Parents should never have to give up custody to secure crucially needed mental health services for a child.
Parents forced to make this devastating choice are victims of an irrational and wholly inadequate system of insurance coverage. Employer-based health insurance may cover outpatient therapy and acute hospital care, but the intensive community-based services (such as wraparound services) required by many children with serious disorders are typically beyond the reach of private insurance. As a consequence, working families who cannot pay out of pocket for such services must forego essential care for their child, often with dire consequences, or relinquish custody to the state so that the child will become eligible for public insurance, typically Medicaid.
Relinquishing custody sends a powerful message to a child of being bad, incorrigible, or unwanted. This message is reinforced when the child is relocated far from the child's family and community to a restrictive residential facility, often with the accoutrements of a correctional center. In addition, parents feel they have failed as caregivers, a view often espoused by the state agency that takes custody. Nevertheless, for decades, health care providers and child serving agencies have recommended relinquishing custody to parents as a passport to services.
The essential problem is not the child and not the family, but a longstanding cynicism about children’s mental health services that has become manifest in commercial insurance policies and elsewhere (for example, our schools and courts). For many years, the Bazelon Center has advocated for reforms that would allow children to receive needed services--in their homes and communities--without parents having to relinquish custody to the state. A number of recent initiatives have promise in accomplishing this goal, but much remains to be done.