Congressman Tim Murphy introduces controversial Helping Families in Mental Health Crisis Act of 2013

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On Friday, one day before the anniversary of the Newtown school shooting tragedy and on the same day of yet another tragic shooting at a school in Colorado, Congressman Tim Murphy introduced the Helping Families in Mental Health Crisis Act of 2013, a bill that would effectively rewrite how the Substance Abuse and Mental Health Services Administration (SAMHSA) operates and significantly narrow the focus of the types of mental health services and supports it helps promote through its grant programs. While the bill is at this point just a proposal, it is an important read for Network faithful as it sheds a light on the thinking of many individuals across the country about how to improve mental health services in America. Unfortunately, with the continued tragedies occurring at schools across the nation the tendency to equate guns and violence with mental illness leads to recommended solutions in this bill that are narrow in focus and could potentially set back the advances in the field of mental health 20 to 30 years.

What makes writing this Morning Zen piece difficult for me is that I have the utmost respect for Congressman Murphy. A child psychologist by training, co-author of two books ("The Angry Child: Regaining Control When Your Child Is Out of Control" and "Overcoming Passive-Aggression), it is obvious that Congressman Murphy cares deeply about improving mental health services. For that he is to be applauded. But what is in this proposed bill for the most part is either mystifying or antithetical to what the research tells us works best for young people with emotional challenges and their families. In fairness, at the end of this post I have included links to position statements on the proposed bill from national organizations and thought leaders both for and against the bill. As always, we pride ourselves on providing as many perspectives as possible so that our educated readers can make up their own minds and respond to their elected officials accordingly.

The response from mental health advocates and provider groups both for and against the bill was swift. As is the general approach of the Children's Mental Health Network we took the weekend to read and digest the 135-page bill before making our comments. The list is long so grab a cup of coffee for this one.

The proposed bill is complex in that mixed in with proposals that are administratively bureaucratic, relying on reference resources that in some cases are twenty years old and frankly dismissive of anything outside of the realm of narrowly defined evidence based practice, are some excellent proposals such as continuing funding for the Garrett Lee Smith and National Child Traumatic Stress initiatives.

However, overwhelmingly the recommended changes in the bill set the advances made in knowledge about what works for youth with mental health challenges and their families back a good twenty to thirty years.

Clouding the picture of how to interpret this proposed bill was the timing of its release – on the eve of the anniversary of the Newtown tragedy and on the day of yet another shooting at a school in Colorado, where emotions were already running high and the popular press was flooded with news stories about guns, violence and mental illness. Even though research shows that those with a mental illness are significantly more likely to be a victim of violence than a perpetrator of violence, discussions in Congress about what to do tend to fall too easily into the guns + violence = mental illness equation.

Note: Be sure to read Lisa Lambert's Morning Zen post for a parent’s reflection on the anniversary of the Newtown tragedy.

Okay, with all of this in mind as a backdrop for what is in the proposed bill, let’s take a walk through some of the highlights. The 135 page document is one I encourage you to read to get your own sense of its merits and drawbacks. In this post I will focus on some of the key areas that are important to highlight. Page numbers of the bill are cited so that you can read the full text in the copy of the proposed bill that you can download here.

Additional layers of bureaucracy added while diminishing the decision-making role of key SAMHSA personnel (Page 4)
The position of Assistant Secretary for Mental Health and Substance Use Disorders would be created. This individual would directly supervise the Administrator of the Substance Abuse and Mental Health Services Administration. Reading through the responsibilities that this individual would have left me perplexed, as the duties described appear to already be in place under the responsibility of the Administrator.

National Mental Health Policy Laboratory (page 7)
The proposed bill calls for the creation of a National Mental Health Policy Laboratory (NMHPL) headed by a Director. The purpose of this Director position would be to:

The description of the NMHPL goes on to say that "In selecting evidence-based practices and services delivery models for evaluation and dissemination under paragraph (2)(C), the Director of the NMHPL 

On page 10 the language continues with "In carrying out the duties under this section, the Director of the NMHPL shall consult with representatives of the National Institute of Mental Health on organization, hiring decisions, and operations, initially and on an ongoing basis; (B) other appropriate Federal agencies; and (C) clinical and analytical experts with expertise in medicine, psychiatric and clinical psychological care, and health care management.

