[Congressional Record Volume 151, Number 16 (Tuesday, February 15, 2005)]
[Senate]
[Pages S1419-S1423]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Pryor, Mr. DeWine, Mr. Bingaman, 
        Mr. Smith, Mr. Lieberman, and Mr. Coleman):
  S. 380. 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 very pleased today to join several 
of my colleagues--Senator Pryor, Senator DeWine, Senator Bingaman, 
Senator Smith, Senator Lieberman, and the Presiding Officer, Senator 
Coleman--in introducing the Keeping Families Together Act. This 
legislation is intended to reduce the barriers to care for children who 
are struggling with serious mental illness. It is intended to ensure 
their parents are no longer forced to give up custody of their children 
solely for the purpose of securing mental health treatment.
  As the Presiding Officer is well aware, because he was an active 
participant in them, the Governmental Affairs Committee in the last 
Congress held extensive hearings on this issue.
  What we heard was a tragedy. We heard case after case where families

[[Page S1421]]

made the wrenching choice to give up custody of their children in order 
to secure the mental health treatment that they needed. No family 
should ever be forced to make that decision.
  Imagine what it feels like for a child who is suffering from mental 
illness to be wrenched from his family, put into either the juvenile 
justice system or the foster care system simply because that is the 
only way to get that child the care that he so desperately needs.
  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. What I find most disturbing, however, 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 a daughter with serious mental health 
needs 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, or the juvenile justice systems. Yet no one agency, at 
either the State or the Federal level, is clearly responsible or 
accountable for helping these children and their families.
  My interest in this issue was triggered by a compelling series of 
stories by Barbara Walsh in the Portland Press Herald which detailed 
the obstacles that many Maine families have faced in getting 
desperately needed mental health services 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.
  When a child has a serious physical health problem like diabetes or a 
heart condition, the family turns to their doctor. When the family 
includes a child with a serious mental illness, it is often forced to 
go to the child welfare or juvenile justice system to secure treatment.
  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. 
While neither of these systems is equipped to care for a child with a 
serious mental illness, in far too many cases, there is nowhere else 
for the family to turn.
  In some extreme cases, families feel forced to file charges against 
their child or to declare that they have abused or neglected them in 
order to get the care that they need. As one family advocate observed, 
``Beat 'em up, lock 'em up, or give 'em up,'' characterizes the choices 
that some families face in their efforts to get help for their 
children's mental illness.
  In 2003, the Government Accountability Office, GAO, issued a report 
that I requested with Representatives Pete Stark and Patrick Kennedy 
that found that, 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. I believe that this is just the 
tip of the iceberg, since 32 States--including five States with the 
largest populations of children--did not provide the GAO with any data.
  Other studies indicate that the problem is even more pervasive. A 
1999 survey by the National Alliance for the Mentally III 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.
  Some States have passed laws to limit custody or prohibit custody 
relinquishment. Simply banning the practice is not a solution, however, 
since it can leave children with mental illness 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.
  Last Congress, I chaired a series of hearings in the Governmental 
Affairs Committee to examine this issue further. We heard compelling 
testimony from mothers who told us that 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 or 
juvenile justice 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 mothers also described the barriers they faced in getting care 
for their children. They told us about the limitations in both public 
and private insurance coverage. They also talked about the lack of 
coordination and communication among the various agencies and programs 
that service children with mental health needs. One parent, desperate 
for help for her twin boys, searched for 2 years until she finally 
located a program--which she characterized as ``the best kept secret in 
Illinois''--that was able to help.
  Parents should not be bounced from agency to agency, knocking on 
every door they come to, in the hope that they will happen upon someone 
who has an answer. It simply should not be such a struggle for parents 
to get services and treatment for their children.
  We also need to question what happens to these children when they are 
turned over to the child welfare or juvenile justice authorities. I 
released a report last year with Congressman Henry Waxman that found 
that all too often they are simply left to languish in juvenile 
detention centers, which are ill-equipped to meet their needs, while 
they wait for scarce mental health services.
  Our report, which was based on a national survey of juvenile 
detention centers, found that the use of juvenile detention facilities 
to ``warehouse'' children with mental disorders is a serious national 
problem. It found that, over a six month period, nearly 15,000 young 
people--roughly 7 percent of all of the children in the centers 
surveyed--were detained solely because they were waiting for mental 
health services outside the juvenile justice system. Many were held 
without any charges pending against them, and the young people 
incarcerated unnecessarily while waiting for treatment were as young as 
seven years old. Finally, the report estimated that juvenile detention 
facilities are spending an estimated $100 million of the taxpayers' 
money each year simply to warehouse children and teenagers while they 
are waiting for mental health services.
  The Keeping Families Together Act, which we are introducing today, 
will help to improve access to mental health services and assist states 
in eliminating the practice of parents relinquishing custody of their 
children solely for the purpose of securing treatment.
  The legislation authorizes $55 million over 6 years for competitive 
grants to states 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. States already dedicate significant dollars to 
serve children in state custody. These Family Support Grants would help 
States to serve children more effectively and efficiently, while 
keeping them at home with their families.

