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When Parents Must Give Up Custody to Get Mental Health Care

Parents who are unable to find or afford mental health services for severely troubled children are often required to relinquish custody to child welfare or juvenile justice systems in order to obtain care. In a study released in July, the U.S. General Accounting Office (GAO) found that an estimated 12,700 parents gave up custody of their children in 2001—the children were mostly male, adolescent, with multiple problems, and exhibiting behaviors that threatened their safety and that of others. But because no agency tracks such placements, and local officials often were unable to provide figures, the GAO believes the number of custody-relinquished children may actually be much higher.

The dilemmas that bring parents to the point of relinquishing custody include desperation at finding mental health care or inability to pay for it under insurance plans that provide less protection for mental than for physical illnesses. Parents may be pressed to exhaustion by the needs of severely troubled children, or they may fear that the children will hurt themselves or others. Often the care of one child prevents parents from meeting the needs of other children in the family. Children at risk of placement come from families at a range of economic levels, but officials in six states visited by the GAO said children from middle-class families are more likely to be placed because they are not covered by Medicaid and their families do not have the funds to pay for services that are not covered by private insurance.

No federal law requires parents to give up their parental rights in order to place their children with child welfare agencies. But after a child has been in such care for a specific period of time, the law requires that a court be involved to determine if termination of the parents’ rights is in the best interest of the child. State laws differ widely. Eleven states allow parents to place a child in the welfare system on a voluntary basis, in order to access mental health services for as long as necessary, without relinquishing custody. Eight other states and the District of Columbia do not allow voluntary placement, and laws in the remaining states are generally silent on the subject.

Ironically, the GAO found, even when parents do give up custody, the care they are hoping for may not be forthcoming, in part because local child welfare or juvenile justice officials have little guidance on how to locate or pay for appropriate mental health care. "Neither the child welfare nor the juvenile justice system was designed to serve the health needs of children who have not been abused or neglected or have not committed a delinquent act," the GAO noted.

At a hearing of the U.S. Senate Committee on Governmental Affairs July 15, families told of their anguish at giving up custody of their mentally ill children and pleaded for enactment of a law now before Congress, the Family Opportunity Act, S. 622, sponsored by Senators Charles Grassley (R-IA) and Edward Kennedy (D-MA) that would help expand Medicaid coverage to children whose families would not otherwise be eligible and give states greater flexibility to use the Home- and Community-Based Services Waiver to serve children with serious emotional and behavioral disorders.

In another approach to the problem, the National Institute of Mental Health announced July 28 that a study in eight of the poorest Appalachian counties in eastern Tennessee will provide treatment to adolescents and teens with serious emotional and behavioral problems. Researchers will work with judges, school administrators, and community leaders to overcome barriers to mental health services. Half the children will receive an evidence-based practice known as multisystemic therapy in their homes, and the other half will receive the "usual care for children referred to juvenile justice from community mental health centers." In Tennessee, the researchers noted, 60,000 children, many from rural areas, are referred annually to juvenile courts for delinquency and other illegal acts.

The GAO report, "Child Welfare and Juvenile Justice: Several Factors Influence the Placement of Children Solely to Obtain Mental Health Services," GAO-03-865T, is available online on website www.gao.gov Information about the Rural Appalachia Project is available from the National Institute of Mental Health at www.nimh.nih.gov