Privatization of Publicly Funded Community Mental Health Services

Approved by Council December 2004
To be reviewed December 2009

Historically, the majority of children with no health insurance and those covered by state Medicaid programs have received treatment for psychiatric illness in public and private clinics. These clinics are generally community centered and exist within a network of publicly funded child health services where treatment is coordinated a cross a number of agencies and providers, providing the child and their family with an integrated system of care.

In a climate of limited resources, many states have shifted state and federal Med funds away from these community-based clinics to private insurers and managed behavioral healthcare organizations. This method of “privatizing” has had a number of unintended consequences. In these instances, it has led to the fragmentation of treatment services by eliminating interdisciplinary teams and interagency programs. It has shifted service burdens and costs to other child serving agencies (such as education, child welfare, and juvenile justice), while diminishing the quality of services for children and adolescents. Children who are dependent on publicly funded health services (particularly poor and underserved) are disproportionately affected.

The American Academy of Child and Adolescent Psychiatry (AACAP), representing over 7,400 child and adolescent psychiatrists, supports maintaining standards of quality mental health services for all children and adolescents regardless of their socioeconomic status. The AACAP policy is that all children’s mental health care systems (public, not-for profit, and for profit) must adopt and follow existing standards of care. These include the AACAP Best Principles for Managed Medicaid RFP’s, American Psychiatric Association Quality Indicators for Child and Adolescent Psychiatry, AACAP Practice Parameters, the Child and Adolescent Service System Program Principles for Community—based Systems of Care, and Center for Mental Health Services’ Cultural Competence Standards. These standards ensure quality, cost-effective care and should be incorporated into provider contracts, and implemented. State governments must not relinquish their ultimate responsibility and accountability roles, and must ensure sufficient resources to oversee contracting agencies to ensure quality of care. Furthermore, children’s community mental health service systems must be family-centered and governed with representation and participation of all stakeholders (including families and youth served, providers, and payors). These basic guidelines must be implemented to ensure that the mental health needs of our nation’s most vulnerable children and adolescents are adequately addressed.