  The legislation would also 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 needs. 
This waiver provides a promising way for States to address the 
underlying lack of mental health services for children that often leads 
to custody relinquishment. While a number of States have requested 
these waivers to serve children with developmental disabilities, very 
few have done so for children with serious mental health conditions. 
Our legislation would provide parity to children with mental illness by 
making it easier for States to offer them home- and community-based 
services under this waiver as an alternative to institutional care.
  And finally, the legislation calls for the creation of a federal 
interagency task force to examine mental health issues in the child 
welfare and juvenile

[[Page S1422]]

justice systems and the role of those agencies in promoting access by 
children and youth to needed mental health services. The task force 
would also be charged with monitoring the Family Support grants, making 
recommendations to Congress on how to improve mental health services, 
and fostering interagency cooperation and removing interagency barriers 
that contribute to the problem of custody relinquishment.
  The Keeping Families Together Act takes a critical step forward to 
meeting the needs of children with serious mental or emotional 
disorders. Our legislation has been endorsed by a broad coalition 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 Bazelon Center for Mental Health Law, the National Child 
Welfare League, the National Mental Health Association, the American 
Correctional Association, the American Psychological Association, the 
American Psychiatric Association, the American Academy of Child and 
Adolescent Psychiatry, and Fight Crime, Invest in Kids.
  Mr. President, I ask unanimous consent that their letters of 
endorsement for the bill be printed in the Congressional Record, and I 
urge all of our colleagues to join us as cosponsors.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                February 14, 2005.
     Hon. Susan Collins,
     Hon. Mark Pryor,
     U.S. Senate,
     Washington, DC.
     Hon. Jim Ramstad,
     Hon. Nancy Johnson,
     Hon. Pete Stark,
     Hon. Patrick Kennedy,
     U.S. House of Representatives,
     Washington, DC.
       Dear Senators Collins and Pryor and Representatives 
     Ramstad, Johnson, Stark, and Kennedy: As national 
     organizations representing mental health consumers, families, 
     advocates, professionals and providers dedicated to improving 
     the lives of children and adolescents living with mental 
     disorders and their families, we applaud your leadership in 
     reintroducing the Keeping Families Together Act in the 109th 
     Congress.
       This legislation promises to help end a scandal that has 
     lingered too long in states throughout our nation. As you 
     know, thousands of families every year are forced to give up 
     custody of their children to the state in order to secure 
     vitally necessary mental health services. This unthinkable 
     practice tears families apart, is devastating for parents and 
     caregivers and leaves children feeling abandoned in their 
     hour of greatest need.
       This practice occurs because most families have 
     discriminatory and restrictive caps on their private mental 
     health coverage or insurers fail to cover the required 
     treatment. The majority of these families are not eligible 
     for Medicaid coverage because of their income. This truly 
     unfortunate practice also exists because of the lack of 
     appropriate mental health services in many states and 
     communities for children and adolescents with mental 
     disorders. This was well documented in President Bush's New 
     Freedom Commission report on mental health (July 2003).
       This legislation promises to help end this growing crisis 
     by providing grants to states to establish interagency 
     systems of care for children and adolescents with serious 
