The District does not do enough to provide support for hundreds of youth with serious mental illnesses, according to a report published Monday.

The examination into the city’s youth behavioral health system was conducted by Disability Rights DC, an organization that advocates for people with disabilities. It found that the city cycles children and teenagers through psychiatric hospitals and other treatment facilities rather than provide care that allows them to stay with their families or in the community.

“The system’s just broken and it needs to be reassessed,” said Kelsey Woodford, a staff attorney with Disability Rights DC.

The District is required by federal law to provide mental health services to youth who qualify for Medicaid, which provides healthcare coverage to people who are low-income.

Under the American with Disabilities Act, youth must also receive services in the “most integrated setting” as possible. That can mean providing in-home therapy, mentoring and access to paraprofessionals who give children individualized academic and behavioral support.

But Woodford said D.C. youth with severe mental health challenges are too often referred to psychiatric hospitals or residential treatment facilities in other states for months or years at a time, separating them from family members and disrupting their education.

“Sometimes parents can’t visit,” Woodford said. “If the parent can’t get on a plane or doesn’t have the ability to do that, it just isolates the kid even more from their community.”

In many cases, children are discharged without adequate access to outside support such as counseling, leading them to return to psychiatric hospitals or residential treatment facilities. That leads to a “pattern of institutionalization,” the report says.

The D.C. Department of Behavioral Health, which contracts with mental health service providers that work with Medicaid-eligible children, declined to comment about the report because of pending litigation with Disability Rights DC.

Between September 2016 and September 2019, over 200 Medicaid-eligible children in D.C. were admitted more than once to a psychiatric hospital, according to the report. Nearly 100 children were admitted to psychiatric residential treatment facilities.

Another 400 children were placed in residential treatment centers while under the custody of the D.C. Department of Youth Rehabilitation Services, which oversees facilities and rehabilitation programs for incarcerated youth.

The report recounted the experience of a 17-year-old boy who experienced “worsening behaviors” at school after the death of his grandmother, his main caretaker.

In elementary school, the boy was hospitalized several times in the city’s two psychiatric hospitals, the report says. And in the sixth grade, his school referred him to a psychiatric residential treatment facility in Virginia, where he lived for a year.

The report says the child failed to receive outpatient counseling each time he was discharged from a facility, and that the boy’s great-grandmother repeatedly warned his social worker that he wanted to stay with the family.

“I don’t think he would have had to go to residential placements if he had received services that helped him live at home,” the boy’s great-grandmother said in the report.

The report identifies gaps in the city’s response to youth with severe mental health disabilities, including a dearth of resources available in the community.

Families often encounter long waiting lists for services. And youth who do receive services in their communities find they are only offered for a limited period of time, according to the report. High staff turnover can also make it hard for children to form relationships with social workers or other clinicians, compromising the quality of care.

“In many cases, a child may not get the support they need until a crisis occurs,” the report says. “Even then, the support is often inadequate.”

Disability Rights DC laid out recommendations for bolstering services. It urged D.C. officials to establish a system where every child has a team of family members, health care providers, teachers and other adults who work together with the child to devise and execute individualized plans for youth with severe mental health illness.

The advocacy organization also called on the city to improve its mobile crisis response, a service available at all hours that deploys trained workers to help a child experiencing a mental health crisis. The current mobile response is strained by several issues, the report says, including long wait times, inadequate staffing and poor follow-up.

Those methods of providing services to youth have proven effective in communities that have adopted them, according to Lewis Bossing, a senior staff attorney with the Bazelon Center for Mental Health Law, which provides legal services for people with disabilities.

“These are the tools that we have found to be most effective. It’s just making it a priority,” he said. “In D.C., it’s not a question of not having the resources. I think the resources are there.”

This is not the only time Disability Rights DC., a federally-designated organization responsible for protecting the rights of people with disabilities, has criticized the District for its handling of mental health services for youth.

The organization filed a lawsuit against Mayor Muriel Bowser and the Department of Behavioral Health in 2018, accusing the city of failing to provide adequate services for two children with mental health disabilities.

The lawsuit is ongoing and attorneys with Disability Rights DC have asked permission from a federal court judge to continue the case as a class action lawsuit.