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Whether a child gets mental health care depends a great deal on where he lives, according to a study released today. It is the first to examine geographic differences in children's treatment.
A child in Massachusetts is more than twice as likely as a similarly needy child in California to get care, the RAND survey of 45,247 parents shows.
The geographic differences remain even after accounting for family income and race, says study author Roland Sturm, a RAND senior economist. The report is in the Pediatrics online journal.
''We like to think we have equal rights for all, but some kids apparently are a lot more equal than others when it comes to getting the care they need,'' says Peter Jensen, director of the Center for the Advancement of Children's Mental Health at Columbia University in New York.
The survey included parents of 40,112 children in 13 states and 5,135 in other states. Questions from a widely accepted list of behavioral problems identified the kids who needed help.
Among key findings:
* Colorado, Minnesota and Massachusetts do best at meeting children's needs for mental health treatment.
* Florida, Texas and California offer the least help to children who need it.
* In states doing well -- such as Alabama and Mississippi -- poor kids are more likely than wealthier ones to get treatment. In states with worse records, such as Texas and California, children from prosperous families get more care.
The geographic differences are driven by public and private insurance money for children's mental health, as well as cultural differences between the states, experts say. States vary greatly in how much Medicaid money for poor families they put into children's mental health needs, says Richard Dougherty, a Lexington, Mass., consultant on mental health services.
Also, the federal and state funding program for uninsured, working-poor families varies from state to state. The Texas Legislature just cut most children's mental health benefits out of its program, ''so things will get even worse there,'' says Michael Faenza of the National Mental Health Association, an advocacy group.
Florida, Texas and California have huge immigrant populations, says Stephen Mayberg, director of the California Department of Mental Health. Many immigrants are ''not so sure of the value of mental health services, and many are in low-paying jobs with no insurance.''
More than 10 million children live in California, and there is a shortage of mental health professionals, Mayberg adds.
Private insurance plans vary in benefits for kids' mental health needs. Also, states vary in how stringently they require insurers to cover mental disorders the same as physical ailments, Faenza says.
Fewer than 1 in 5 kids with mental disorders receive treatment, a surgeon general's report concluded two years ago. Disparities across states do exist, ''but it's a matter of drowning in 10 feet of water or 100 feet of water,'' Faenza says. ''Many, many children are being left behind.''
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