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Determining the risk of harm or neglect
June 2, 2014 9:36 AM   Subscribe

Should a Mental Illness Mean You Lose Your Kid?

This article is also available on The Daily Beast (with a different headline) and Salon.com.
posted by zarq (32 comments total) 9 users marked this as a favorite

 
No matter how many times us humans try this, attempts to place black-and-white regulations on gray areas don't tend to work so well. Isn't continuing to do the same thing over and over despite knowing that it will fail a sign of something?
posted by The 10th Regiment of Foot at 9:46 AM on June 2 [6 favorites]


The headline is too simplistic, I think. The reasoning that the state would take one child away and not the other is what's inconsistent and hard to understand here.
posted by roomthreeseventeen at 9:50 AM on June 2


Depends entirely on the illness and situation.
posted by MartinWisse at 9:54 AM on June 2 [12 favorites]


roomthreeseventeen: "The reasoning that the state would take one child away and not the other is what's inconsistent and hard to understand here."

There's inconsistency across the board, not just for parents with more than one child.
posted by zarq at 9:55 AM on June 2


Yeah I think the title should be something closer to "Should a serious untreated mental illness, especially those which include serious psychotic breaks, mean that you temporarily lose your child until you get treatment?" In which case, the answer is probably yeah.

At least in Mindi's case, the system seemed to work pretty well actually up until the part where she was supposed to get her child back - especially considering that they found no reason to keep her second child away from her. Even more surprising considering that reunification is ostensibly the primary goal of the foster system and usually isn't a particularly difficult place to arrive it - and maybe sometimes even too easy. So an especially tragic case perhaps, and probably says more about the ridiculously protracted nature of legal wrangling than a universal ruling on mental illness and parenting.

In something like Rudy's case where there have been multiple hospitalizations and questions regarding his ability to live independently, I don't know - I think that's a seriously difficult situation where there is no real clear or correct answer. I think honestly that it's a lot of folks with the best of intentions involved that have different but perhaps equally legitimate ways of viewing the situation.

Mental illness is just an impossibly broad category and I can see where mental health advocates take issue with leaving the legal language so broad, as it opens the possibility for very non-debilitating mental illnesses to be treated with stigma and carry unfairly severe consequences for more or less well-functioning folks. On the other hand, I can also see where courts would want to leave it pretty open in order to approach it on a case-by-case basis and to give themselves some legal wiggle room to ensure child welfare.

A pretty interesting and complex problem for sure. If anything, it's another subject that shows just how many problems are caused by having such a huge umbrella like "mental illness" applied to so many different problems. It's like being called sick and having it be unclear whether that means a cold or cancer.
posted by Lutoslawski at 10:15 AM on June 2 [11 favorites]


Yes, when you're seeing things on your child that aren't there, you should probably lose custody rights, at least temporarily. Other instances will probably have to be judged on a case by case basis.
posted by Brandon Blatcher at 10:17 AM on June 2


The article was really clear that everyone thought Mindi should have temporarily lost custody of her older daughter, and that the problem wasn't that the child went into foster kid then but that she never got back to her mother.

I think that the Rudy case is more complex, because I'm not sure what happens if something changed with his mother or sister's lives that they could no longer co-parent.
posted by jeather at 10:27 AM on June 2 [3 favorites]


That "making faces" in the courtroom detail confounds me. I wish there was more of an explanation or that they had asked her about it. I can't imagine it was as simple as frowning or looking upset, but who knows? In general the article really skates over how Mindi is doing today. She's living by herself (with a friend who is apparently rarely around) and has no family support. Even someone without mental illness would struggle raising two kids in those circumstances, though I wouldn't call it a termination of parental rights situation.

I'd be more interested in hearing from people who had grown up with mentally ill parents vs taken away and raised in foster care. This really is about what is best for the kid, I'm not as interested in the angle the article takes of how it affects the parents. Just check out the human relation section on askme, growing up with mentally ill parents can leave incredibly deep scars.
posted by Dynex at 10:28 AM on June 2


It seems to me that the major thing those two cases have in common is that the child taken away was a highly desirable for adoption healthy baby. I have the deeply cynical and uncharitable feeling that if we'd been talking about older children with problems of their own that couldn't be so readily adopted out, the outcome in these cases would have looked a lot different.

