Parents Give Up Custody of Children for Mental
Health Services, Says New Government Report
Thousands are placed in child welfare, juvenile
justice systems to obtain needed services
Washington, DC April 21, 2003 —Thousands of families have
been forced to choose between obtaining needed mental health services
and relinquishing custody of their children with mental or emotional
disorders, according to a new government study scheduled to be released
today.
The US General Accounting Office (GAO), Congress’ investigative
arm, documented at least 12,700 cases in fiscal year 2001 of children
placed in child welfare and juvenile justice systems so they could
access needed mental health services.
“Custody relinquishment is absolutely devastating to families,”
said Laurel Stine, director of federal relations at the Bazelon
Center for Mental Health Law, a national non-profit organization
that has worked for three years to end the dilemma that faces many
parents who lack access to mental health services for their children.
“Children with mental health needs face the added stress of
being displaced and feeling abandoned. Meanwhile, parents have to
give up their say about key aspects of their children’s lives,
like where or whether they go to church and how late they can stay
up at night.”
Custody relinquishment may be even more prevalent than the GAO’s
study suggests. Data on the practice are not generally tracked and
officials in 32 states—including the five with the highest
child populations—did not respond to the agency’s request
for data on custody relinquishment.
“This may be the tip of a much larger iceberg,” said
Stine. “Families across America are being ripped apart because
they can’t find the help their children with mental and emotional
disorders need.”
Approximately 3,700 children were placed in child welfare systems,
according to the report. The GAO estimated that another 9,000 were
“placed” in the juvenile justice system by police who
had detained children—sometimes at parents’ request—for
delinquent behaviors that stemmed from or were related to their
mental or emotional disorders.
The GAO identified several factors that influence parents’
decisions to relinquish custody:
• Gaps in and limits on mental health coverage—Some mental
illnesses are not covered and families often face limits on the
intensity or duration of care that private insurers will pay for.
Medicaid, the main public funder of child mental health services,
covers a limited number of children who could benefit from mental
health services. Both public systems and private insurers often
fail to cover the intensive community-based services that could
reduce the need for more expensive residential treatment.
• Limited child mental health resources—Parents may be
encouraged to take drastic measures to make their children a priority
for scarce mental health resources.
• Lack of coordination—Eligibility requirements for services
often differ from agency to agency, making it difficult for children
to obtain coordinated care. According to the GAO, some service providers
and officials have also “misunderstood the role of their own
and other agencies” and have given parents incomplete or inaccurate
information, creating service gaps for children with mental health
needs.
Thirteen states— Colorado, Connecticut, Idaho, Indiana, Iowa,
Maine, Massachusetts, Minnesota, North Dakota, Oregon, Rhode Island,
Vermont and Wisconsin—have passed laws that prohibit child
welfare from requiring custody relinquishment in order for parents
to obtain mental health care for their children. But such laws do
nothing to improve access.
“Just banning the practice closes one door to services without
opening another,” said Stine. “States certainly must act,
but a more coordinated effort with the federal government is needed.”
Many barriers to accessing care can be removed at the federal level,
according to the Bazelon Center. The group also believes that more
can be done to give states and communities the incentive to develop
and implement the kinds of services that can keep children out of
crisis and with their families.
“In the private sector, families need parity in insurance
coverage for mental health services, so children aren’t denied
access to needed services because of stigma and discrimination,”
continued Stine. “In the public sector, states and the federal
government need to expand Medicaid eligibility to cover more children.”
The Family Opportunity Act, which has been reintroduced in Congress
again this year, would reduce the need for custody relinquishment
by expanding access to Medicaid-financed mental health services
for more children. Despite broad bipartisan support for the bill,
Congress adjourned last year without passing the bill.
“The congressional logjam shouldn’t stymie efforts to
enact legislation to deal with this problem,” said Stine. “Custody
relinquishment is not a partisan issue.”
Senator Susan Collins (R-ME) and Representatives Patrick Kennedy
(D-RI) and Pete Stark (D-CA) requested the GAO report. In response
to the GAO’s findings, the lawmakers plan to introduce a proposal
to improve state systems of care for children with mental or emotional
disorders.
“Families have faced the terrible choice between retaining
custody and obtaining needed mental health services for far too
long,“ said Stine. “Congress can and should act this year
to end this horrible practice.”
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The Bazelon Center for Mental Health Law is the nation’s leading
advocate for the rights of children and adults with mental disabilities.
The Bazelon Center authored Relinquishing
Custody: The Tragic Result of Failure to Meet Children’s Mental
Health Needs.
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