A central gap across the relevant systems is the difficulty of implementing screening and services responsive not just to adults or to children, but to both, taking into account the family context. Barriers to a responsive family-focused perspective from the adult mental health system, for example, include the failure to require in protocols or administrative regulations that adults in treatment for any mental health issues are asked whether they are parents and what the impact of the illness is on the children. A recent study found that only 12 states report that they systematically inquire as to whether adults with any mental illness under their care are parents and provide some parenting services (Biebel et al., 2006). Similarly, the child mental health system lacks the capacity to provide either treatment or parenting interventions to parents with depression.
Furthermore, despite evidence about the importance of addressing the risks that parental depression poses to children, particularly young children, most children’s mental health agencies lack the resources (or the legal mandate) to serve children at risk of developing mental health problems and instead focus all resources on those with diagnosed problems (Cooper et al., 2008). Financing for services and supports for children without a diagnosis remains limited. Nor are we aware of states that explicitly set forth referral priorities for children. This is further compounded for the youngest children because only a handful of states permit an early childhood diagnostic classification system, known as DC-03, as a basis for reimbursement for Medicaid (Stebbins and Knitzer, 2007), although it is widely recognized that there is a lack of fit with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) for this age group. Similarly, there are still some states that do not permit family therapy for children under age 3 years, although according to a Kaiser Permanente study, 1 in 10 children from birth to age 3 has a parent with diagnosed depression or depressive symptoms (Dietz et al., 2007).
Taking the family context into account requires policy and administrative remedies to resolve several challenges. Introducing a responsive family-focused perspective from the adult mental health system, for example, will require changes in protocols or administrative regulations so that adults in treatment for any mental health issues are asked about their parental status and are invited to describe the impact of their illness on their children.
A responsive policy framework for parental depression has to be flexible enough to support different approaches focused on different populations. For example, given that depression disproportionately impacts