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23 There are a lot of suffering kids. They have to rely on their parents to access services and pay with their own insurance,but with more complicated cases they don't get what they need unless the family has sufficient funds. School-based mental health services are needed in order to avoid dependence on the quality of their own health care insurance and resources. Lexington relies on a system of private practitioners to provide services to kids,which is inadequate. In Cambridge, there is a citywide crisis team, and counselors in the schools and teen centers.Newton also has a coordinated response. We asked the providers what they believed were the major unmet mental health needs of residents of Lexington. A paucity of youth services headed the list(54 percent), with an additional 14 percent citing a need for more help for children and for parenting. Support groups and group psychotherapy services were mentioned by 9 percent, and another 9 percent cited a shortage of geriatric services. We also asked the providers to identify serious impediments, if any,they met in the course of their work. HMO regulations and related management actions were named by 31 percent, and insufficient state funding was cited by 27 percent. Burdensome amounts of required paperwork was cited by 14 percent and 29 percent identified a variety of other impediments. When we asked whether each provider estimated the conditions affecting mental health challenges for Lexington residents were changing, 71 percent said they thought that conditions were worsening, 25 percent did not know or were not sure, and 4 percent said they were improving. When we asked whether, in their judgement, mental health services in Lexington are better or worse now than they were a few years ago, 54 percent thought they had gotten worse, 21 percent thought they were as good now as they were earlier, and 14 percent thought they had improved.