[Congressional Record Volume 153, Number 14 (Wednesday, January 24, 2007)]
[Senate]
[Pages S1067-S1070]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Harkin, Mr. Kennedy, Mr. Pryor, 
        Mr. Coleman, Ms. Cantwell, Mr. Durbin, Ms. Mikulski, Mr. 
        Bingaman, Mr. Lautenberg, and Mr. Kerry):
  S. 382. 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 Harkin, Kennedy, Coleman, Pryor, Cantwell, Durbin, Mikulski, 
Bingaman, Lautenberg and Kerry, in introducing the ``Keeping Families 
Together Act.'' This legislation is intended to reduce the barriers to 
care for children with serious mental illness so that their parents are 
no longer forced to give up custody 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. 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 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, 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 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.

[[Page S1068]]

  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. This likely 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 on Mental Illness 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.
  In 2003 and 2004, I chaired a series of hearings in the Homeland 
Security and 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 two 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 in 2004 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 seven 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 $100 million over six 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.
  In addition, the legislation calls for the creation of a federal 
interagency task force to examine mental health issues in the child 
welfare and juvenile 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 on 
Mental Illness, the Bazelon Center for Mental Health Law, Mental Health 
America, the American Psychological Association, and the American 
Psychiatric Association. I ask unanimous consent that letters from 
these organizations endorsing the bill be printed in the Record.
  The Keeping Families Together Act will help to reduce the barriers to 
care for children with serious mental illness, and I urge our 
colleagues to join us as cosponsors.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

                                               Bazelon Center,

                                 Washington, DC, January 17, 2007.
     Hon. Susan Collins
     U.S. Senate,
     Washington, DC.
       Dear Senator Collins: The Judge David L. Bazelon Center for 
     Mental Health Law--the leading national legal-advocacy 
     organization representing children and adults with mental 
     disabilities who primarily rely on the public mental health 
     system for treatment--is pleased to support the Keeping 
     Families Together Act and commends your leadership on this 
     important legislation.
       A lack of access to appropriate mental health services and 
     supports for children in both the private and public sectors 
     is a significant barrier families across the country face 
     when they are confronted with the horrific problem of custody 
     relinquishment of a child solely to access necessary menta1 
     health treatment. Custody relinquishment for these purposes 
     should not and does not need to happen. It is a symptom of a 
     flawed children's mental health system that is in crisis.
       The Keeping Families Together Act serves to address this 
     fragmented system by assisting states in developing and 
     expanding capacity to serve children with severe mental and 
     emotional disorders so families have options when their child 
     is in need of mental health care. With studies showing 
     approximately two-thirds of children and adolescents are not 
     receiving the mental health services they need, we welcome 
     this vital legislation. Promoting early intervention, 
     ensuring access to wide range of services and supports and 
     helping to maintain family integrity are achievable goals 
     supported by your legislation--goals we are confident will 
     help reduce these appalling statistics.
       The Bazelon Center looks forward to working closely with 
     you and your staff throughout the legislative process to 
     enact the Keeping Families Together Act. Thank you for your 
     commitment to the health and mental health needs of our most 
     vulnerable chi1dren.
           Sincerely,
                                          Robert Bernstein, Ph.D.,
     Executive Director.
                                  ____



                           American Psychological Association,

                                 Washington, DC, January 19, 2007.
     Hon. Susan M. Collins,
     U.S. Senate,
     Washington, DC.
       Dear Senator Collins: On behalf of the 145,000 members and 
     affiliates of the American Psychological Association (APA), I 
     am writing in support of the Keeping Families Together Act. 
     This vital legislation would establish a state family support 
     grant program to end the practice of parents needing to 
     relinquish legal custody of their children to state agencies 
     for the sole purpose of obtaining mental health services for 
     their children.
       As you know, the custody relinquishment problem stems from 
     a paradox that exists in many states. Private healthcare 
     plans frequently do not cover many services needed by 
     children with physical, mental, or developmental 
     disabilities. As a result, many parents turn to the child 
     welfare or juvenile justice system for assistance. Neither of 
     these

