Issues in mental Health care

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When Paul Raeburn needed immediate help for his suicidal son, he had few good options. The teen had threatened to sit on nearby railroad tracks until a train came. Even though Raeburn, a leading health and science writer, was in a position to know more about the best available mental health services and treatment options for his son than most, when a crisis hit, he felt he only had one choice: to call the police and risk that his child would wind up incarcerated rather than hospitalized.

“I tried to physically restrain him, but that’s not easy with a teenager, ” Raeburn says, “I had no other option and this doesn’t seem like an ideal situation to take care of our sick kids.”

While it’s not clear whether mental illness— alone or in combination with a developmental disorder—played any role in the devastating tragedy in Newtown, CT, the shootings have triggered a much-needed discussion about how we care for psychiatric patients. The debate has thrown a harsh light on the piecemeal nature of America’s mental health system, which is leaving too many children and young adults, like Raeburn’s son, without the resources they need.

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Experts agree that “system” isn’t even an appropriate descriptor for the state of services designed to treat mental illness: there is little coordination of care and various agencies in health, education, mental health, addiction, disability, child welfare and law enforcement, often work at cross-purposes. For example, a child’s school may recommend residential treatment while her psychiatrist supports in-home services; the juvenile justice system may mandate one type of placement while the parents and education team believe another is more appropriate. Behavior management techniques or medications that have been known to fail with a child may be used on him by professionals in a new setting or agency unfamiliar with the child’s history.