     mental disorders. The grants will allow states to build more 
     efficient and effective mental health systems for children 
     and families. It also eliminates barriers to home and 
     community-based care for children by enabling a greater 
     number of children to receive mental health services under 
     the Section 1915(c) Medicaid home- and community-based 
     waiver. The waiver promises to make appropriate services 
     available to children in their homes and communities and 
     close to their loved ones at a considerable cost savings over 
     providing those services in an institutional setting.
       The legislation also calls for the creation of a federal 
     interagency task force to examine mental health issues in the 
     child welfare and juvenile justice systems. A GAO report 
     released in April 2003 showed that when parents give up 
     custody of their child to secure mental health services, 
     those children are placed in one of these two systems--
     neither of which is designed to be a mental health service 
     agency.
       No family in our nation should ever be asked to make the 
     heart-wrenching decision to give up parental rights of their 
     seriously ill child in exchange for mental health treatment 
     and services.
       We welcome this legislation as a critical step toward 
     ending this practice and toward delivering more cost 
     effective and appropriate services for children and families.
       Once again, we thank you for your leadership and commitment 
     to ending this practice and for continuing to stand up for 
     children, families and common sense.
           Sincerely,
       Adoptions Together, Inc.
       Alabama Foster and Adoptive Association.
       Alliance for Children and Families.
       American Academy of Child & Adolescent Psychiatry.
       American Correctional Association.
       American Counseling Association.
       American Mental Health Counselors Association.
       American Association for Marriage and Family Therapy.
       American Psychiatric Association.
       American Psychological Association.
       Association of University Centers on Disabilities.
       Bazelon Center for Mental Health Law.
       Child and Adolescent Bipolar Foundation.
       Children's Action Alliance.
       Children and Adults with Attention-Deficit/Hyperactivity 
     Disorder.
       Child Welfare League of America.
       Children Awaiting Parents.
       Children's Defense Fund.
       Depression and Bipolar Alliance.
       Family Voices.
       Federation of Families for Children's Mental Health.
       Foster Family-based Treatment Association.
       Girls Incorporated of Memphis.
       Learning Disabilities Association of America.
       Lutheran Children and Family Service.
       National Alliance for the Mentally Ill.
       National Association for Children of Alcoholics.
       National Association for Children's Behavioral Health.
       National Association of County Behavioral Health and 
     Disability Directors.
       National Association of Mental Health Planning and Advisory 
     Councils.
       National Association of Protection and Advocacy Systems.
       National Association of School Psychology.
       National Association of Social Workers.
       National Association of State Mental Health Program 
     Directors.
       National CASA Association (Court Appointed Special 
     Advocates).
       National Foster Parent Association.
       National Independent Living Association.
       National Mental Health Association.
       National Respite Coalition.
       Physicians for Human Rights.
       School Social Work Association of America.
       Suicide Prevention Action Network USA.
       Supportive Child Adult Network, Inc. (Stop Child Abuse Now, 
     Inc.)
       The Rebecca Project for Human Rights.
       Voice for Adoption.
       Volunteers of America.
       Youth Law Center.
                                  ____



