[NYAPRS Enews] New Report Underscores Parents w Psych Disabilities

[Harvey Rosenthal]

NYAPRS Note: The following report takes a penetrating look at policy and
funding changes that are necessary to preserve and promote families
where there is a parent with a psychiatric disability. NYAPRS, MHANYS
and our allies are working for passage of legislation removing mental
illness as a potential factor in parental custody removals (see next
week's e news) and successfully secured $850,000 in state funding in
2007. A portion of those monies funded two Parents with Psychiatric
Disabilities Legal Projects via the Commission on Quality of Care and
Advocacy for People with Disabilities (see below for reference to the
one operated by the Urban Justice Center): their one year funding is
running out and should be extended. We're expecting that OMH's $500,000
initiative to provide more programmatic support to parents within
community mental health programs will be out soon.

 

New School, Center For Urban Future Issue Report On Helping Children
With Mentally Ill Parents

March 18, 2009 News Release   (formatting by NYAPRS)

 

The Center for New York City Affairs at The New School and the Center
for an Urban Future today issued a joint report documenting the issues
facing poor and working class parents with mental illness and their
children.

 

Child Welfare Watch, Vol. 17, " Hard Choices: Caring for the children of
mentally ill parents," looks at issues facing parents with psychiatric
problems who come in contact with the city's child welfare system. 

 

Today, adults who struggle with mental illness are as likely as anyone
else to become parents. Yet the city's human services programs are
neither structured to support single and low-income parents with mental
illness who are trying to raise their children, nor able to
systematically evaluate a parent's ability to care for her children
despite her illness.

 

Highlights of the report's findings include:

*         In New York City, as many as one-fifth of parents who come in
contact with the foster care system have a diagnosis of mental illness.
A parent who comes in contact with the foster care system is much more
likely to have her children enter foster care if she has a mental
illness. Experts estimate that between one-quarter and three-quarters of
parents with serious mental illness lose custody of their children.

*         Last year, New York City children were removed from their
homes in 56 percent of Family Court abuse and neglect cases that
involved an allegation of mental illness--while in cases that did not
include such an allegation, children were removed and placed in foster
care only 35 percent of the time.

*         Some parents with mental illness can safely care for their
children if given the proper supports. Supported-housing programs such
as the Emerson-Davis Family Development Center, in Brooklyn, offer
single mothers with mental illness the opportunity to live with their
children while receiving help and supervision. But programs like this
are extremely rare, and nationwide, there is little coordination or
communication between the mental health system--geared to treat
adults--and the child welfare systems designed to protect children.

*         In many cities, including New York City, Family Court makes
critical decisions about a parent's fitness based on mental health
evaluations. But these evaluations can be highly subjective and often
offer contradictory diagnoses. Inaccurate diagnoses can hurt families by
minimizing the problems of a parent who is seriously ill, or by
exaggerating the problems of a parent who is able to cope.

*         How successfully women with mental illness care for their
children depends not just on their particular diagnoses, but also on the
level of support they receive at home, their awareness of their own
illness and their willingness to accept professional help, researchers
in Chicago found. The Chicago court system has used this information to
create a more reliable method of evaluating a parent's fitness.

 

The report features the stories of families affected by mental illness
and the foster care system, including: a young parent who asked for help
with her depression only to have her children removed; another young mom
who is learning effective parenting and coping with her bi-polar
disorder with the help of preventive support services; and a teen's
experiences growing up with parents diagnosed with schizophrenia.

 

In addition, the report found that many New York City foster children
with severe mental illness who need long-term residential care do not
get the help they need. Meanwhile, residential programs designed to
serve upstate children with severe mental illness have beds sitting
empty.

 

And, in light of the rising wave of municipal and state budget cuts
which will hit human services hard--including many preventive family
supports--the 17th issue of Child Welfare Watch looks at how the stress
of poverty has profound implications for a parent's mental health--as
well as for the brain development of young children.

 

The report also contains policy recommendations drafted by the Child
Welfare Watch advisory board aimed at helping policymakers address
issues of mental illness and parenting. The full report is available at
the Center for New York City Affairs Web site, www.centernyc.org.

 

Child Welfare Watch is published jointly by the Center for New York City
Affairs at The New School and the Center for an Urban Future. This
edition is made possible thanks to generous grants from the Child
Welfare Fund, the Ira W. DeCamp Foundation, the Viola W. Bernard
Foundation and the Sirus Fund.

