The Healthy Families Program: Mental Health Benefits

By: the California Institute for Mental Health

As a Healthy Families Program member, your child has access to mental health services through your health plan. If needed, a separate set of expanded mental health services, the Healthy Families Program Serious Emotional Disturbance (SED) benefit, may be available to your child as well. This Healthy Families SED benefit is offered only through your local mental health department.

Contact your doctor, health plan or county mental health department to determine whether or not counseling or mental health services will help.

If your child needs help . . .

As a Healthy Families Program member, your child's health plan benefits include:

• Outpatient visits with a mental health professional
• Inpatient psychiatric services
• 24-hour crisis care
• Other mental health rehabilitative services

Your child's doctor can refer your child for these services through your health plan. Each mental health visit through your health plan will cost $5.

Is your child anxious or depressed?
Is your child afraid of other children or new situations?
Is your child often angry or hostile?
Do you think your child needs help?

SED stands for Serious Emotional Disturbance. Children younger than 19 years are considered to have SED if:

• They have a mental disorder as defined in the most recent edition of The Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-IV)
• They do not have a primary drug or alcohol substance abuse problem or developmental disorder which results in behavior that is not normal for their age.
• They have a problem in more than one of the following areas:
• Taking care of themselves
• Doing well in school
• Getting along in the family
• Getting along with others in public

Children who see or hear things that aren't there, have very unusual behavior, or threaten or try to hurt themselves or others should also be referred for SED evaluation and treatment.

The Healthy Families Program SED Benefit

Q. What if I disagree with the doctor's or the county mental health department's recommendations?

A. You can contact your child's health plan or the county mental health department to file a grievance.

Q. Whom do I call for more information?

A. Your child's doctor, health plan, or your local county mental health department.

Q. How can my child get help?

A. Your child's doctor can refer your child for SED evaluation at the county department of mental health. Or you may take your child to the county mental health department, identify your child as a Healthy Families Program member and request an SED evaluation. Your health plan can assist you in accessing services as well.

Did You Know . . .

One in ten children and adolescents suffers from a mental illness severe enough to cause impairment? (NIMH 1999)

Suicide is the third leading cause of death among youth aged 15 to 19? (NIMH 1999)

It is estimated that one in thirty three children, and one in eight adolescents, suffer from depression? (CMHS 1996)

If your child needs MORE help . . .

If you and your child's doctor feel your child needs more help than these services provide, you or the physician can refer your child for SED treatment services at the local mental health department. Your child's health plan is also available to help you access these services, if needed.

Healthy Families SED Benefit

Questions & Answers

Serious Emotional Disturbance (SED) evaluation and services are provided by your local county mental health department. County mental health departments offer specialized services for children with SED.

Q. What qualifies my child for the SED benefit?

A. Being a Healthy Families Program member and having an emotional or mental health problem that impairs functioning at home, school or in the community may qualify your child for SED treatment services at the county mental health department.

Q. Who determines whether my child can receive SED benefits?

A. The county mental health department evaluates your child's needs and decides.

Q. If my child is referred for SED services, do I have to pay to get help for my child?

A. No. SED evaluation and services are free to Healthy Families Program members.

Q. If my child is referred for SED care, will health plan benefits be lost?

A. No! Children with Healthy Families Program benefits continue to receive health care through their health plan. Vision and dental benefits are similarly unaffected.

Many parents are afraid when they hear words like “emotional disturbance” used in reference to their child. Proper treatment is the best chance for children who struggle with emotional or mental problems to get better.