"Applying the population estimates obtained in this survey, approximately 814,300 . . . children had a substantial need for mental health services, but only about 192,175 were receiving these critical services," state the authors of an article published in the August 2004 issue of the Journal of the American Academy of Child & Adolescent Psychiatry. The article describes a study to identify factors related to the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment.

Data for the study were drawn from the National Survey of Child and Adolescent Well-Being. The study sample included 3,803 children and adolescents ages 2-14 for whom investigations and/or assessments had been completed between October 1999 and December 2000. Study measures included need for mental health services, mental health services use within the past 12 months, types of alleged maltreatment (physical abuse, sexual abuse, emotional abuse, neglect), types of placement (in home versus out of home), and child welfare worker risk assessment.

The authors found that

* Almost half (47.9%) of the children and adolescents had clinically significant emotional or behavioral problems, yet only 15.8% received any mental health specialty services in the 12 months preceding the survey.

* Although children and adolescents with clinical need were 2.5 to 3.5 times more likely to receive mental health services than those who were not in the clinical range, only one fourth (11.7%) of those in the clinical range had received any mental health services.

* Children ages 2-5 who were sexually abused were approximately four times more likely to receive mental health services than children in this age group who had experienced neglect.

* African-American children ages 6-10 were less likely to receive mental health services than white children in this age group.

* Children ages 6-10 living at home (versus out of home) were significantly less likely to receive mental health services, even after controlling for clinical need.

* Adolescents ages 11-14 living at home (versus out of home) were also less likely to receive mental health services, whereas having a parent with severe mental illness increased their likelihood for receiving services.

"The need for serious attention to the mental health needs of these youths is apparent and the potential to intervene effectively is within reach," conclude the authors. They suggest that "this can become a reality when a true partnership is established between the child mental health and child welfare service systems."

Burns BJ, Phillips SD, Wagner HR, et al. August 2004. Mental health need and access to mental health services by youths involved with child

welfare: A National Survey. Journal of the American Academy of Child & Adolescent Psychiatry 43(8):960-970.

Readers: At the request of Representative Henry A. Waxman and Senator Susan Collins, the U.S. House of Representatives' Special Investigations Division surveyed every juvenile detention facility in the United States to assess what happens to youth when community mental health services are not readily available. The results of the survey are presented in the report, Incarceration of Youth Who Are Waiting for Community Mental Health Services in the United States. The report covers the period from January 1 to June 30, 2003, and is available at http://www.house.gov/reform/min/pdfs_108_2/pdfs_inves/pdf_health_mental_health_youth_incarceration_july_2004_rep.pdf.