A boy runs toward the camera.

How Are the Children?


We know that one of the top issues facing our schools is how to support students’ mental health. Hospitals in Minnesota and across the country are finding the number of children and youth ending up in the emergency departments are increasing rapidly. New studies show the prevalence rate of mental illnesses among children and youth is going up at the same time providers, school staff, and advocates have observed the increasing complexity of mental health symptoms and service needs. At a time when the demand for our children’s mental health system is high, it is crumbling and facing a huge crisis.

Understanding Minnesota’s intensive mental health services

The Centers for Medicare and Medicaid ended federal Medicaid reimbursement for most of Minnesota’s children’s residential programs in 2018. They decided that many were what are called “Institutes of Mental Disease (IMDs)” and thus not eligible for Medicaid. The legislature stepped in to provide “bridge” funding, essentially picking up what was the federal share.

Assuming that this was going to happen, the legislature in 2017, asked the Minnesota Department of Human Services to conduct an analysis of Minnesota’s current continuum of intensive mental health services and identify the service models and funding mechanisms needed to address gaps in the state’s system of care. The goal: ensure that youth and families have access to appropriate and effective residential and community-based treatment options; and ultimately improve youth well-being and success in home, school, and community settings. It was conducted by Wilder Research in collaboration with AspireMN, NAMI Minnesota, Minnesota Association for Children’s Mental Health (MACMH) and independent consultants, Glenn Andis, Chris Bray, and Glenace Edwall.

Recommendations to ensure that youth and families have access to appropriate mental health treatment

The recommendations include how to improve residential treatment along with how to build our community-based services. Funding and staff training need to increase to increase the ability of residential treatment to implement evidence-based and culturally responsive practices. Families want greater communication and coordination upon discharge. Expanding the number of Psychiatric Residential Treatment Facility beds (a new type of residential treatment in Minnesota that is not viewed as an IMD) by converting existing residential facilities and increasing the overall capacity is high on the list.

There is a great need to create more intensive in-home services which could be accomplished by expanding Intensive Treatment Foster Care to additional settings and expanding the age range for Youth Assertive Community Treatment teams (ACT). Funding is needed for other services such as respite care, mobile and residential crisis, school-linked mental health, care coordination, Collaborative Intensive Bridging Services (CIBS), and Wraparound. A huge barrier to in-home and community services is the lack of enforcement of Mental Health Parity.

Looking ahead

As we near the end of the legislative session we must keep the pressure on to resolve the crisis facing our children’s mental health system. We need to do everything we can to ensure our children and youth have access to the right level of mental health care when and where they need it. If we address the crisis and build our children’s mental health system, our answer to the question “How are the children” will be “They are great.”

Read the Children’s Intensive Mental Health Services Study summary and report.

Sue Abderholden

Sue Abderholden is the executive director of NAMI Minnesota.