The Children’s Mental Health Network is troubled that there is no mention of youth and family involvement in such a consulting pool, especially with the impressive track record achieved by SAMHSA in cultivating a family-driven, youth guided approach through its system of care grants and cooperative agreements over the past 20+ years.

Interagency Serious Mental Illness Coordinating Committee (page 14)
Yet another bureaucratic layer is added to the decision-making process with the recommendation to establish an Interagency Serious Mental Illness Coordinating Committee to "assist the Assistant Secretary in carrying out the Assistant Secretary's duties.

The responsibilities of this Committee include:

There is a long list of required members for this committee (page 15), including the Director of NIH, the Attorney General of the United States; the Director of the Centers for Disease Control and Prevention and more. Members of the Committee serve 4-year terms and would be required to meet a minimum of two times per year. In addition, the Committee “may establish subcommittees and convene workshops and conferences "to enable the subcommittees to carry out their duties."

And finally, with regard to administrative duties, on page 70 it is noted that the administration of block grants would be removed from the Director of the Center for Mental Health Services and shifted to the Assistant Secretary for Mental Health and Substance Use Disorders. Gonna be one busy Assistant Secretary if this proposal goes through!

I can't help but think that if this plan were to come to fruition there would be bureaucratic gridlock. Two new significant leadership positions assuming key duties of currently existing high ranking officials within SAMHSA and a large Committee with sub-committees to "assist the Assistant Secretary in carrying out the Assistant Secretary's duties" (Page 14). In my mind, this is a huge duplication of duties already ascribed to the SAMHSA Administrator, the Director of the Center for Mental Health Services and others within SAMHSA.

Let's move away from administrative duties to some of the new grant programs proposed, specifically the Assisted Outpatient Treatment Program. The proposed bill calls for up to 50 grants each year for a 4-year pilot program to focus on assisted outpatient treatment programs (Page 19). Each grant would be eligible for one million dollars per year for four years - $15,000,000 per year would be authorized totaling $60,000,000 over the four-year period.

Assisted outpatient treatment is a controversial topic, with some saying it is the best option for an adult with a mental illness who "lacks capacity to fully understand or lacks judgment to make informed decisions regarding his or her need for treatment, care, or supervision." Others, including the Children's Mental Health Network, see this as a potentially dangerous road to travel in that it could have wide-ranging impact on those who might be swept up unnecessarily. You can review both sides of the argument regarding Assisted Outpatient Treatment at the end of this post.

Number of seriously mentally ill who are imprisoned (page 63)
Section 405 focuses on reports of the number of seriously mentally ill who are imprisoned. An important topic for sure, the intent is to "calculate the number and type of crimes committed by persons with serious mental illness each year, and detail strategies or ideas for preventing crimes by those individuals with serious mental illness from occurring… For purposes of this section, the Attorney General, in consultation with the Assistant Secretary of Mental Health and Substance Use Disorders shall determine an appropriate definition of ‘‘serious mental illness’’ based on the Health Care Reform for Americans with Severe Mental Illnesses: Report’’ of the National Advisory Mental Health Council, American Journal of Psychiatry 1993; 150:1447–1465. The link is provided though you will need to pay the journal for the download. We can only hope that this document, written 20 years ago, reflects the evolution of thinking about mental health challenges since then. Of greater concern is the proposed process for decision-making about defining "serious mental illness." Should this just be left to the Assistant Secretary and the Attorney General? This is much too vague for our liking.

Reducing the stigma of serious mental illness (page 79)
It is hard to even comment on this section when the entire document is stigma-laden, focusing primarily on a narrow subset of those individuals with a diagnosis of serious mental illness when describing what needs to happen within a federal agency charged with looking at the full spectrum of behavioral health issues. However, Network faithful should read it and decide for themselves.

Title XI-SAMHSA Reauthorization and Reforms (page 99)
Mentioned earlier is the fact that the Assistant Secretary for Mental Health and Substance Use Disorders would be in charge of SAMHSA. One of the more fascinating recommendations is that "At least 30 days before awarding a grant, cooperative agreement, or contract, the Administrator shall give written notice of the award to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate.’’ This suggests adding yet another layer of review, more opportunity for delay and added bureaucracy. Though not specified, one could assume that a member of either Committee could block a grant award.

In addition, it would be required that "Before awarding a grant, cooperative agreement, or contract, the Secretary shall provide a list of the members of the peer review group responsible for reviewing the award to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate." This is yet another opportunity for delay and bureaucratic red tape.

