An estimated one in five Rhode Island children ages 9 to 17 has a diagnosable mental health disorder, but the resources available to help them are so limited that many are boarded in medical hospitals, put in state custody, or just go without needed care.

That’s the core of an issue brief by Rhode Island Kids Count, the think tank and advocacy organization, released Thursday at a policy forum at Bradley Hospital.

The brief, which draws on information from the state and from local mental health providers, plus national research, shows Rhode Island has made some progress in its longstanding effort to build a “system of care” for kids that keeps them in the least-restrictive settings possible.

But it still falls woefully short, according to the study.

In 2008, the brief shows, 1,535 children and teens under age 19 were admitted to either Bradley or Butler Hospital – but another 219 were boarded at a medical hospital because there were not appropriate mental health services available to meet their needs.

And between July 1, 2008, and June 30, 2009, 136 children and youth were voluntarily placed in the care of the R.I. Department of Children, Youth and Families so they could access services for a developmental, behavioral or mental health problem, the brief says, often because the family could not afford the cost and it wasn’t covered by private insurance.

On the positive side, children’s mental health hospitalizations are down, at least in part due to concerted efforts by community-based providers and Neighborhood Health Plan of Rhode Island to boost intermediate-level services so an inpatient stay isn’t needed, or can be shorter.

In 2008, the brief shows, there were 1,696 hospitalizations of children under age 18 with a primary diagnosis of a mental disorder at Rhode Island hospitals, mostly Butler and Bradley. The average length of stay in the general psychiatric services unit at Bradley was 17 days, down from 19 in 2006, while at Butler, it was 11 days, down from 17.5 in 2006.

While 58 percent of children’s mental health hospitalizations in 2008 were covered by private insurance, savings from the 42 percent who had public coverage, such as RIte Care, have been building up, the brief shows.

Between 2006 and 2009, spending on psychiatric hospitalizations for children on RIte Care or medical assistance dropped 22 percent to $17.5 million. Spending per hospitalized child dropped 32 percent to $23,465, mostly due to shorter stays.

The number of children in foster care or substitute care who are hospitalized for mental problems has also dropped sharply, by 23 percent from 2005 to 2008 (from 131 to 101), and the number of hospital admissions decreased 16 percent (172 to 144), the brief shows.

“Rhode Island’s efforts to increase access to a broader array of mental health services in the community has led to reductions in public spending on psychiatric hospitalizations,” said Elizabeth Burke Bryant, executive director of Kids Count.

“Psychiatric hospitalizations are a critically important part of the continuum of mental health care for children and youth,” she added. “It is important that Rhode Island continues to work toward a system that includes the appropriate balance of high-end crisis intervention services, such as psychiatric hospitalizations, while also providing increased access to short-term interventions that divert children from the hospital when appropriate.”

Children also benefit, Bryant noted, “when there are adequate resources devoted to intensive home-based and outpatient treatment services that enable families to maintain their children at home with appropriate therapeutic support.”

The brief offers recommendations to create an effective “system of care,” focusing on five goals:

The full issue brief can be downloaded on the Kids Count Web site.