially for children with serious emotional disturbances. The CMHS demonstration grant program has encouraged innovative approaches to improving service delivery for children and their families who receive services from more than one service system. The demonstration grants have also encouraged innovative managed care practices to improve cost effective service systems. Children ages zero to three are an emerging area of research focus. Programs for this age group have demonstrated cost effective results in reducing neglect and abuse, improving intellectual and cognitive functioning and helping infant brain development.
In Alaska and nationally, public awareness of the extent of mental illness/emotional disturbance in children has been growing, with a concomitant realization of the need for services to address those problems. The federal CMHS has focused attention on best practices in providing services for children (Making It Happen, 1997) and federal funds have been made available on a competitive basis for several years. The consumer movement has also begun to target the needs of emotionally disturbed children.
At the request of state governors, more freedom has been given to states to use innovative funding practices: the waiver process for Medicaid has been liberalized; states are allowed to blend funding streams to eliminate many federal funding limitations and to re-focus funding into early interventions. Also, on the national level, additional funds have been provided for Early Periodic Screening Diagnosis and Treatment and the Child Health Insurance Program.
When A Shared Vision I was written in 1991, recommendations were made to increase use of federal funds to augment state funds. We must also look to optimum use of all public and private economic and human resources, if we are to meet the mental health needs of Alaska's children and youth.
Since A Shared Vision I, public awareness has grown in distinguishing the variety of mental health needs of children. While some children are born with neuro-biological disorders that require mental health interventions, other children develop emotional disorders in response to environments which do not provide the care, love, safety and predictability that children need. For those whose illnesses are biological, cost effective programs can reduce the disabilities associated with untreated illnesses. Some children, such as those experiencing Fetal Alcohol Syndrome/Fetal Alcohol Effects develop "secondary disabilities" of emotional disorders because their very different learning and interpersonal needs are not met. Advocates and providers (and the Alaska Mental Health Board) struggle to allocate appropriate attention to those children whose needs begin at birth and those whose needs might have been prevented. Any child may have mental health needs that should receive attention, including occasional counseling, and in such areas as skill development or "emotional literacy," and better interpersonal and decision making skills.
Mental health services in Alaska have mirrored the national history of a focus on adult needs and earlier development of a system of care for adults. However, as children are very different from adults, their needs were not readily met by the adult service system. It has taken considerable national effort to identify what works for children and their families. This knowledge has developed within the context of the national consumer advocacy movement which has stressed the importance of meeting the needs of children and their families, through family centered services and treatment of the child in a holistic manner. Following are the core values which the Children and Youth Action Team and the Alaska Mental Health Board support in developing a complete system of care for children's mental health needs in Alaska.