Transfer of all functions and responsibilities of the Center for Behavioral Health Statistics and Quality to the National Mental Health Policy Laboratory (page 102)
This section discusses the transfer of "all functions and responsibilities of the Center for Behavioral Health Statistics and Quality to the National Mental Health Policy Laboratory. Why would one do this? In addition, in this section responsibilities currently assigned to the Administrator are reassigned to the Assistant Secretary. I am beginning to wonder what is left for the Administrator to do?

Establish a clearinghouse of evidence-based practices  (page 106)
In this section there is mention of the establishment of "a clearinghouse of evidence-based practices, which has first been reviewed and approved by a panel of psychiatrists and clinical psychologists, for mental health information to assure the widespread dissemination of such information to States, political subdivisions, educational agencies and institutions, treatment and prevention service providers, and the general public, including information concerning the practical application of research supported by the National Institute of Mental Health that is applicable to improving the delivery of services..."

Unfortunately there is no mention of consumers, families or youth involved in this review.

Limitations on Authority (page 133)
The section on Limitations on Authority includes some questionable items. For example, in this section it is stated that in order for SAMHSA to host or sponsor a conference they "must give at least 90 days of prior notification to the Committee on Energy and Commerce and Committee on Appropriations of the House of Representatives and the Committee on Health, Education, Labor, and Pensions and Committee on Appropriations of the Senate." Again, this seems like yet another unnecessary layer of bureaucracy.

No financial assistance to any program without evidence-based practices (page 133)
Continuing on page 133 is the directive that the Administrator of SAMHSA "shall not provide any financial assistance for any program relating to mental health or substance use diagnosis or treatment, unless such diagnosis and treatment relies on evidence-based practices."

If you have made it this far in this lengthy post you know that this leads back to the question "What is an evidence-based practice and who is involved in deciding that?" From reading the full text of the proposed bill the decision makers are definitely skewed toward the medical community with a strong focus on a narrow slice of the overall population of individuals needing mental health services.

Elimination of unauthorized SAMHSA programs without explicit statutory authorization (page 134)
Saving one of the more controversial items for last (at least as based on the tenor of emails sent to the Network over the weekend) is the section on the elimination of unauthorized SAMHSA programs without explicit statutory authorization. The language is clear that no new programs are to be created that are not explicitly authorized or required by statute and that "by the end of fiscal year 2014, any program or project of the Substance Abuse and Mental Health Services Administration that is not explicitly authorized or required by statute shall be terminated."

The proposed bill goes on to say "The Assistant Secretary for Mental Health and Substance Use Disorders shall seek to enter into an arrangement with the Institute of Medicine under which the Institute (or, if the Institute declines to enter into such arrangement, another appropriate entity) agrees to submit a report to the Congress not later than July 31, 2014, identifying each program, project, or activity to be terminated under subsection (a).

So, there you have it. Quite a bit to chew on and I cut this post down significantly. Please take the time to read the proposed bill. Whether it gains traction in the House or not it is important to remember that this proposed bill reflects the thinking of many. If you are concerned about this, as we are, then you might want to consider an education campaign.

Next week we will share our collaborative efforts with Maryland-based mental health providers, adult and youth representatives with experience receiving mental health services, and family advocates and other agency representatives to put together a site visit for Senate and House Appropriations Committee staff to not only show them what a coordinated system of care approach looks like in the effective provision of services and supports for young adults with mental health challenges, but also to provide them the opportunity for one on one dialogue with youth and adults who utilize mental health  services, families and the amazingly dedicated professionals who work side by side with them. We began organizing this effort for Senate Appropriations staff as a result of our inquiry into the Healthy Transitions Initiative in August of this year. Senate Appropriations Committee staff have agreed to come and we will be extending an invitation to House Appropriations Committee staff this week. I will give you full details in the Morning Zen post this coming Friday.

What is so important about our education campaign is that it is not focused on one grant or particular service. We are not bringing staffers to a visit to ask for money. We are bringing staffers to a visit to let them experience firsthand the importance of a comprehensive approach to meeting (in this case) the needs of young adults with mental health challenges. Sounds like a systems of care approach to me!

And finally, here is a sampling of different individual and organizational analyses and reactions to the proposed bill, both pro and con. Remember, an educated voice is a powerful voice.

For the proposed bill

Against the proposed bill

Time to do your homework folks!

