Behavioral health equity and parity must become part of our healthcare agenda if we truly wish to eliminate harm that comes from the stigma associated with behavioral health.
Recently, the American Psychiatric Association apologized for it’s long-standing history of discriminatory practices that have undermined the health, safety and welfare of BIPOC individuals and their families. NPR posted a story about how COVID-19 has exacerbated an already broken children’s behavioral health system. The situation in Washington is as dire as any other state. We are boarding children in emergency rooms because we wait for a crisis to help. Yet the crisis in our children’s behavioral health system has not reached into the awareness of the general public. Why? I blame stigma and the biases that come from that.
How many of these faulty assumptions do you hold? How do these assumptions influence your approach to system reform?
When a child has chronic misbehavior, it’s usually the parent’s fault
- The first place to look for why a child is misbehaving is the parent
- Children can’t be diagnosed with mental illnesses
- It’s acceptable for a teen drug addict to withhold information about their substance abuse disorder from their parents.
- It’s acceptable to have to re-explain the horrors of your child’s situation to each new person you call for help before they decide if they can help
- Parents are not to be believed. Only when a professional witnesses the behavior does anyone take it seriously
- It doesn’t hurt anyone to require endless recounting of traumatic narrative, and youth should be present when possible.
- Parents don’t have trauma related to caring for their children
- We can only help children who want to be helped
- If you aren’t getting the help your child needs, help is a phone call away
Child Protective Services protects children
- When parents ask for help by describing family violence brought on by a highly dysregulated child, mandatory reporting leads to CPS
- Foster care is a viable alternative to a parent who can’t control their child.
- When a parent feels unsafe to take a child home where no bed is available, CPS targets removing the healthy children from the home, while offering no intensive treatment for the one with severe emotional regulation issues
- Violent children are not placeable so removal of the other children is simpler
- When children assault their parents, CPS will not intervene
The foster care system protects children
- Legal abandonment of a child is sometimes a necessary step in getting them the “help they need”
- Therapeutic foster care group homes work better than residential treatment
- It’s acceptable to put foster children in offices and hotel rooms instead of providing them therapeutic residential behavioral health care
The At Risk Youth system protects children
- Children are capable of making appropriate mental health decisions
- Children involved in the at risk youth system need a free lawyer, their parents don’t
- A parent with an ARY can get a judge to make their children comply with what’s in their best interest
Jail is a good thing for a defiant child
- Restraint and isolation are appropriate measures in schools
- It’s acceptable to handcuff children who are acting out in school
- We should call the police when a child is out of control
- Juvenile rehabilitation approximates anything equivalent to residential behavioral health care
- Allowing or even advocating your child be arrested and charged will open doors to resources that will help address the child and family’s needs
- Juvenile delinquents need to be punished
Behavioral health isn’t a special education issue
- School refusal isn’t a behavioral health issue
- Emotional regulation issues aren’t behavioral health problems
- ACEs trauma can be overcome by a few outpatient sessions in the early years
- School systems can be trusted to provide appropriate special education interventions for children with behavior disorders.
We can address children’s behavioral health the way we treat adults
- Emergency rooms are the appropriate place to send children who have emotional regulation melt-downs
- Children in treatment don’t need to have their parents involved in treatment with them
- Children are resilient and can tolerate waiting months or years to get appropriate services
- Talk therapy is an effective treatment practice for children with language disorders
- The ITA standards for dependent children and the Crisis Response Workers who evaluate them should be the same as for adults
- Children are resilient. There aren’t long term implications for under-funding schools and the child welfare system
- An intellectually disable child with bipolar disorder doesn’t qualify for disability because the brain injury is a mental health problem
- Teen drug use and mental health are two separate things, so we need different facilities to treat them
- Parents should be grateful to be able to send their children to out-of-state treatments when all else has failed, even though much evidence shows natural support systems are essential to recovery and positive life outcomes.
- Health Care Authority client values don’t need to consider the right of a child to have a family
- Governmental agency personnel are not allowed to advocate for change, even when presented with repeated and consistent testimony that change is needed because current policies and/or resource gaps are causing widespread trauma.
- Any kind of long term residential treatments are abusive and not as effective as less restrictive alternatives
The system is broken, there’s nothing anyone involved can do
- Parents should be satisfied to hear “I’m so sorry you’re going through all of this. The system is broken.”
- There are already enough intensive services in place. Wraparound services are enough to keep high risk children and families safe.
- The legislature can’t prioritize children’s education and behavioral health because there’s no money but we can provide tax breaks for businesses
- There are no long term consequences to our failed behavioral health system
- We can reimburse children’s behavioral health therapists half as much as those who work with adults (neglecting to realize they are actually more complex than adults because they are still dependent on their parents)
- Children’s behavioral health services are an excellent way for young professionals to learn on-the-job training.
- Frequent staff turn-over is acceptable.
- We don’t have enough money for residential care so we will make up a system that we say is better (WISe) but then not deliver on that promise
- This isn’t my responsibility — this is a problem for another department to fix (i.e. the issue is foster care reform, juvenile justice reform, behavioral health treatment resources, child protective services reform, a developmental disability, etc.)