Problems in Children's Residential Mental Health Facilities

Nearly five million children and adolescents in the United States suffer from a serious mental illness. The majority of children respond to standard treatment given through local mental health offices within the community. However, some children require more intensive intervention in a residential setting. In 2008, there were approximately 10,000 to 14,000 children and adolescents in private residential treatment facilities in the United States, according to the National Alliance on Mental Illness. While some of these residential mental health facilities use evidence-based treatment and give quality care, others show disturbing problems.

Regulatory Inadequacy

• Each state has the responsibility to regulate residential mental health facilities for children. They must ensure that facilities meet basic standards of staffing, safety and service. However, regulatory requirements vary greatly from state to state. Differences appear in licensing practices, accreditation requirements, incident reporting procedures and complaint reviews. Additionally, many types of private residential programs are not subject to state monitoring as mental health facilities, according to the Federal Trade Commission.

Treatment Practices

• Officials reported 71 different types of residential programs across the country for young people with mental illnesses, according to a 2006 report by the Substance Abuse and Mental Health Services Administration. Some of these programs define themselves as academies, behavioral modification facilities, wilderness therapy programs and boot camps. All of these facilities provide a residential component; however, their treatment approaches vary dramatically. While some provide appropriate medical treatment, others use unconventional practices that could harm a child's mental health and result in traumatic experiences.

Safety Concerns

• The Government Accountability Office reports widespread abuse allegations in residential facilities. Some of these abuse allegations involve the death of a child. A report from the National Child Abuse and Neglect Data Systems reveals that, in 2005, 1,619 residential staff members took part in abuse incidents as reported by 33 states. Reporting is voluntary and thus incomplete since not all states participated.

Family Involvement

• Reputable facilities will allow and encourage family involvement and contact. However, some programs have policies that restrict both input from families and contact. These programs may ignore a child's medical history and current treatment. Additionally, they may not provide for family therapy or reintegration back into the family environment.