Scott Bryant-Comstock
President & CEO

Children’s Mental Health Network

Comments

Douglas Ronsheim's avatar

Douglas Ronsheim

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Scott, Thanks for placing many items in one place. This provides a starting point for anyone who is interested in this legislation. This is a daunting task.In the end I hope the conversation and action will truly serve our clients, families and communities.We can do no less. I have forwarded the link to members of the American Association of Pastoral Counselors. Doug
Garry's avatar

Garry

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Hello,

While policies/systems and service availability are important and often necessary components of the mental health conundrum, the focus of much debate has been on child & adolescent mental health, especially with regard to early intervention. While many think that increasing funding for services is the solution, I beg to differ as evidenced in my essay of March 2013.

March 23, 2013

CHILD & ADOLESCENT MENTAL HEALTH - “THE IGNORED”

In the wake of the Sandy Hook Elementary School tragedy in Newtown, Connecticut on December 14, 2012, a groundswell of interest in all things mental health placed child and adolescent mental health on the national agenda. That interest seemed to focus exclusively on increasing funding for mental health services, thereby short-changing and excluding from the necessary dialogue, other critical aspects. Assuming such interest translates into action, it is imperative that the whole picture be considered.

Anyone working within the mental health field and those in need of services would find it difficult to deny that, when it comes to managed care, mental health services are at the bottom of the managed care barrel. Following from that, it is a small step to realize that child and adolescent mental health services are at the bottom of the mental health barrel. Were it only about services, perhaps all the talk about boosting them with hoped-for increased budgeting might actually help. Unfortunately, it is neither that simple nor simplistic a solution.

The reality is, that while increasing budgets/funding could actually be a step in the right direction, it presumes other underlying aspects are already in place when in fact they are not. Those aspects are personnel, training and supervision.

PERSONNEL
In the United States, child and adolescent psychiatry was established as a recognized medical speciality in 1953 with the founding of the American Academy of Child Psychiatry, but was not established as a legitimate, board-certifiable medical speciality until 1959.
(See Wikipedia: (http://en.wikipedia.org/wiki/Child_and_adolescent_psychiatry). See also The American Academy of Child & adolescent Psychiatry: http://www.aacap.org/cs/root/about_us/about_us).

In regard to the shortage of child and adolescent psychiatrists, the entry continues:
The demand for child and adolescent psychiatrists continues to far outstrip the supply worldwide. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced. There are currently only approximately 6,500 practicing child and adolescent psychiatrists in the United States. A report by the US Bureau of Health Professions (2000) projected a need in the year 2020 for 12,624 child and adolescent psychiatrists, but a supply of only 8,312. In its 1998 report, the Center for Mental Health Services estimated that 9-13% of 9- to 17-year-olds had
serious emotional disturbances, and 5-9% had extreme functional impairments. However, in 1999, the Surgeon General reported that "there is a dearth of child psychiatrists." Only 20% of emotionally disturbed children and adolescents received any mental health treatment, a tiny percentage of which was performed
by child and adolescent psychiatrists. Furthermore, the US Bureau of Health Professions projects that the demand for child and adolescent psychiatry services will increase by 100% between 1995 and 2020. (http://en.wikipedia.org/wiki/Child_and_adolescent_psychiatry)

The supportive research into this appalling situation was published in the Journal of the American Academy of Child & Adolescent Psychiatry (45:9, September 2006, 1023-1031) in an article entitled: The Continuing Shortage of Child and Adolescent Psychiatrists by Christopher R. Thomas, M.D., and Charles E. Holzer III, Ph.D.

Unlike board-certified psychiatrists, clinical social workers and psychologists have no analogous, specific designation that denotes any expertise in child and adolescent mental health. While I have that expertise, neither my degree (M.S.W.) nor my level of licensure (L.I.C.S.W.) Indicates or designates any such “specialized expertise.” Although many professional clinicians claim such expertise, few have it. Accordingly, the major impediments needing to be addressed with regard to services are the lack of personnel, clinical supervision and training (including continuing education).

TRAINING - SUPERVISION - PROFESSIONAL DEVELOPMENT

TRAINING
Academic training (within programs for human services, psychology, education - especially early childhood and even nursing) should commence at the undergraduate level and not just at four year institutions, at community colleges as well. Without this foundation of exposure and instruction, graduating students securing positions involving juvenile mental health clients are at a tremendous disadvantage. Such clients, be they in out-patient clinics, residential settings or even in public school classrooms, will suffer the consequences. And, let’s not forget about being able to knowledgeably and effectively screen youngsters for mental health issues now, in preparation for their later years.