[[Page S1069]]

     systems is intended nor equipped to care for a child with a 
     serious mental health problem. Yet, as the law currently 
     exists in many states, parents must relinquish custody to 
     receive otherwise unaffordable specialized care for their 
     children. Ironically, these children are frequently placed 
     with foster families that receive full funding for the 
     children's care, while competent parents lose contact with, 
     influence over and decision making authority for their 
     children. Custody relinquishment of a child solely so he or 
     she may access necessary mental health services is a national 
     tragedy.
       The Keeping Families Together Act lays a strong foundation 
     for needed reforms by promoting access to needed services and 
     reducing fragmentation in service delivery. Some of the 
     legislation's main provisions include providing grants to 
     states to establish interagency systems of care for children 
     and adolescents with serious mental health and emotional 
     problems. Additionally, this legislation will establish a 
     federal interagency task force to examine mental health 
     issues in the child welfare and juvenile justice systems.
       APA members are actively engaged in research and practice 
     initiatives related to helping children and their families 
     receive the mental health services they need. Please view APA 
     as a resource to you for empirically-based research on child 
     mental health matters when considering the enactment of the 
     Keeping Families Together Act.
       In closing, we would like to thank you once again for your 
     efforts in developing the Keeping Families Together Act and 
     to offer our association's assistance in furthering passage 
     of this vital legislation. Please contact Annie Toro of our 
     Public Policy Office if you would like any additional 
     information.
           Sincerely,

                                      Gwendolyn Puryear Keita,

                                               Executive Director,
     Public Interest Directorate.
                                  ____



                                        Mental Health America,

                                Alexandria, VA., January 22, 2007.
     Hon. Susan Collins,
     U.S. Senate, Washington, DC.
     Hon. Pete Stark,
     House of Representatives, Washington, DC.
     Hon. Tom Harkin,
     U.S. Senate, Washington, DC.
     Hon. Jim Ramstad,
     House of Representatives, Washington, DC.
       Dear Senators Collins and Harkin and Representatives 
     Ramstad and Stark: On behalf of Mental Health America 
     (formerly the National Mental Health Association), I am 
     writing to commend you for reintroducing the Keeping Families 
     Together Act in the 110th Congress.
       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 custody 
     relinquishment tears families apart, is devastating for 
     parents and caregivers, and leaves children feeling abandoned 
     in their hour of greatest need. Parents are often forced to 
     take this tragic step because their private health care 
     coverage imposes discriminatory and restrictive caps on 
     mental health care or their insurers simply refuse to cover 
     the required treatment. The majority of these families are 
     not eligible for Medicaid coverage because of their income. 
     Furthermore, there is a widespread lack of appropriate mental 
     health services for children and adolescents in most states 
     and communities which forces families to make desperate 
     choices.
       Your legislation promises to improve access to the services 
     these families need to stay together by providing grants to 
     states to establish interagency systems of care for children 
     and adolescents with serious mental disorders. These grants 
     will allow states to build more efficient and effective 
     mental health systems for children and families. Your bill 
     also calls for the creation of a federal interagency task 
     force to examine mental health issues in the child welfare 
     and juvenile justice systems. This analysis is greatly needed 
     because, as you know, children who become wards of the state 
     in order to receive mental health services are generally 
     placed in the child welfare or juvenile justice systems even 
     though neither system is designed or intended to serve as a 
     mental health provider.
       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. 
     We welcome this legislation as a critical step toward ending 
     custody relinquishment 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 and families.
           Sincerely,
                                            David L. Shern, Ph.D.,
     President and CEO, Mental Health America.
                                  ____

