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New Report: The Decline in Residential Mental Health Treatment for Youth

As a range of adverse outcomes in youth mental health spike, access to a critical component of the youth mental health-care continuum remains limited

NEW YORK, NY — Over the last decade, public concern has grown dramatically over increased rates of mental illness among American youth. These worries are not unfounded: suicides of Americans under 18 have increased by almost 50% in the last 10 years and are now the third leading cause of death among that cohort. At the same time, one potential solution—youth residential mental health treatment—has sharply declined in availability. In a new Manhattan Institute report, Scott Dziengelski, a consultant at King & Spalding LLP and former legislative director in the U.S. House of Representatives, highlights the clinical benefits of residential treatment programs and makes recommendations for stabilizing their supply and expanding access. 

High-quality youth residential mental health treatment programs, which are less intensive than hospitalization but more intensive than outpatient services, have been shown to improve mental health outcomes. However, since 2010, activists motivated by isolated incidents of abuse and neglect have pushed policies that have decreased the number of beds by 66.2%. The declines have been driven not by evidence of failure but by ideological opposition to this mode of treatment. Dziengelski finds these decreases coincide with an assortment of adverse outcomes including rising rates of suicide, usage of psychiatric hospitals, emergency department boarding, and criminal justice involvement.

To course-correct, Dziengelski recommends five ways of improving and expanding high-quality residential treatment and thereby combatting this harmful ideologically driven deinstitutionalization. These include: 

  • Exempting residential treatment programs from the Institutes for Mental Disease (IMD) Exclusion; 
  • Expanding the use of section 1115 Medicaid waivers; 
  • Increasing the youth behavioral healthcare workforce; 
  • Improving timely access to other levels of behavioral healthcare, including inpatient; 
  • Ensuring funds, particularly education funding, follows children to their place of treatment. 

Click here to view the full report. 


Are you interested in supporting the Manhattan Institute’s public-interest research and journalism? As a 501(c)(3) nonprofit, donations in support of MI and its scholars’ work are fully tax-deductible as provided by law (EIN #13-2912529).

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