This is the second in a series of studies that report on strategies to sustain children’s mental health services and prevent the onset of problem behaviors.

Implementation of the Patient Protection and Affordable Care Act (ACA) is well under way, creating long-overdue opportunities for growing the capacity of child and adolescent mental health systems and meeting children’s pressing needs. The good news is that as of January 1, 2014, coverage of mental health conditions and substance use disorders will be required as part of the broad Essential Benefits package of services under the ACA. While states will determine specific benefits, it is widely accepted that mental health and substance abuse coverage will substantially increase, though the details remain to be determined. Additionally, as a result of this new law, funding for prevention, early intervention, and treatment services and programs will likely expand.

A challenge to capitalizing on the ACA opportunity, however, is the underdeveloped state of children’s mental health services across the United States. Unlike children’s physical health services, for which there is a robust private and publicly funded functioning system, management and delivery of mental health services are much less well developed or coherent. From significant disconnects between the multiple institutions that serve children and their families, to chronic financial instability, the children's mental health system is fragile and at-risk. Realizing the promise of the ACA for children and adolescents will require acknowledging systemic barriers that often lead to significant disparity and gaps in care. 

This research, conducted by the George Washington University Center for Health and Health in Schools (CHHCS), identifies the systemic challenges to ensuring children’s access to mental health care common among many states, and points to encouraging examples of success. The bright spots can serve as a guide for those responsible for implementing the ACA or developing other policies that strengthen children’s mental health supports.