Levine A Brief History of Children's Mental Health Services

Policy milestones and shifts

1961 Joint Commission on Mental Health and Illness identified child welfare and adolescent problems; spurred JFK’s 1963 address and the Community Mental Health Act (1963).
Deinstitutionalization moved care from state hospitals to community settings (homes, schools, etc.); focus on prevention called by Kennedy, but funds and ideas were limited.
Early epidemiology: 7%–12% of children under 14 had problems requiring professional help; 80% of counties lacked mental health clinics; long wait lists where clinics existed.
Post-WWII training expansion under the VA created a large workforce; however, the focus was mostly on adult men with service-connected disabilities; women, children, and the aged were largely excluded from early training pipelines.
1949: National Institute of Mental Health (NIMH) established to support research, training, and service; began funding training grants to universities and clinical centers.
Training grants evolution: in 1958, 547 training grants were awarded; initial focus was mainly on psychiatrists; no requirement to enter public mental health or to work with children/families.
By 1960, about half of psychiatrists trained entered independent practice rather than public service, where need was greatest.
1969 Joint Commission on the Mental Health of Children found services for children and adolescents to be grossly inadequate, poorly coordinated, and limited in scope.
1978 President’s Commission on Mental Health described children and adolescents as “underserved,” with serious gaps in foster care, residential facilities, and follow-up; rising drug use and adolescent suicide noted; services were poorly coordinated and scarce.
Eleven federal programs provided services to children in addition to welfare and education funds, highlighting fragmented federal support.

Education, disability rights, and school services

Education for All Handicapped Children Act of 1975 (now IDEA): guarantees a free appropriate public education (FAPE), including special education and related services; extensive litigation around appropriate services and parental participation (e.g., Board of Education v. Rowley).
2015 statistics: 6.4 imes 10^6 youth aged 3–21 receive special education services; about 13 ext{%} of all public school students.
Disabilities represented among those served: autism, intellectual disabilities, developmental delays, emotional disturbances each account for 6 ext{%}–8 ext{%}.
Mainstreaming: 61 ext{%} of students spend 80%+ of their time in regular classrooms.
Concerns: teaching to high-stakes tests; insufficient teacher preparation for diverse needs; school-based mental health programs discussed as a priority.
Wraparound services: comprehensive, cross-agency care plans (including respite, crisis services, in-home support, tutoring, recreation) beyond standard counseling; requires cross-system collaboration and overcoming funding and bureaucratic barriers.

History of poverty, poverty focus, and early service delivery

Early child guidance clinics (1922) often aimed at preventing delinquency and served the poverty population; later shifted toward in-clinic therapy led by professionally trained social workers; focus expanded to middle-class mothers seeking therapy for children.
The “poverty” label faded from the literature by the 1950s; services increasingly targeted higher-functioning, easier-to-reach cases, leaving harder cases under-supported in the community.
School-based mental health services emerged episodically; funding structures (fee-for-service vs. universal supports) influenced accessibility and equity.
Stanton Coit’s community organizing approach highlighted the need for many helpers to match magnitude of need; community-based organization seen as essential for scalable care.

Child protection, mandatory reporting, and system burdens

Henry Kempe’s battered child syndrome (early 1960s) catalyzed public attention to child abuse and neglect; many states enacted mandatory reporting laws.
Reporting laws increased CPS investigation workloads without proportional resource gains; many cases lacked adequate follow-up.
2013: 4.02 imes 10^5 children in foster care (down from 5.23 imes 10^5 in 2003); system changes aimed at adoption and family preservation.
Reunification is an important goal, but many parents cannot care for children; parental rights termination leads to adoption in some cases.
Adoption and Safe Families Act (1997) improved some outcomes, but older youth remain at higher risk of aging out; about 54 ext{%} in foster care >1 year; 5 ext{%} for 5+ years.
Foster children have high need: estimated psychiatric disorder prevalence >20 ext{%}; supports are often insufficient for complex needs.
About half of foster children live with relatives; many are eventually adopted or reunified, but uncertainties persist.

Juvenile delinquency and youth justice

Delinquency interventions traditionally favored psychotherapy and counseling; effectiveness varied; punitive approaches grew under “get tough” policies.
Arrests (2011): male 1{,}043{,}700; female 426{,}300.
Court disposition: ~60 ext{%} of youth placed on formal probation; ~27 ext{%} placed in residential programs.
Status offenses (e.g., running away, truancy) affected ~400{,}000 youths in 2004; diversion programs common but with mixed evidence on effectiveness.
Outcomes for status offenders and delinquents vary by community resources; some affluent communities show better outcomes when supports are available, but generalizability to all populations is uncertain.

School-based mental health services and funding challenges

School-based programs reflect a push to provide preventive services within schools; funding often tied to health insurance and fee-for-service paradigms, which may limit access.
Wraparound models emphasize cross-system collaboration, including external service vendors; success depends on political will and funding flexibility.
The field increasingly recognizes the need to treat the child within their community context rather than in isolated clinical settings.

Prevention and community-based approaches

Prevention emphasis includes prenatal care and near-universal postnatal home visiting by trained professionals addressing practical infant/child care issues.
Community centers should offer education, recreation, and adult–child activities; universal access minimizes stigma and improves uptake.
Settlement-house-inspired community models with research networks could identify best practices and enable scalable prevention.

Conclusion and implications

Despite calls to put children first, actual policy and resource allocation often lag behind the magnitude of problems.
Barriers include political clout for low-income families and the limitations of the medical model in addressing complex social needs.
A community-based approach leveraging education, recreation, and vocational supports can complement clinical care and reduce stigma.
Parental stability and broader macroeconomic policies (e.g., stable, adequate wages) are critical to effective child mental health outcomes.
Activism and organized parent involvement can drive reforms, as seen in mental retardation reforms from collective advocacy.
The takeaway: there are multiple paths to improve child mental health; a one-size-fits-all approach is insufficient.

Keywords

children’s mental health; school-based services; child protection; prevention; delinquency