Rudy probably shouldn't have sole custody of his child, given what the article says about his ongoing condition -- but since he had a sister who was willing to commit to the child's care, it seems entirely likely that custody could have been kept in the family, which should be a preferred option over giving the child up completely to strangers.
posted by jacquilynne at 10:28 AM on June 2 [4 favorites]


No matter how many times us humans try this, attempts to place black-and-white regulations on gray areas don't tend to work so well. Isn't continuing to do the same thing over and over despite knowing that it will fail a sign of something?

So by that logic all human children should be removed and placed with Martian foster families.
posted by Holy Zarquon's Singing Fish at 10:37 AM on June 2


With Rudy is part of the issue that they could find he is capable based on the plan to live with his sister but that he wouldn't necessarily have to follow through with that plan?
posted by Area Man at 10:45 AM on June 2


My mom had untreated bipolar when I was growing up. My parents separated when I was 8. I sure wish my dad had gotten custody; her illness (and the concomitant abuse) has left indelible marks on my life.
posted by desjardins at 10:54 AM on June 2 [11 favorites]


Tucked in there is a judge deciding that Mindi wasn't actually abused by her ex-partner, it was a delusion. That's why she lost her a second time, because her claims of past abuse were determined to be unfounded based on nothing. With no mental health professional evaluating her and determining her delusional, just a judge disbelieving her.
posted by the young rope-rider at 11:06 AM on June 2 [6 favorites]


I don't think having a mental illness should necessitate your parental rights to be revoked, but it would seem there may be extenuating circumstances in both these cases beyond the very subjective tone of this article.

One element in particular: Rudy's sister agreeing to help create a stable home sounds nice and neat, but while there is nothing to indicate that this isn't what exactly what will happen, there also is nothing to indicate that he wouldn't change his mind and decide to leave town with his child. If he has parental custody, no law enforcement agent could stop him from taking the child wherever he wanted to unless he proved to be a danger to himself or others. Not to mention that the family members themselves might, at some point in the next 16 or so years, renege on the agreement, become infirm, or pass away.

Then there is the passage where Q.A.H's foster family notes "delusional" and other "odd" behavior coming from the mother. Again, this could be some paranoid confirmation bias from them, but it could also be something more accurate.

...

Then it occurred to me that I will be a father twice over this month.

Then I thought back to that time several years ago, (thankfully before I had children) when I demonstrated to the entire world how I was unfit to even take care of myself due to substance abuse.

Then I thought about how indescribably important and precious my children are to me...

Then I thought about how I would have felt if I had had my children years ago, and that the State had removed my children during this time, but still refused to give them back with years sober.

Now I don't know anymore... Damn you, perspective....
posted by Debaser626 at 11:09 AM on June 2 [1 favorite]


This is an example of a situation that could be managed with money. The writer presents Mindy as healthy and capable. The judge found her not competent. Regular mental health supervision would likely make all the difference in helping Mindy stay healthy, and making sure her kids are safe, without her having to lose a child to adoption. Quality mental health care is expensive, and in the current environment of tax cuts and service cuts, the state took away her child rather than ensure that she get proper care.

When authorities take a child, a 1997 federal law mandates that they must provide parents with access to the programs and services they need to reunite with their children. If the issue that brought a child into foster care is homelessness, child welfare systems must find parents housing. If it's drugs: treatment. If it's abuse: parenting classes. Parents can be compelled to attend anger management classes, seek counseling or leave an abusive partner. But the law does not explicitly cover disabilities, mental or physical. Mental health is a disability, it's often treatable. This is just plain discrimination.

When the Clinton administration tried to enact health care reform, it didn't include mental health. ACA (Obamacare) does, which is one more really significant reason to support it.
posted by theora55 at 11:46 AM on June 2 [10 favorites]


I don't have time to read the articles right now, and will probably have something more in depth to say in a few hours when I can, but:

Why does mental illness even need to enter into it? If you are unable to care for your child, for whatever reason, in a healthy and safe manner, the state tends to intervene.

Plus, tying removal of children directly to the mental health of the parent(s) creates an incredibly strong disincentive for those parents to seek the mental health treatment they need.

I mean, what's better for a child? A parent with treated and managed Bipolar I, or a parent who is afraid that if they seek counselling and/or medication, their children will be taken away? I would venture to guess that in the latter scenario you end up with an unmedicated/untreated parent with BI raising a child(ren).

