One Parent's Voice

When one of my sons developed leukemia, our family experienced terrific support as he underwent difficult treatments. Our friends and family rallied around us and really made a difference. However the next year, when our other son developed a mental health problem, there was no outpouring of support. Our family was isolated, without the help and understanding of doctors, friends, the schools, and the community. Why was the mental health problem treated so differently?

Children's Mental Health-

Nurturing Children's Behavioral
and Emotional Well-being

What is Mental Health?

Mental health is how we think, feel, and act in order to face life's situations. It is how we look at ourselves, our lives, and the people we know and care about. It also helps determine how we handle stress, relate to others, evaluate our options, and make choices. Mental health is important at every stage of life. As with physical health, staying well requires the use of prevention strategies and, in some cases, treatment.

Children's Social and Emotional Health
is Important to Their Success
A growing body of research shows that promoting the emotional wellness of young children and fostering secure, warm relationships with parents and other caregivers are keys to healthy early development and later success. These early experiences set the stage for how children relate to other children, how they relate to adults, how they manage anger, and how they feel about themselves.

Medical professionals treating infants and young children sometimes overlook emotional health. California lawmakers have suggested including mental health screening in a child's pre-kindergarten physical examination to encourage early treatment of behavioral problems or mental illness, but this is not yet required by state law.

The goal of this report is to raise awareness about children's mental health issues in order to:

• promote a nurturing environment for children;
• encourage earlier recognition of problems; and
• secure better services and treatment for children.

Children's Mental Health

How do we promote mental health in children? Families, childcare providers and communities must employ a range of strategies and resources to care for and nurture the mental health of children. Prenatal health education, an understanding of child development, family supports, and behavior management strategies are all part of a community effort to promote mental health in young children.

How many children exhibit mental health problems? Studies show that at any given time, 1 in 5 children and adolescents may have a mental health problem. At least 1 in 10-or as many as 6 million young people (or about 12,000 children in Sonoma County)-may have a serious emotional disturbance that disrupts his or her ability to function.

Why don't children receive treatment? An estimated two-thirds of all young people with emotional problems who need help are not getting it. Many parents and providers have found that there are too few mental health services available for young children. Latino parents in Sonoma County report that barriers such as language, transportation, and childcare prevent them from taking advantage of services.2 The stigma or sense of shame about mental health problems keeps many people from asking for help.

Every Child's Mental Health is Important

In my experience, Sonoma County has a lack of referral resources-a lack of providers with expertise in young children's mental health. There is often no one to do a diagnostic evaluation, as there are very few child psychologists or child psychiatrists who specialize in treating young children. Families encounter many barriers as they try to locate and utilize the few mental health services that are available for young children.

Cathy Franchetti
School Nurse
Sonoma County Office
of Education Preschool

What Do We Know About Children's Mental Health in Sonoma County?

The primary focus of this report is young children from 0 to 5 years of age. Unfortunately we know very little about this age group and little data is available on the mental health status of Sonoma County children in general.3 Here is what we do know:

• In Sonoma County during 1998, mental disorders were the second leading cause of hospitalization of 5 to 14 year olds.

• Sonoma County Child Protective Services reports that 4,151 children suffered from some form of abuse or neglect in the year 2000. The Sonoma County Sheriff's Department reported that 565 children were present during felony domestic violence arrests in 1999 in the unincorporated parts of Sonoma County.

  If young people are exposed to violence, abuse or neglect, they are at a higher risk for developing mental health problems.

• Comprehensive mental health services for seriously ill children are expensive. For the year 1999/2000, Sonoma County Mental Health Division reported serving 1,343 clients through the Youth Services Program at a total cost of $5,934,204 or an average of $4,419 per child.

• In a Family Action review of mental health programs serving young children and their families, the following concerns were identified as problems in our community:

  • high cost of services and limited funding;
  • lack of qualified staff to meet the need, and lack of Spanish-speaking staff;
  • stigma associated with mental health problems keeps families from seeking services;
  • lengthy waiting lists for programs serving young children; and
  • physician referrals to mental health programs appear to be lacking- only one mental health program reported that clients were referred by physicians.

More information about the number of families struggling with mental health issues would strengthen advocacy efforts to increase services and make them more accessible and affordable.

How Do I Know if a Child Has an Emotional Problem?

It's easy for parents to recognize when a child has a high fever. However, a child's mental health problem may be more difficult to identify. Mental health problems can't always be seen; but many symptoms can be recognized.

Some Warning Signs
A variety of signs may point to a possible mental health problem in a child who:

• Is deeply troubled by ongoing feelings of:
  • sadness and hopelessness without obvious cause;
  • strong anger, excessive crying, or overreactions; and
  • fear that seems extreme for the child's age, especially if it also seems unjustified.
• Experiences big changes, for example:
  • has unexplained changes in sleeping or eating habits;
  • avoids friends or family and wants to be alone all the time; and
  • hears voices that no one else can hear.

• Is limited by:
  • an inability to focus attention or sit still;
  • a worry about being harmed, hurting others, or about doing something bad;
  • the need to wash, clean things, or perform certain routines dozens of times a day; and
  • constant nightmares.
• Behaves in ways that cause problems, for example:
  • often hurts other people or animals, destroys property, or breaks the law.

It is very important for parents, childcare providers, teachers and other people in close contact with children to pay attention to these warning signs. Often children's mental health problems are not recognized for what they are-and opportunities for early diagnosis and treatment are lost. Children affected by mental health problems may act or behave in ways adults find inappropriate and are sometimes punished instead of helped.

