The outside of the Maine Department of Health and Human Services at 41 Anthony Ave. in Augusta.

As a consultant’s top-to-bottom review of Maine’s system of services for children with mental health needs gets underway, a new federal audit highlights how such a review matters for children involved in the child welfare system.

The review is long overdue and much needed. It’s a positive development that the state has retained a consultant to examine the system’s strengths and weaknesses, hear from children and families who depend on mental health services, and develop recommendations for moving forward. It will be the first such comprehensive review of children’s mental health services since 1997.

The review comes as hundreds of children with behavior disorders, autism, cognitive impairments and other mental health challenges, especially in rural areas, are on waitlists for services delivered in their homes and local communities. It comes as the state has sent dozens of children to out-of-state treatment facilities due to a lack of available treatment in Maine, while other children spend extended periods in psychiatric hospitals and hospital emergency rooms in part because providers have gradually stopped offering treatments that allow young people prone to violent behavior to live safely with their families.

And the review comes as children with mental illness continue to end up at Long Creek Youth Development Center, the state’s youth prison in South Portland. Children’s mental health specialists also question whether Maine children with mental health needs are even receiving the right set of services when they’re available.

The new federal audit, from the U.S. Department of Health and Human Services’ Office of the Inspector General, highlights why such a review is particularly important for children caught in limbo in Maine’s child welfare system.

The audit, released Monday, focused on the treatment of children in foster care with psychotropic medications, and it focused on Maine and four other states — the states with the five highest rates of children in foster care being treated with such medications. Auditors from the inspector general’s office reviewed children’s files and discovered many were prescribed psychiatric drugs without plans to ensure that the drugs were part of a well-thought-out treatment regimen and that medications didn’t conflict with others. Children in foster care weren’t all receiving the necessary follow-up care, either, to ensure their treatment was effective.

Children in foster care are many times more likely than others to be treated with psychiatric medications. They’re more likely than the population at large to need mental health treatment. They’ve been through the trauma of removal from their families, long periods of limbo as their family and living situations remain unsettled, potentially multiple foster care placements, and even nights spent in hotels with child welfare caseworkers. They’re also caught in a situation in which multiple parties are responsible for their well-being, including foster parents, their child welfare caseworkers and their birth parents. With responsibility dispersed, children’s needs are more likely to fall through the cracks.

“These kids are set up for mental health problems,” Dr. Lindsey Tweed, a child psychiatrist and president of the Maine Council of Child and Adolescent Psychiatry, told the BDN.

Gov. Paul LePage’s administration, lawmakers and others have been focused on problems in the child welfare system this year. Since children in the system are more likely than others to need — and benefit from — a robust system of mental health services, policymakers should be just as focused on the outcome of DHHS’ ongoing children’s mental health services review.

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