Without adequate academic training in child and adolescent mental health conditions and accompanying issues, it can take a clinician or educator years of experience to ferret out and acquire the necessary knowledge required to help those in need. That there is a dearth of professional development opportunities in child and adolescent mental health should be obvious. If the fundamental knowledge is not provided, service delivery personnel commence careers flying blindly. Years of on-the-job experience would be required before one could adequately supervise junior personnel. And, since professional development opportunities in child and adolescent mental health are rare, personnel scramble to keep up-to-date and often are not. Continuing in this vein, where, pray tell, does one find professional development trainers?

SUPERVISION
Historically, in professional social work, one secured a position in a certain type of setting wherein one wanted to “specialize,” say in a child guidance clinic, family service agency or in an adult mental health facility. Supervision by senior staff (i.e. those who had acquired specific expertise) was provided as part and parcel of one’s employment. Assuming one continued in the profession, becoming a supervisor was indicated.

That was then. Now, much out-patient clinic work is provided by those working on a fee-for-service (FFS) basis. That is, one is compensated when one actually delivers the service, the therapeutic hour. There is no compensation for missed appointments, paperwork demands or phone calls to follow-up or to make appointments or for one’s time to facilitate referrals. It is common that such FFS personnel are recent graduates of various counseling programs as those are the types of positions available to them. Unfortunately, many such counseling programs do not provide sufficient, in-the-field, internship training time (under supervision) to prepare them for the clientele they will encounter. Such programs, to the detriment of clients are “speeded up” versions of older, more intense, programs, perhaps generated by the profit motive. More critically, though, clinical supervision in FFS facilities, is lacking. Not only is there little money provided for it, there is a lack of critical clinical expertise to provide it.

PROFESSIONAL DEVELOPMENT
Nowhere within the entire genre of child and adolescent mental health is the lack of skill acquisition more apparent than with professional development. One need only scan the available offerings in this specific area of expertise to ascertain that not many options exist. Those that do tend to focus on behavioral management, particularly directed to educators who struggle to maintain some semblance of order in their classrooms. Since such a situation exists, how then, are those who need the training/update, supposed to acquire it? Furthermore, even when informed presenters are available, why are such professional development opportunities not offered?

For example, once Massachusetts passed its anti-bullying legislation, school district resources for professional development were expended on all things bullying. Rarely was bullying seen, let alone acknowledged, as a mental health issue. Consequently, youth mental health concerns were once again, shunted aside. Short-sighted, indeed.

THE RESPONSE
Child and adolescent mental health is highly specialized and requires specific expertise. One cannot “dabble” in it. Rather, one needs to “be all in,” as it is too complex, too demanding. The contention could easily be made that the lack of personnel is due to a lack of avenues of study - there is no major in child and adolescent mental health (save for psychiatry) as there is, for example, with education, history, archaeology or English literature. While there may be certificates of advanced graduate study in, for instance, substance abuse or gerontology, finding such in child and adolescent mental health is problematic, if one even exists. Were it to exist, one does not usually pursue such a certificate until later in one’s career, making the point for much earlier educational opportunities all the more poignant. Without such a course of study, little is available to attract potential candidates. Discussions about how to “market” the speciality are regular occurrences. And, when clinicians (or special educators) DO want to work with youngsters, they become frustrated by the lack of available avenues of study to accomplish their goal. (Note: Recent investigation of this issue uncovered an undergraduate minor in child and adolescent mental health offered by New York University via their NYU Child Care Center. (See: www.aboutourkids.org for the center and: www.aboutourkids.org/education/undergraduate_minor for the minor.)

On a tertiary note, realize that other, more traditional educational concerns, co-mingle with existing neuro-psychiatric ones. Special education issues such as learning disabilities, information processing disorders and sensory integration aspects often co-exist with those of a mental health nature. This generates an additional conundrum in that there is no cross-training, no inter-departmental collaboration, say between education and psychology. There is no course of study (even by taking electives as a psychology major) that focuses on early childhood “psycho-educational issues;” an approach that would integrate all these concerns.

