A national survey conducted in early 1999 by the Commonwealth Institute for Child and Family Studies found that many families are relinquishing custody of their children in order to give them access to mental health services. The survey, "Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness," was based on a poll of 903 parents of children with mental illness. Thirty-six percent of survey respondents said their children were in the juvenile justice system because mental health services were otherwise unavailable. Another 1999 report by the National Mental Health Association and the National GAINS Center for People with Co-Occurring Disorders in the Justice System found that although most youth in the juvenile justice system have mental health and substance abuse problems, the majority do not receive treatment. Other findings from the survey indicate that many communities have problems with insurers and managed care companies as a barrier to treating youth; officials at some sites reported that a "punishment mentality" toward youth in the juvenile justice system has made the provision of services difficult; categorical funding and differing treatment philosophies among agencies were also cited as barriers to treatment. A report released in 1998 by Amnesty International stated that a lack of mental health services outside the juvenile justice system placed in the system children who should have received help in the community. In addition, a lack of services within the system and inadequate staff size and training resulted in children with mental health problems being subjected to excessive use of seclusion and restraints. This article describes initiatives that have been mounted to address these inadequacies in mental health services for at-risk children and youth both within and outside the juvenile justice system. In addition, managed care and privatization of juvenile justice services are discussed as possible barriers to mental health services for children and youth.