Are Children Affected by Their Parent's Mental Health?
Studies suggest that children are strongly affected by their parents' mental health. For example, children whose mothers are depressed are at greater risk of behavioral and emotional problems. Postpartum depression (depression following childbirth) is estimated to occur in approximately 12% of new mothers, with much higher rates for low-income and adolescent mothers. Although postpartum depression can be quickly and effectively treated, perinatal clinics rarely provide screening, treatment or referrals.6 If parental mental health problems were addressed, large numbers of children would benefit.

Families with health insurance should call their providers and ask how to receive services. If a child does not have insurance, many public insurance programs are available for families that meet certain eligibility requirements.

For local assistance call 1-800-427-8982.

Finding the Right Services

Caring for and nurturing a child's mental health is critical to helping a child grow to become the best he or she can be. Often the first resource for families is their physician or pediatrician. Ideally, the child will be carefully evaluated and may begin some type of therapy. There are many treatment options available to meet the child's needs. In some cases medications are needed to help a child become more able to cope with everyday activities.

It is important to keep looking until the right services are found. Some families don't seek help because they are afraid of what other people may say or think. Other barriers may also get in the way, such as the cost of care, limited insurance benefits, or lack of health insurance.

Insurance plans typically provide only limited mental health benefits. Families may be eligible for services from the Sonoma County Department of Health Services, Mental Health Division. Children eligible for services include:

• Medi-Cal recipients who have symptoms that impair their daily functioning;
• Students referred by their schools who are experiencing barriers which prevent them from bene?ting from Special Education Programs; and
• Those with insurance who have serious emotional disturbances.

Other families are referred to appropriate programs.

Seeking help can require a lot of patience and persistence. The following local and national organizations and advocacy groups can help parents find services in their community:

The National Mental Health Services, Knowledge Exchange Network
P.O. Box 42490
Washington, DC 20015
www.mentalhealth.org

National Alliance for the Mentally Ill
NAMI Sonoma County provides mutual support, advocacy and community education.
phone 707-527-6655
www.namisonomacounty.org

Sonoma County Mental Health-
Resource Team
phone 707-565-6900

Parents Share Their Experiences

These parents suggested some changes that could make it easier for families:

Teachers need more information and education about children's emotional and behavioral health.

Community education is needed:

• To encourage parents to keep seeking services for their children.
• To combat the myth that "bad parents" are solely responsible for their children's mental health problems.

There should be places families can go before a situation becomes a crisis, with information about who to call, how to find services, and how to pay for services.

Responsive and Effective Services for Children

Agencies that are effective and responsive to families share certain characteristics and values:

• Staff is approachable, receptive, responsive, caring and committed to the children and families they serve;
• Community diversity is recognized and the agency is committed to providing culturally competent service;* and
• Families are valued and respected and involved in case planning.

Discrimination and Stigma

Stigma is a barrier that discourages individuals and their families from getting the help they need due to the fear of being discriminated against.

The stigma of mental illness is a major reason why only 1 in 4 of the estimated 50 million Americans who experience a mental disorder in any given year get help.

Families may choose not to request services for their children because they fear:

Take Action for Children's Mental Health

Things you can do:

• Learn how to nurture your child's mental health.
• Help eradicate the stigma associated with mental disorders by educating yourself and those around you.
• Support policies and legislation that reduce barriers to mental health services.

• Advocate for supports for families, including health insurance for all children that includes mental health coverage.
• Speak out, write, email, fax or call local, state and federal lawmakers and request that funding for mental health promotion programs and services for children be increased.
• Join Family Action as we campaign to improve health promoting activities and access to mental health services for Sonoma County children and their families.

Family Action is grateful to the many individuals who contributed to this report:

Partnership to Address Children's Mental Health in Sonoma County

Family Action and St. Joseph Health System of Greater Sonoma County convened a Partnership of more than 40 individuals and organizations to develop a plan to improve children's mental health in Sonoma County. The Sonoma County Mental Health Partnership invites your participation as it develops and implements the following Action Plan.

3650 Standish Avenue
Santa Rosa, CA 95407

PHONE: 707.586.3032
FAX: 707.586.3057
WEBSITE: www.fasc.org

The mission of Family Action of Sonoma County is to improve the lives of children and their families through research, community education, advocacy, and policy change.

The goal of this project, co-sponsored by St. Joseph Health System, is to improve the mental health status of children in Sonoma County.

The mission of the St. Joseph Health System-Greater Sonoma County is to extend the Catholic healthcare ministry of the Sisters of St. Joseph of Orange by continually improving the health and quality of life of people in the communities we serve.

Action Plan

Desired Outcome: Children with Optimal Mental Health

Assumptions

• The mental health of children is inextricably linked to the health of our community and the systems that serve our community.
• Children have the right to optimal mental health and high quality mental health services delivered in a culturally and linguistically sensitive manner.
• Children's mental health must be viewed and treated in the context of their family, school, community and environment.
• Prevention and early intervention, important components of mental health programs for children, should include a strong focus on the young child (under age 5), since such efforts are likely to yield the greatest long-term benefits.
• Protective factors as well as risk factors must be assessed and incorporated into prevention efforts.
• While some psychiatric disorders are unavoidable, there are often steps that can be taken to reduce family stress, the severity of disorders, and negative impacts on the child and family.

• Increase access to mental health services for children.
• Reduce the stigma that creates barriers to seeking mental health services.
• Reduce the public policy barriers to prevention, intervention and treatment efforts.
• Improve practices for meeting the diverse cultural and linguistic needs of children.
• Increase public awareness regarding mental health in an effort to promote community norms that support and prioritize community, family and individual mental health.