                                              National Alliance on


                                               Mental Illness,

                                  Arlington, VA, January 18, 2007.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Tom Harkin,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins and Harkin: On behalf of the 210,000 
     members and 1,200 affiliates of the National Alliance on 
     Mental Illness, NAMI, I am writing to offer our strong 
     support for the Keeping Families Together Act, KFTA. As the 
     nation's largest organization representing families of 
     children and adolescents living with mental illness, NAMI is 
     proud to offer our support for this important legislation.
       The KFTA represents a major step forward in helping to end 
     a national 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 a child to the 
     state in order to secure vitally necessary mental illness 
     treatment and support services. This unthinkable practice 
     tears families apart, devastates 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 and assets. 
     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 2003 
     New Freedom Initiative Mental Health Commission report.
       Your legislation would help end this growing crisis by 
     providing grants to states to establish interagency systems 
     of care for children and adolescents with serious mental 
     disorders. These grants would allow states to build more 
     efficient and effective mental health systems for children 
     and families. It would also. eliminate 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 KFTA also creates a federal interagency task force to 
     examine how the child welfare and juvenile justice systems 
     serve children and adolescents with mental illness. 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.
       NAMI feels strongly that no family 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. Thank you for your leadership and 
     commitment to ending this practice and for continuing to 
     stand up for children, families and common sense.
           Sincerely,
                                   Michael J. Fitzpatrick, M.S.W.,
                                               Executive Director.
  Mr. HARKIN. Mr. President, I am honored to join with the 
distinguished junior Senator from Maine, Ms. Collins, in introducing 
the Keeping Families Together Act. As a long-time advocate for people 
with disabilities, I believe that this legislation represents an 
important step forward in ensuring the health and wellbeing of our 
children, in particular those with mental illness.
  One in five children has a diagnosable mental disorder, and one in 
ten children has a mental disorder serious enough to hinder their 
functioning at school, at the home, and in their communities. 
Regrettably, two-thirds of children in this latter group do not receive 
the treatment they need. Without treatment, mental illness negatively 
affects all areas of children's lives, and it can have dire 
consequences for their future, including their ability to become 
productive members of society. Children with mental health problems are 
at higher risk of chronic illness, academic difficulties and school 
discipline problems, delinquency, incarceration, and suicide.
  The good news is that 90 percent of all mental health disorders are 
treatable by therapy and medication. Yet parents face a multitude of 
obstacles and challenges in finding appropriate services for a child 
with serious mental illness. Often, they find that their private 
insurance will not pay for necessary mental health services, or that 
they do not qualify for Medicaid. In their efforts to secure effective 
treatment, many parents exhaust their own financial resources and find 
that they have nowhere else to turn. Tragically, many dedicated, loving 
parents reach the point where they believe that they have no other 
option but to relinquish custody of their child to the State in order 
to access appropriate services. These out-of-home placements can be 
traumatic for children, and profoundly disruptive and heart-breaking 
for families that are already in crisis.
  Making matters worse, state systems are often poorly equipped to 
serve the needs of these children. Many children end up being placed in 
expensive residential institutions, rather than less

[[Page S1070]]

costly home- and community-based services. Our juvenile justice system 
is overwhelmed by young people in need of mental health services. A 
congressional report authored by Senator Collins and Representative 
Henry Waxman of California suggests that, every night, nearly 2,000 
youths are placed in juvenile detention facilities not because they are 
criminals but because they do not have access to necessary mental 
health services. This results in a $100 million bill to the taxpayers. 
Not only is this a serious misuse of public funds, it is a tragic 
injustice to the children and families involved. We simply cannot allow 
children to languish in detention facilities when they are really in 
need of mental health treatment.
  The Keeping Families Together Act lays a foundation for securing 
better access to mental health services for children. Consistent with 
recommendations by the President's New Freedom Commission on Mental 
Health, this legislation encourages interagency coordination in the 
provision of mental health services for children. The bill gives States 
incentives to remedy the fragmentation that now exists among child 
welfare, education, juvenile justice, and mental health agencies 
responsible for helping children. It ensures that States will improve 
access to mental health services and eliminate the practice of parents' 
relinquishing custody of their children solely for the purpose of 
securing mental health treatment. Our bill also promotes sustainable 
financing by requiring States to provide graduated matching funds.
  In sum, by providing a sustainable, coordinated system of mental 
health care, children will be able to receive needed services within a 
stable, loving home environment. Families will be able to stay 
together.
  In a decent, humane society, every family should have access to 
appropriate mental health services for their children. Parents should 
not have to surrender a child to the State as the price for obtaining 
access to mental health treatment. The Keeping Families Together Act 
offers a better way. It allows children with mental disorders to stay 
where they belong--in the custody and care of their loving family. I 
join with Senator Collins in urging our colleagues to support this 
urgent and important legislation.
                                 ______