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Children with mental illness need an advocate

Craig F. Walker/Globe Staff

Some of the state’s most vulnerable children — those with serious mental health issues — continue to have difficulty accessing the care they so desperately need. Meanwhile, the Baker administration has chosen to appeal the court monitoring that has at least brought some improvements to the system.

If that appeal — however ill-advised — is successful, lawmakers will need to provide a backstop: someone who can oversee whether those services are being provided in a timely fashion, advocate for children with mental health disorders, and help families who find it difficult to access those services. What the state needs is a children’s mental health ombudsman to keep the state on track — well in advance of the end of federal court monitoring.


A bill to create just such a post within the existing state Office of the Child Advocate got a hearing before the Joint Committee on Mental Health, Substance Abuse, and Recovery recently and some significant support — in addition to its dozens of cosponsors.

Maria Mossaides, the state’s child advocate, who spoke in favor of the bill, told the committee, “Despite significant improvements in the availability of mental health services, especially for children who are covered by MassHealth, it is still very hard for many children and their families to get the mental health care that they need.”

Massachusetts has made most of those improvements in the wake of the 2006 lawsuit known by the name of one of its youthful plaintiffs, Rosie D., which documented the plight of children in crisis who went weeks or even months without treatment for serious mental disorders — victims of a system that had broken down.

At the time, the court identified some 15,000 children covered under Medicaid who were simply not getting the level of services they were entitled to. The federal court has continued to prod three separate administrations, going back to Governor Mitt Romney, to do better. And they have, to a point.


But as US District Court Judge Michael Ponsor found back in February, when he rejected the Baker administration’s request to be relieved of the court oversight that has been in place since Rosie D. was decided:

“Depending on the particular month and year, between 30 and 60 percent of the Plaintiff children seeking [intensive care coordination] services continue to wait beyond the 14-day period for their first appointment, often for much longer. These delays have grave potential consequences for the health and welfare of these vulnerable children, as Plaintiffs’ evidence confirms.”

The judge noted rather pointedly, “If a Medicaid-eligible child had appendicitis, no one would suggest that a ‘reasonably prompt’ response would be an appointment within two weeks of onset.”

A recent report by the Children’s Mental Health Campaign found, “Despite near universal health insurance coverage and a diverse array of behavioral health services” in the state, “children and adolescents with behavioral health conditions seeking care are faced with delays in access to a fragmented system . . . that reflect gaps in care and systemic issues in delivery.”

The study noted in particular the absence of behavioral health services at the many new medical urgent care centers.

A “fragmented system” means too many children still end up in emergency rooms (often waiting for one of those all-too-few in-patient beds) for lack of early in-home or out-patient care.


And while the Rosie D. case and the ongoing order from Judge Ponsor are in effect only for children covered by Medicaid, the proposed ombudsman would be empowered to help those covered by private insurers as well.

An ombudsman isn’t a miracle worker and can’t — even with sufficient staff resources — wave a magic wand and heal a fractured system. But the right person in the job can and must keep the pressure on a bureaucracy that too often moves at a snail’s pace. It’s a small but essential step to help children who need our help the most.