It's a thorny question, and as MartinWisse said above: depends entirely on the circumstances. Which brings me back to what I said: look at what's in the best interests of the child; the mental health of the parent only enters into it as a factor in the child's health and safety.
posted by feckless fecal fear mongering at 12:05 PM on June 2


feckless fecal fear mongering: "Why does mental illness even need to enter into it?"

Some of this is answered in the article. The short answer: because there are laws in place in some states (but not others) that specifically protect a parent with a mental illness' right to take care of and raise their child. The metric by which suitability is being judged: "harm," is not necessarily easily quantified except on a case-by-case basis. It is applied inconsistently in different states. Some courts do not seem to recognize that a person may have a mental illness yet still be capable of safely parenting their child.

If person A is an exemplary parent, but has an "episode" where they can't recognize their child, does that justify permanent removal of the child from the home? Even if they are subsequently being treated for their condition?

Laws regarding these types of situations differ from state to state, as does the level of protection for Person A's right to custody -- and then to have them applied inconsistently by judges... it can be a bit of a mess.
posted by zarq at 12:20 PM on June 2


The metric the courts seem to be using is, "Is there a possiblity that one day this person will become incapicitated enough to be unable to parent appropriately?" Which is a question whose answer is always going to be "Yes," regardless of the parent's mental or physical health, because shit happens. Yet it seems that only parents with mental health diagnoses or physical disabilities are getting their rights taken away, and that's not ok.
posted by jaguar at 12:25 PM on June 2 [2 favorites]


jaguar: "Yet it seems that only parents with mental health diagnoses or physical disabilities are getting their rights taken away, and that's not ok."

I think it's more accurate to say that there is a focus on those with mental illness. I doubt that they are the only ones having children removed from homes unfairly.

Worth noting that Federal protections of parents with mental illness with regard to children and the child welfare system were only established in the US in 1997 with the enactment of the ASFA. It might seem like a long time ago, but state addendums and provisions have taken quite a few years to address relevant issues.
posted by zarq at 12:44 PM on June 2


"Should a Mental Illness Mean You Lose Your Kid?"

Depends entirely on the illness and situation.


Yeah, exactly. That question is (formally, but not substantively) akin to asking "Should illness mean you get surgery?"

Mindi's case is certainly sad, I think it's clear from the article that the outcome was somewhat arbitrary, and I wouldn't want to down-play how significant that kind of loss would be for a parent. But at least the girl has a family that wants her and will, presumably, be able to have a relatively normal life. This isn't in distinction to how Mindi would raise her, but in comparison to children who don't get those things for various reasons.
posted by clockzero at 12:50 PM on June 2 [1 favorite]


When my son was born we got an information package from the BC government tell us how to avoid SIDS. It basically told us to take out everything, including the bumper pads, leaving only the mattress cover and a blanket tucked tightly over the midsection.

Needless to say, exactly zero babies will ever sleep peacefully in this situation and you will be required to ignore the advice you've been given. Near as I can tell, what the BC government did to was look at anything that might go into a cradle and asked "could a baby suffocate on this" and if the answer was yes, they recommended removing it. I'm pretty sure the only reason they deemed to allow the sheet was because it was determined to be worse to leave a baby uncovered. This way, any SIDS event cannot be linked to government recommendations and nobody can be blamed.

Using "predictive neglect" as a method to determine whether a child should be removed sounds like a similar policy. Pure CYA.

In a system starved of resources any reliance on qualitative assessments by trained caring people is doomed to failure so the only incentive for the law makers is to minimize their risk of liability.
posted by Reyturner at 1:14 PM on June 2


I think it's more accurate to say that there is a focus on those with mental illness. I doubt that they are the only ones having children removed from homes unfairly.

Sorry, yes, you are entirely right. I meant that the idea of "predictive neglect" seems, from what is stated in the article, to apply legally to only parents with mental illness and physical disabilities.

But at least the girl has a family that wants her and will, presumably, be able to have a relatively normal life. This isn't in distinction to how Mindi would raise her, but in comparison to children who don't get those things for various reasons.

