State Effort to Help Troubled Youth Faulted

California is failing dismally at providing mental health services to disturbed children and youths, many of whom end up dropping out of school and crowding jails and mental hospitals, a state oversight panel said in a report released Wednesday.

More than 1 million children in California will experience an emotional or behavioral disorder this year and more than 600,000 will not receive adequate treatment, concluded the Little Hoover Commission, a bipartisan watchdog agency that issues studies to the governor and Legislature.

“For some of these children their symptoms will go unnoticed; their needs will not be understood,” the report said. “For others, the symptoms will be obvious to parents, teachers and doctors, but they will not receive attention because of how California organizes, funds and delivers mental health and other services.”

Bertha Gorman, a spokeswoman for the California Department of Health and Human Services, said state officials were still reviewing the report and would not respond to it immediately.

She said, however, that the Davis administration had funded several new initiatives this year, including a project aimed at preschool children with emotional problems.

“There is a commitment to provide the best care possible to mentally ill children and adults,” Gorman said.

But the report described a system in disarray, an expensive patchwork of social, health and educational services that frequently overlap and present a bewildering maze to families in need of help.

The problem is not a lack of funding, the report suggested, but rather the lack of a coherent, coordinated approach. It said that in the next year the state will spend more than $56 billion for child and family services. And yet no single agency is accountable for how decisions affect the children and their families. Various eligibility requirements often mean that parents, children and even siblings receive different services from different providers. And children get no continuity of care as they age or their needs evolve.

The report also faulted the state for restricting families that earn higher wages from getting publicly funded mental health services.

Those services are generally available to low-income families, children in foster care and, in some counties, through programs in juvenile halls and schools.

But even needy children go wanting, said the commission: More than 50,000 children in the foster care system who may need mental health services do not get them, and many children in the juvenile justice system statewide--including victims of abuse and neglect--do not receive treatment.

The system’s failures carry a high price. County juvenile detention facilities spend about $3,500 to house a child for a 27-day stay; each month an average of more than 200 children reside in state mental hospitals at a cost of more than $10,000 per child, said the report.

Children “endure a system that turns them away until their needs are severe,” said Little Hoover Chairman Michael E. Alpert.

“Because there are no standards, children often do not receive the right care at the right time in the right way. Because we do not measure outcomes, there is no pressure on the system to improve.”

Recommendations include ensuring that all families are covered by public or private mental health insurance, addressing the duplication and gaps in services, creating a cabinet-level Secretary for Children Services and addressing the acute shortage of qualified mental health specialists.

The report said that Los Angeles County has about 30% of its public psychiatrist jobs unfilled, that 24% of county mental health directors have retired in the last five years and that an additional 25% are expected to retire in next five years.

Randall Hagar, acting president of the California branch of the National Alliance for the Mentally Ill, agreed with the commission’s conclusions that the mishmash of mental health services is leaving many children behind.

But at a time when the state is forecasting budget shortfalls and cutbacks, he conceded that wholesale reform may face an uncertain future.

“As advocates, though, I don’t see how we can stop from making our case,” he said.

“I think Gov. Davis has indicated some programs are closer to his heart than others. With his support of schools and leadership with the homeless mentally ill and addict populations, he may be receptive.”