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CHARLESTON, W.Va. (AP) — West Virginia's mental health system relies too much on facilities like psychiatric hospitals to treat children and should make changes such as expanding in-home services to comply with the Americans with Disabilities Act, federal authorities said.
The U.S. Department of Justice said West Virginia never implemented its 2005 response plan to federal requirements that the mentally disabled be placed in the community whenever appropriate.
"The unnecessary segregation of children with mental health conditions violates their civil rights and wastes the state's fiscal resources," wrote Vanita Gupta, the acting assistant attorney general for the civil rights division.
The 30-page report released Monday said state child-services agencies have not collaborated to address the needs of children with mental health conditions in different systems, resulting in duplicated efforts, wasted resources, fractured care delivery and confusion.
Changes suggested by the report include eliminating unnecessary residential placements and ensuring that mentally disabled children aren't kept there longer than necessary. It also calls for expanding in-home and community services and ensuring family involvement.
Long before the report's release, the state Bureau for Children and Families was given a federal waiver allowing the state to use funding to pay for various mental health services for children in their homes. When the investigation started, the Justice Department "recognized we were working on initiatives to reduce our reliance on residential treatment," said Karen Bowling, secretary of the state Department of Health and Human Resources.
Among other things, DHHR also has promoted child development through a program that supports pregnant women and helps parents improve child-raising skills.
The government could take action such as a lawsuit to ensure the state complies, but officials are "encouraged by our positive interactions thus far" with state leaders, Gupta said.
In April 2014, the Justice Department began its investigation of West Virginia programs for children with mental health conditions who enter through child welfare, juvenile justice and Medicaid systems.
The department conducted four visits to assess the system over the next seven months. It toured nine segregated residential treatment facilities and two shelters housing children with disabilities, and visited treatment facilities in two neighboring states where West Virginia places significant numbers of children. Such facilities include group residential care, psychiatric residential treatment facilities and hospitals.
The report found 1,017 children with mental health conditions living in residential treatment facilities in December 2014. That represented 25 percent of all children in DHHR custody, well above the national average of 15 percent.
And 71 percent of placements involving children ages 12 to 17 were in these facilities — a rate higher than 46 other states, according to the report.
Such placements can be expensive. The report noted in fiscal 2012, DHHR spent $67.5 million on residential placements, including more than $20 million on out-of-state placements.
Many mentally ill children on Medicaid are at risk of being unnecessarily segregated or put in institutions because of limited access to services, including children who are minorities, have been exposed to trauma or identify as gay or transgender, the report said.
Hospitals can't compare to homes for raising children in a healthy environment, said Dr. Toni Goodykoontz, chief of adolescent psychiatry at West Virginia University.
While that's not always possible because of instances of abuse and neglect or when a child needs acute psychiatric treatment, "where there's a home for parents to be able to provide nurturing and at least a mom or a dad and sibling, that unit provides a sense of belonging, a sense or nurturing, development and attachment," she said.
The concern is even bigger in rural areas, where families often don't have access to mental health care for proper diagnosis and medicine, Goodykoontz said.
The investigation's results were first reported by The Register-Herald of Beckley.
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