Does that mean it's value-neutral if we go around seizing children from their families and reassigning them to others?
posted by jaguar at 1:22 PM on June 2 [1 favorite]


I'm still reading the article, but I've just gotten to the picture of her meds and it strikes me as a bit over-the-top. One of the medications in the pictures seems to be meloxicam (parts of the first two letters are obscured) which I also take. It's a non-steroidal anti-inflammatory. I think the picture implies that the mom is on a cocktail of psych meds, which might be true, but not all the meds in the picture are psych meds. Given the stigma that people often hold about psychiatric medications, I think the picture should have been chosen more carefully.
posted by not that girl at 1:30 PM on June 2 [3 favorites]


jaguar: " Sorry, yes, you are entirely right. I meant that the idea of "predictive neglect" seems, from what is stated in the article, to apply legally to only parents with mental illness and physical disabilities."

So... you're absolutely right: the article actually does imply that and I think it's sort of problematic.

In states that have a predictive neglect legal doctrine, mental illness is not usually mentioned directly. The concept is simple: remaining in a specific environment could be injurious to a child's well being, so the state steps in and pulls them out into what is hopefully a more healthy environement. The parameters usually codified into law are things like previous abuse incidents, living conditions, associations with dangerous people -- or neglect/abandonment/denial of care, such as denial of medical attention, proper nutrition, emotional, physical or moral neglect, etc.

But even though they're not specifically mentioned under the law, Child Welfare Services departments do use predictive neglect laws to take kids away from parents who have been diagnosed with mental illnesses. I don't know if it would be accurate to characterize that as happening often (I would bet it is,) but we know for sure that it definitely happens.
posted by zarq at 1:56 PM on June 2


Needless to say, exactly zero babies will ever sleep peacefully in this situation and you will be required to ignore the advice you've been given.

I have three kids all of whom slept in the in cribs with the minimal setup you describe. In my experience, my babies didn't actually need pillows, bumper pads, etc. to sleep. I felt comfortable using the crib setup recommended by government agencies in the U.S. and Canada. I got some pushback from older relatives who assumed babies couldn't possibly sleep without pillows, fluffy blankets, etc., but I always figured that was adults projecting their own sleep preferences onto babies.

On a more relevant note, I don't think the courts are actually using "[i]s there a possiblity that one day this person will become incapicitated enough to be unable to parent appropriately" as the metric. If they were, every kid would be succesfully yanked and state supreme courts would not be reversing decisions made by lower courts and government agencies, which is something the article specifically notes has happened some in recent years. I think the tough question is how much of a probability of future neglect the agencies and courts have to believe there is to terminate rights or remove custody and what types of evidence and evaluations they use in making those decisions.
posted by Area Man at 2:34 PM on June 2


On a more relevant note, I don't think the courts are actually using "[i]s there a possiblity that one day this person will become incapicitated enough to be unable to parent appropriately" as the metric. If they were, every kid would be succesfully yanked and state supreme courts would not be reversing decisions made by lower courts and government agencies, which is something the article specifically notes has happened some in recent years. I think the tough question is how much of a probability of future neglect the agencies and courts have to believe there is to terminate rights or remove custody and what types of evidence and evaluations they use in making those decisions.

I think one alternative to this is to have continual support systems in place so that parents are unlikely to become incapacitated. I also think the risk of being reported to child protective services likely discourages people from seeking treatment or disclosing symptoms while in treatment at a stage where they could be more easily mitigated.
posted by CBrachyrhynchos at 2:47 PM on June 2 [2 favorites]


There are some data on the implications of predictive neglect in the USA:
Beginning with the investigation into a report of child maltreatment, bias pervades the child welfare system, and “at any step in the process, societal prejudices, myths, and misconceptions may rear their heads.” Systematic discrimination by state courts, child welfare agencies, and legislatures against parents with disabilities and their families has taken a toll. Statistics indicate that children of parents with disabilities are removed from their parents with alarming frequency.
National Council of Disabilty — Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their Children
posted by Jesse the K at 4:25 PM on June 2


Child Welfare Services departments do use predictive neglect laws to take kids away from parents who have been diagnosed with mental illnesses.

