[Congressional Record Volume 149, Number 138 (Thursday, October 2, 2003)]
[Senate]
[Pages S12381-S12382]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Pryor, Mr. Coleman, and Mr. 
        Bingaman):
  S. 1704. A bill to amend the Public Health Service Act to establish a 
State family support grant program to end the practice of parents 
giving legal custody of their seriously emotionally disturbed children 
to State agencies for the purpose of obtaining mental health services 
for those children; to the committee on Health, Education, Labor, and 
Pensions.
  Ms. COLLINS. Mr. President, I am pleased to join my colleagues 
Senators Pryor, Coleman and Bingaman in introducing the ``Keeping 
Families Together Act.'' Among other provisions, our bill authorizes a 
new, competitive State grant program to support statewide systems for 
care for children with serious mental illness so that parents are no 
longer forced to give up custody of their children solely for the 
purpose of securing mental health treatment.
  Serious mental illness afflicts millions of our Nation's children and 
adolescents. It is estimated that as many as 20 percent of American 
children under the age of 17 suffer from a mental, emotional or 
behavioral illness. Of these, nearly half have a condition that 
produces a serious disability that impairs the child's ability to 
function in day-to-day activities. What is even more disturbing is the 
fact that two-thirds of all young people who need mental health 
treatment are not getting it.
  Behind each of these statistics is a family that is struggling to do 
the best it can to help a son or daughter with a serious mental illness 
to be just like every other kid--to develop friendships, to do well in 
school, and to get along with their siblings and other family members. 
These children are almost always involved with more than one social 
service agency, including the mental health, special education, child 
welfare, and juvenile justice systems. Yet no one agency, at either the 
State or the Federal level, is clearly responsible or accountable for 
helping these children.
  Recent news reports in more than 30 States have highlighted the 
difficulties that parents of children with serious mental illness have 
in getting the coordinated mental health services that their children 
need. My interest in this issue was triggered by a compelling series of 
stories by Barbara Walsh in the Portland Press Herald last summer which 
detailed the obstacles that many Maine families have faced in getting 
care for their children.
  Too many families in Maine and elsewhere have been forced to make 
wrenching decisions when they have been advised that the only way to 
get the care that their children so desperately need is to relinquish 
custody and place them in either the child welfare or juvenile justice 
system.
  Yet neither system is intended to serve children with serious mental 
illness. Child welfare systems are designed to protect children who 
have been abused or neglected. Juvenile justice systems are designed to 
rehabilitate children who have committed criminal or delinquent acts 
and to prevent such acts from occurring. While neither of these systems 
is equipped to care for a child with a serious mental illness, in far 
too may cases, there is nowhere else for the family to turn.
  Earlier this year, the General Accounting Office (GAO) completed a 
report that I requested with Representatives Pete Stark and Patrick 
Kennedy titled ``Child Welfare and Juvenile Justice: Federal Agencies 
Could Play a Stronger Role in Helping States Reduce the Number of 
Children Placed solely to Obtain Mental Health Services.''
  The GAO surveyed child welfare directors in all States and the 
District of Columbia, as well as juvenile justice officials in the 33 
counties with the largest number of young people in their juvenile 
justice systems. According to the GAO survey, in 2001, parents placed 
more than 12,700 children into the child welfare or juvenile justice 
systems so that these children could receive mental health services.

[[Page S12382]]

  Moreover, the GAO estimate is likely just the tip of the iceberg, 
since 32 States--including the five States with the largest populations 
of children--did not provide the GAO with any data.
  There have been other studies indicating that the custody 
relinquishment problem is pervasive. In 1999, the National Alliance for 
the Mentally Ill released a survey which found that 23 percent--or one 
in four of the parents surveyed--had been told by public officials that 
they needed to relinquish custody of their children to get care, and 
that one in five of these families had done so.
  While some States have passed laws to limit or prohibit custody 
relinquishment, simply banning the practice is not a solution, since it 
can leave mentally ill children and their families without services and 
care. Custody relinquishment is merely a symptom of the much larger 
problem, which is the lack of available, affordable and appropriate 
mental health services and support systems for these children and their 
families.
  In July, I chaired a series of hearings in the Committee on 
Governmental Affairs to examine the difficult challenges faced by 
families of children with mental illnesses. We heard compelling 
testimony from families who told the Committee about their personal 
struggles to get mental health services for their severely ill 
children. The mothers who testified told us they were advised that the 
only way to get the intensive care and services that their children 
needed was to relinquish custody and place them in the child welfare 
system. This is a wrenching decision that no family should be forced to 
make. No parent should have to give up custody of his or her child just 
to get the services that the child needs.
  The legislation that we are introducing today was developed in 
response to concerns raised by both the GAO report and in the 
Governmental Affairs Committee hearings.
  First, the legislation authorizes $55 million for competitive grants 
to States that would be payable over six years to create an 
infrastructure to support and sustain statewide systems of care to 
serve children who are in custody or at risk of entering custody of the 
State for the purpose of receiving mental health services. These grants 
are intended to help states serve these children more effectively and 
efficiently, while keeping them at home with their families.
  States would use funds from these Family Support Grants to foster 
interagency cooperation and cross-system financing among the various 
State agencies with responsibilities for serving children with mental 
health needs. The funds would also support the purchase and delivery of 
a comprehensive array of community-based mental health and family 
support services for children who are in custody, or at risk of 
entering into the custody of the State for the purpose of receiving 
mental health services. This will allow States, which already dedicate 
significant dollars to serving children in state custody, to use those 
resources more efficiently by delivering care to children while 
allowing them to remain with their families.
  In response to recommendation made by the GAO report, the Keeping 
Families Together Act will also establish a Federal interagency task 
force to examine mental health issues in the child welfare and juvenile 
justice systems and the role of their agencies in promoting access by 
children and youth to mental health services.
  And finally, the legislation will remove a current statutory barrier 
that prevents more states from using the Medicaid home and community-
based services waiver to serve children with serious mental health 
conditions. The Medicaid home and community-based services waiver is a 
promising way for States to reduce the incidence of custody 
relinquishment and address the underlying lack of mental health 
services for children. While a number of States have requested these 
waivers to serve children with developmental disabilities, to date very 
few have done so for children with serious mental health conditions. 
That is because, under current law, States can only offer home- and 
community-based services under these waivers as an alternative to care 
in hospitals, nursing facilities, or intermediate care facilities for 
the mentally retarded. Our legislation will correct this omission and 
provide parity to children with mental illness by including inpatient 
psychiatric hospitals and residential treatment facilities on the list 
of institutions for which alternative care through the Medicaid home- 
and community-based services waivers may be available.
  The legislation we are introducing today will help to reduce the 
barriers to care for children who suffer from mental illness and will 
assist States in eliminating the practice of parents relinquishing 
custody of their children to State agencies solely for the purpose of 
securing mental health services.
  Our legislation has been endorsed by a number of mental health and 
children's groups including the National Alliance for the Mentally Ill, 
the Federation of Families for Children's Mental Health, the National 
Child Welfare League, the Bazelon Center, the Children's Defense Fund, 
and the National Mental Health Association. I urge all of my colleagues 
to join us as cosponsors.
                                 ______