There's No Place Like Home: Realizing the Vision of Community-Based Mental Health Treatment for Children

On the heels of the recession, the recent U.S. Census data reveals that the percentage of children living in poverty in the United States has grown to almost a quarter. Because children from low-income families are more likely to be exposed to high levels of stress, violence, abuse, overcrowding and other risk factors, they are far more likely to develop a mental health disorder— and to have their mental health needs go unmet. Rather than receive the necessary educational and mental health services, these children are often suspended and expelled, funneled through the “school-to-prison pipeline” into the juvenile and criminal justice systems, which are not equipped to meet their needs. This article analyzes legal regimes related to child welfare, juvenile justice, disability rights, healthcare, and special education, and argues that they are all explicitly structured to ensure that children with behavioral and emotional problems receive services and treatment in the community and remain out of institutional settings whenever possible. While most scholars, courts, attorneys, and systems view the needs of at-risk children through one particular lens, this article makes an important contribution through its holistic examination of the intersections among these multiple legal regimes. Despite the shared intentions of federal statutes, regulations, policies, and case law in all of these realms, local and state agencies fail to timely and effectively provide children with the mental health and educational services they require. Instead, child-serving agencies continue to institutionalize children from low-income families, and particularly children of color, in residential treatment facilities, to the detriment of those youth and at high cost to taxpayers. Having presented a synthesis of the intersections among these legal regimes, the article assesses the reasons for this disjunction between their shared goals and the reality that many children living in poverty are often unable to gain access to necessary community-based services. The compartmentalization of child-serving legal systems into isolated silos, the stigma surrounding mental illness, and the scarcity of children’s mental health providers all contribute to this disjunction. Drawing upon research from the fields of health policy, psychology, and social work, the article argues that coordination among public agencies and implementation of scientifically proven treatments in children’s mental healthcare, known as evidence-based practices, can achieve the shared vision of federal legal regimes that children with mental health disorders remain in their homes and communities, and achieve true inclusion, stability and mental health