Dilemmas in provision of urban mental health services for latency age children

Urban mental health facilities are increasingly overwhelmed by the sheer number of cases, at a time when federal, state and local funding cutbacks are greater than ever before. Additional to the numbers of cases needing care, is a growing number of cases presenting overwhelming social problems, i.e., emotional and medical pathology, economic deprivation, and substance abuse, with resultant family violence and child abuse. The case-loads in mental health agencies have become almost indistinguishable from those on the roles of child protection, juvenile justice, and child welfare agencies. Mental health service is near to impossible to provide, prior to major environmental manipulation, via educational planning, and frequent placement of children in day treatment programs, day care, or securing of in-home assistance, via home-maker services. These needed referrals take inordinate time, given the unresponsive, poorly coordinated bureaucracies providing such services. Many of the families seen are burdened by overwhelming social pathology, e.g., poverty, huge numbers of children per family, single-parenthood, drugs, and neighborhood violence. Treatment is increasingly difficult to provide, given the poor access to child serving systems, by parents and professionals, alike. Token services and worker burn-out in response to overwhelming difficult cases and excessive assignments, suggest a situation of crisis proportion. Clearly coalitions must be formed by over-burdened professionals, to better educate governing bodies, politicians, boards and administrators, and parents regarding this growing crisis. Professionals, battle-weary, are retreating from agency practice, simultaneous with agency cut-backs of staff and service. Agency administrators are cowed by local and state directives regarding budgetary cuts, and the situation worsens daily, as overburdened line staff struggle with an impossible challenge. Some sort of advocacy and social action must be taken by leaders in the field, to better inform and educate those responsible for budgetary allocations. Latency age children are among the most vulnerable, caught in deteriorating schools and neighborhoods, living with incredible daily violence, and pressures from drug dealers, pushers, adolescent gangs, and inadequate supports in their homes. This group of children is being pushed to become the violent adolescents of tomorrow. Major innovations and changes in delivery of services is necessary in health and mental health agencies serving this at-risk population. Proposed is a school based model of practice to provide access, coordination and collaboration of needed services.This paper was presented at the National Health Policy Forum, National Academies of Practice, April 1992.Ph.D. Specialization in the treatment of Children and Adolescents, Ph.D. Program.