As many as 70 percent of young people involved in the juvenile justice system may have a serious mental health condition. But only 8 percent of these youth received treatment within six months after entering detention.
High rates of youth with mental illness in the juvenile justice system are due, in part, to the failure of other child-serving systems to provide appropriate and timely mental health care.
The result: Juvenile detention centers across California and around the country have become de facto mental institutions.
Incarceration instead of treatment doesn’t make sense as a healthcare practice. Providing intensive mental health treatment to youth when it’s needed ensures that young people are developing the social and emotional skills they need to be positive members of our communities. A service array in California, called ‘Katie A.’ services, could meet this critical need for care and better support the state’s most vulnerable youth.
To date, these intensive home and community-based services have only been available to child welfare-involved youth. Last month, the Department of Health Care Services (DHCS) publicly acknowledged, for the first time, that Katie A. services must be provided to all Medi-Cal beneficiaries under the age of 21 for whom these services are medically necessary, including juvenile justice-involved youth.
Even prior to the state’s recent acknowledgment that Katie A.’s scope should be wider, Young Minds Advocacy set out to evaluate what it would take to expand access to intensive home and community-based services.
The resulting report – Fulfilling Medi-Cal’s Promise: Extending Home and Community-Based Mental Health Services to Juvenile Justice-Involved Youth in California – finds that thousands of juvenile justice-involved youth in California should be eligible for these services, and that delivering them to this population could greatly improve the lives of young people.
Incarceration rather than treatment doesn’t make fiscal sense. Because the federal government reimburses about half of the cost of Medi-Cal, providing Katie A. services to juvenile justice-involved youth is less expensive than business as usual. As our report highlights, costs per beneficiary to deliver Katie A. services averaged $4,586 annually.
Without Medi-Cal, counties shoulder the full cost of providing treatment and services to incarcerated young people, costs that can add up to $18,800 for each young person who has a mental health condition.
Overall, the report estimates it would cost $20.7 million annually to deliver Katie A. services to every juvenile justice-involved youth who needs treatment. California’s actual cost would be about half of that because of the federal government match.
Full participation by eligible youth, of course, is unlikely. If enrollment in the program mirrored existing child welfare participation, total costs would be about $2-3 million annually statewide.
The expansion of intensive home and community-based services to all Medi-Cal eligible youth, including those involved in the juvenile justice system, offers a rare opportunity to reduce youth incarceration, improve our communities and save money.
But in order to capitalize on this opportunity, counties need to build service capacity. That means counties need to include Katie A. growth to accommodate all Medi-Cal eligible youth in their budgets and provider contracts for fiscal years 2016 and 2017.
Join Young Minds Advocacy in urging county administrators and supervisors to fulfill Medi-Cal’s promise and do right by California’s youth and families. Together, we can make quality mental health care equally accessible to all young people.