                                  Fight Crime: Invest in Kids,

                                Washington, DC, February 15, 2005.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
       Dear Senator Collins: On behalf of the more than 2,000 
     sheriffs, police chiefs, prosecutors, and victims of violence 
     who constitute the national anti-crime group FIGHT CRIME: 
     INVEST IN KIDS, thank you for introducing the Keeping 
     Families Together Act. This bill would take an important step 
     toward ending the practice of inappropriately placing kids in 
     juvenile detention facilities solely because of the absence 
     of affordable and accessible mental health treatment for 
     them. These placements drain significant resources from an 
     already underfunded juvenile justice system, diverting 
     funding that would otherwise support effective violence 
     prevention programs for at-risk kids and intervention 
     programs for kids who have already committed a criminal or 
     delinquent act.
       A July 2003 General Accounting Office report, Child Welfare 
     and Juvenile Justice: Several Factors Influence the Placement 
     of Children Solely to Obtain Mental Health Services, revealed 
     that over 9,000 kids in selected counties in 17 states were 
     placed in the juvenile justice system merely to obtain mental 
     health services. Furthermore, a House Committee on Government 
     Reform report demonstrated that two-thirds of juvenile 
     detention facilities inappropriately hold kids waiting for 
     mental health services. In 33 states, kids who did not have 
     any criminal charges were held in detention facilities while 
     awaiting community mental health treatment. Other kids had 
     been charged with an offense but would not have been placed 
     in detention but for the lack of available mental health 
     treatment. In fact, the House Committee report revealed that, 
     each night, nearly 2,000 kids wait in detention for community 
     mental health services, representing 7 percent of all youth 
     held in juvenile detention. It is estimated that juvenile 
     detention facilities spend approximately $100 million each 
     year to keep kids who are inappropriately placed as they wait 
     for mental health treatment. This cost does not account for 
     the additional service provision and staff time often needed 
     in juvenile facilities to care for kids with severe mental 
     health problems, although over half of responding facilities 
     reported that staff receives poor, very poor, or no mental 
     health training.
       Every year, 1.4 million kids are charged with an offense 
     for which an adult could be tried in a criminal court. The 
     juvenile justice system is responsible for rehabilitating 
     these kids so that they can leave the system and become 
     productive citizens instead of continuing a life of crime, as 
     well as for preventing such acts in the first place. 
     Inappropriately placing kids who need mental health treatment 
     in juvenile detention facilities places an unnecessary 
     financial burden on the inadequately-resourced juvenile

[[Page S1423]]

     justice system, and jeopardizes the safety of our 
     communities. The Keeping Families Together Act would provide 
     grants to help states provide and coordinate the needed array 
     of mental health services to children so that families do not 
     need to relinquish their kids to the juvenile justice system. 
     This legislation would also establish a federal interagency 
     task force to examine mental health issues in the child 
     welfare and juvenile justice systems.
       We are proud that our Senator introduced the Keeping 
     Families Together Act to help keep families together, focus 
     juvenile justice resources on delinquent and at-risk kids, 
     and make our communities safer.
           Sincerely,
                                                     Mark Westrum,
                                    Sheriff, Sagadahoc County, ME.

  Mr. SMITH. Mr. President, I rise today to join my colleagues, Senator 
Collins and Senator Pryor, in introducing the ``Keeping Families 
Together Act''. This bill will expand Medicaid's home and community 
based services waiver to cover children and adolescents in residential 
treatment facilities. Currently, most state Medicaid agencies, 
including Oregon, do not cover this intensive treatment.
  In 2001, 101 Oregon children and adolescents were placed in State 
custody because this was the only way they could get the mental health 
treatment they need. This situation occurs most often in middle-income 
families, where the family's employer-based insurance does not cover 
intensive treatment for serious mental illness, but the family income 
is too high for them to qualify for Medicaid services. With no other 
way to get their child treatment, parents are forced to choose between 
custody and care. Passage of this legislation is urgently needed so 
that thousands of parents are not forced to relinquish their custody 
rights to State child welfare or juvenile agencies in order to obtain 
mental health care for their seriously mentally ill children.
  In Oregon, children with serious mental illnesses are being taken 
away from their families at a time when they most need to be close to 
home. The availability of family support services, community-based 
services and other effective interventions will help reduce the need 
for costly residential care and consequently reduce the need to place 
children in a setting away from their homes, families and communities. 
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 so that we can hopefully see an end to this 
practice, not just in Oregon, but in every State in our nation.
  I urge my colleagues to join me in support of this critical 
legislation.
                                 ______