Janis Adams, an electric-company employee in Waynesville, Mo., knows her local mental-health system well. Her son Caleb Quesenberry, who has been diagnosed with bipolar disorder, has been in and out of hospitals for a decade. Caleb, now 13, would routinely visit the hospital for a week or so, be stabilized and then go home. But in the fall of 2001, after he grabbed two knives and threatened to kill himself and his mother when she asked him not to watch a cartoon, Adams realized that Caleb needed more intensive care.
She contacted residential treatment centers in her area, but administrators told her that her Medicaid insurance would not cover the services she needed. The only way they could take Caleb, they said, would be to persuade the state to fund his treatment. And to do that, Adams would have to relinquish custody of her son to the state's child-welfare system. "I didn't want to give him up to get him the help he needed, but I couldn't protect him from himself," Adams says. "I had to do something, and as awful as it is, this was the only thing I could do."
Adams is not the only parent who has been forced to make this wrenching choice. Though the exact number of children affected is unknown, scores of families in at least 26 states have had to cede legal guardianship--that is, give up the authority to make decisions concerning their child's residence and care--in order to qualify for services. This often involves removal from the home, either to a facility or to the custody of a trained foster family where the child receives intensive care somewhere in the community. Child advocates estimate that 1 in 5 families with mentally ill children in the U.S. has surrendered custody in exchange for treatment of a child with bipolar or some other disorder, including ADHD, schizophrenia or depression.
"Custody relinquishment has been a well-kept secret to the public, but what's clear is that when you have a child with asthma or a heart problem or diabetes, you go to a doctor. When you have a child with a serious mental-health problem, you often go to child welfare," says Mary Giliberti, a senior attorney at the Bazelon Center for Mental Health Law, based in Washington. "Aside from being inhumane, it's fiscally irresponsible and ends up causing more damage to families."
Indeed, to the injury of cutting the tie between parent and child, many state foster-care systems add the insult of making no distinction between children who have been given up in order to qualify for mental-health care and those who have been removed from their homes because of abuse or neglect. Some systems may even require parents of emotionally ill kids to declare that they are neglecting or abandoning their child--an admission that may get them listed in a state registry, available for background checks to potential employers.