And therein lies my concern. For me, I know I cannot have children at this time because I can barely take care of myself. But 'mental illness' is a huuuuuuuuuuuuuuuuuge umbrella. Unmedicated paranoid schizophrenic? Probably a good idea for the children to be removed from the home until the parent is under treatment. Suffering from a stress disorder? Probably not. That's my concern with these laws specifically defining mental illness as a reason to remove children. It's like saying "If you're physically ill, should your children be taken away?" I mean, maybe, if you're in the terminal stages of cancer and can't fend for yourself let alone children. But if you have the flu? No.

It's so messy. And yet another reason why mental healthcare needs to be freely available without stigma for everybody (I seriously, seriously believe that everyone would benefit from two weeks in a psych ward).

I like to imagine a world where going to see a therapist for a few sessions is no different than getting a physical from your doctor. Sometimes it's going to uncover a serious underlying problem, most of the time it'll be "Get some more exercise, lay off the drinking a bit, and eat more veggies." You know?
posted by feckless fecal fear mongering at 4:41 PM on June 2 [4 favorites]


When authorities take a child, a 1997 federal law mandates that they must provide parents with access to the programs and services they need to reunite with their children. If the issue that brought a child into foster care is homelessness, child welfare systems must find parents housing. If it's drugs: treatment. If it's abuse: parenting classes. Parents can be compelled to attend anger management classes, seek counseling or leave an abusive partner.

But the law does not explicitly cover disabilities, mental or physical. And in the absence of a clearly applicable federal standard, at least five states—Alaska, Arizona, California, Kentucky and North Dakota—have listed mental illness as one of a few "aggravating circumstances" that exempt authorities from having to provide help to attempt to piece families back together. Among the handful of other circumstances? Murdering, torturing or sexually abusing a child.
What I'm reading here is that the authorities (presumably CPS?) must actively work to help parents remedy whatever problem is keeping them from parenting, unless that problem is a mental disability, physical disability, or torturing and murdering children.

Am I reading that correctly? If so, is that a reasonable summary of the law? If so, can those of you who seem to me to be weirdly blase about this explain why offering help and resources to get parents back on track unless they are mentally ill or physically disabled makes any sense at all, or why lumping together child molesters and people with Bipolar Disorder is reasonable?
posted by jaguar at 5:13 PM on June 2 [1 favorite]


My father had untreated bipolar all my childhood, while my mother had periodically untreated major depressive disorder. Childhood was not a barrel of laughs in my home, but from all I hear, the foster system is often much worse. Being fostered by extended family members, on the other hand, if that is available, seems like a good solution. But often I guess they are not in a position to take in kids either.
posted by lollusc at 7:02 PM on June 2 [1 favorite]


Part of that is the medical record. No one wants to be the social worker who sent a kid back to a parent with a known history of mental illness who then harmed the child. And also young children who are placed for fostering when adoption is an option, there becomes a very strong bias (sometimes incentived by adoption goals) to push for the child to stay with their caregivers, not return to biological family they have never been parented by.

Kinship cares rocks. And yes, his mother and sister might get hit by a car and then he's back in the same boat. Or the adoptive parents might get hit by a car!

It is so wrong to hold biological families and extended care to high standards - even the same standards as adoptive families, when they have additional benefits of heritage and biological connection to give the child.

Gah.

I do think case by case while shitty in particular cases, is still much stronger and better than a standards-based quantifiable situation. Families and children are too messy to reduce to rules.
posted by viggorlijah at 9:34 PM on June 2 [1 favorite]


"Predictive neglect" reminds me of "psychosis risk syndrome," which was a disorder that was being considered for addition to the DSM-V (and thankfully never was).

The idea behind psychosis risk syndrome was that it would catch young adults before they developed a psychotic disorder (essentially vying for the holy grail of upstream / preventative mental health care). The problem was that individuals would be within a normal range of functioning (and therefore, by definition, not mentally ill) when they received the diagnosis. And what's more, 9 out of 10 individuals who were diagnosed as being "at risk" would not go on to develop the disorder. Yet, the idea would have been to put these at-risk individuals on anti-psychotic medications, which have a number of serious side-effects. Not to mention the stigma of being labelled as "at risk for developing psychosis".

I think the problem with "predictive" mental health care strategies is that we simply don't know enough about mental health. We treat mental illness as if it's something that a person "has" (and will continue to "have") but in reality the DSM just describes clusters of symptoms. We've barely begun to crack the nut that is the biological basis of mental illness.
posted by tybeet at 5:46 AM on June 3 [1 favorite]


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