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US: The children suffer

LAST WEEK, a federal judge ruled that the Massachusetts Medicaid program has failed to provide medically necessary, legally required services to seriously mentally ill children. It's a tough rebuke, but a sound call for a better mental health system.

United States District Judge Michael Ponsor wrote that the question was whether Massachusetts had ''kept the promise made by Congress to America's children." Ponsor's answer is a damning no. He described state efforts as ''woefully inadequate, with detrimental consequences for thousands of vulnerable children."

In this case, ''vulnerable" is a euphemism. The ruling describes children and families wading through years of illness and obstacles:

Anton B. was born prematurely and diagnosed by age 7 with attention deficit hyperactivity disorder and bipolar disease. By age 9, he had been hospitalized three times. He received state services, but, as with many children, the care was short term and did not fully meet his needs.

Joshua D. was diagnosed with Asperger syndrome, obesity, anxiety disorder, and pervasive developmental disorder. He has a learning disorder and fine-motor problems associated with his weight. Ponsor said Joshua's care lacked adequate coordination.

And the lead plaintiff, Roselin D., after suffering severe physical and sexual abuse while in her parents' care, was diagnosed with bipolar disorder, post-traumatic stress syndrome, oppositional defiant disorder (hostile, defiant behavior that lasts at least six months), dyslexia, and attention deficit hyperactivity disorder. Ponsor called her care ''a familiar picture of inadequate home supports and arbitrary limitations on services."

State officials could appeal, but are considering their options, according to Dick Powers, spokesman for the Executive Office of Health and Human Services. But an appeal would be a waste of resources. The state should follow Ponsor's ruling and meet with plaintiffs to craft a remediation plan. Ponsor has ordered the two sides to return to court on Feb. 23.

This is a chance for Massachusetts to help children and families not only in the midst of a crisis, but also in the daily, long-term work of maintaining good mental health and, when appropriate, giving families the support they need to keep children at home. Far too many mentally ill children are institutionalized when they could be getting more cost-effective and humane care at home.

Ponsor praised three state programs, saying they showed that Massachusetts does provide good care -- but only for handfuls of children living in certain areas. The challenge is to implement such models statewide.

It will take time, money, and aggressive effort. The first step is to end the legal battle and focus on what's best for children.

Posted in: News on February 2, 2006 @ 12:00 AM

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