If one is fortunate enough to secure a position that matches one’s interest (post undergraduate or graduate education), receiving adequate and knowledgeable supervision is problematic. Remember, those currently supervising others had no formal academic foundation either. And, they too have faced and continue to face the lack of appropriate professional development opportunities.

REGIONAL EXAMPLES
Located in Franklin County, Massachusetts, I have seen first hand the disregard for the juvenile mental health population. Despite protests to the contrary, the local community college refuses to offer any course work or professional development workshop in child and adolescent mental health. I know because I have continually approached department heads as well as the college’s president with proposals to do just that.

A regional educational collaborative offers various workshops for educators over the summer. Over the past 2-3 years there have been over 150 offerings listed in the annual catalogs - NONE of which have addressed child and adolescent mental health. I have approached them many times over the years to provide such programming which they insist they provide when in fact they do not.

Western Massachusetts has had an annual special education conference for over 20 years. In the catalog for the 2-day, March 2013 conference, there are 46 workshop offerings listed - NONE address child and adolescent mental health. My inquiry to the conference director about this egregious oversight was met with silence. Even Special Education Directors, who could request such workshops, obviously resist doing so.

Franklin County has an early childhood mental health roundtable with over 100 email registrants. The organization steadfastly insists it is an advocacy organization. Here is the mission statement from their Facebook page:

The Early Childhood Mental Health Roundtable of Franklin County is a coalition of parents, community organizations and providers representing educational, mental health, pediatric, social service, early intervention and other support services. The mission of the Roundtable is to:
• Promote healthy social and emotional development in young children
and support for families
• Improve the provision of early identification and intervention services for children age 0-5 years and their families, with a focus on children 3-5 years with social, emotional and behavioral needs
• Develop services that address the increased needs of families with
limited incomes and resources and children who may have experienced trauma and neglect or abuse, or who are at high risk for future significant mental illness
• Create and integrate existing services that are accessible, effective and
address identified gaps in services for families and children.

While such a mission is admirable, they too scoff at the idea of providing crucial training. Yet, they use phrases like, “Promote healthy social and emotional development... and Improve the provision of early identification and intervention services...” How do those intentions get accomplished without appropriate and adequate education and training? Even when I approached them with an offer (free) to provide a workshop, the offer was dismissed out-of-hand. Perhaps the clinicians involved see no need for it. Even were that true, what about informational sessions on child and adolescent mental health for parents and/or families? Surely, that wouldn’t hurt.

Curiously, while the roundtable is sponsored and supported by Greenfield Community College, and while it hosts other mental health events, the college refuses to offer, with little consideration, course work or workshops in child and adolescent mental health.

Finally, when it comes to student mental health, school districts everywhere are remiss and woeful in not providing professional development offerings in child and adolescent mental health. Consider this - when faced with a mandate to produce an anti-bullying policy, a requirement of the Commonwealth of Massachusetts and despite the impetus for such a policy directive brought about by the suicides of two Western Massachusetts students, NO SCHOOL DISTRICT included anything in their anti-bullying policy report on suicide prevention. How can suicide, especially youth suicide, the most critical of mental health concerns, be ignored?

In essence, those challenged by child and adolescent mental health conditions and accompanying issues are not merely being forgotten, they are being ignored. These sometimes rude, obnoxious and disruptive kids are being penalized for being victimized by their own bodies, minds and brains. Ironically, the penalties inflicted upon them come from well-intended, sincere and caring individuals who are uninformed, misinformed and frustrated as they struggle to help these kids.

It’s time for parents, community entities and interested others to insist that educational institutions, educational collaboratives, professional development and conference coordinators and seminar companies, develop and offer academic course work, continuing educational opportunities and professional development offerings in child and adolescent mental health. In conjunction with that, those who could easily provide such services will need to eliminate any resistance to making those offerings a reality.

More money to merely provide more mental health services is an incomplete strategy. Such monies will do little if educational tracts to solicit and enlist new and additional personnel don’t exist, if experienced supervisors are not available and if appropriate professional development is neglected. Without those underpinnings to support personnel and the increased demand for their services, I suspect many who might consider or even want to be involved with children and adolescents, will step aside. Support for personnel is crucial if they are to provide support for kids and families who are in dire need of and dependent on, receiving it.

Isn’t it about time we help these kids and their families by helping those who are trying to help them?

Thank you for taking the time to read this essay. Your considered response is appreciated.

Best regards,

Garry L. Earles, LICSW

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