------------------

Hard Choices: Caring For The Children Of Mentally Ill Parents

Child Welfare Watch  Winter 2009

 

Half a century ago, when people with chronic and severe mental illness
routinely spent years in institutions, women with psychiatric conditions
were less likely to bear children than they are today. Now, after
decades of deinstitutionalization, women with mental illness are just as
likely to have children as anyone else.

Mental health experts estimate that nearly half of all women experience
psychiatric disorders at some time in their lives. These disorders may
be mild and easily treatable, such as some forms of depression, or they
may be chronic and severe, such as schizophrenia. How successfully these
women care for their children depends not just on their diagnoses,
however, but also on the level of support they receive at home, their
awareness of their own illness and their willingness to accept
professional help. Women with private health insurance and those with
supportive partners or other relatives often manage to rear their
children quite well. But single mothers living in poverty and without
adequate health care and supportive families often wind up with children
in foster care.

Joanne Nicholson, a national expert on parents with mental illness,
estimates that between one-quarter and three-quarters of parents with
serious mental illness lose custody of their children. One small study
of inner-city mothers hospitalized for psychiatric illness found that 80
percent lost custody of their children. Deciding whether a mother is fit
to rear a child is never easy. If a mother has mental illness, the
decision is even more agonizing and complex. In some states, mental
illness-by itself-is grounds for removing a child and not pursuing
reasonable efforts to reunite a family.

But advocates say many parents with severe mental illness can safely
care for their children, if given the proper supports...Programs such as
these are rare. Nicholson estimates there are only a few dozen programs
in the United States specifically designed for mothers with mental
illness, and that only a tiny handful....provide housing. Nationwide,
there is little coordination between the adult mental health systems and
the child welfare systems designed to protect children.

Mental health workers may not even ask a patient if she has children,
while child welfare workers typically have little training in how to
deal with mental illness. ...Perhaps most important, parents with mental
illness are often reluctant to acknowledge they need help. Women fear if
they confide in a therapist-and let someone know how depressed they
really are-they will lose their children... 

A parent with children in foster care and a diagnosis of mental illness
has much more difficulty reuniting with her children. On top of
completing the practical preparations for bringing her children back
home, such as finding an adequate home, she also must persuade a judge
and caseworkers that

her mental illness will not get in the way of safe parenting.

In New York City, Family Court makes critical decisions about a parent's
fitness based on mental health evaluations that can be highly subjective
and that often offer contradictory diagnoses. Inaccurate diagnoses can
hurt families in two ways-by minimizing the problems of a parent who is
seriously ill, or by exaggerating the problems of a parent who is able
to cope.

In Chicago, on the other hand, the court system has experimented with a
more reliable method of evaluating a parent's fitness. A team (made up
of a psychiatrist, a psychologist, and a social worker) looks at a
variety of records including a complete medical history, any criminal or
drug reports, and school records. The team interviews the parent
together with the child, in a home setting, to observe their
interaction. Preliminary results

suggest that children of parents with mental illness now have shorter
stays in foster care because judges are more willing to return them home
on the basis of a thorough and persuasive evaluation (see "A Better Way
to Judge," page 16).

The rising wave of municipal and state budget cuts will hit human
services hard, especially those neither mandated by federal and state
law-including many preventive family supports-nor funded by Medicaid.
These cuts will occur even as families experience intense stresses
caused by economic forces well beyond their control. As researchers have
shown, the stress of poverty has profound implications for a parent's
mental health-as well as for the brain development of young children.

And yet, even in times when funds were more available, government has
made only modest progress toward addressing the needs of low-income
families coping with mental illness. Mothers with mental illness have
received little attention from scholars or policy makers. Only a handful
of researchers have focused on their care and treatment. Policy makers
tend to focus either on the needs of children, or on the needs of the
mentally ill. With this issue of Child Welfare Watch, we hope to focus
attention on the needs of both-parents with mental illness and their
children- and to show that meaningful solutions are inextricably
intertwined across the sectors and generations. -Clara Hemphill

----------------

 

Child Welfare Watch

Recommendations And Solutions

 

The New York City and State mental health and child welfare systems fail
to interact smoothly and often miss opportunities to provide supports
that would effectively keep a child out of foster care-or to place them
in the most appropriate type of care. Following are recommendations
proposed by the Child Welfare Watch advisory board to address many of
the issues raised in this report:

 

A Parent's Ability To Care For Her Children Safely-Not Her Psychiatric
Diagnoses-Must Be The Standard For Determining Whether Or Not Children
Are Placed In Foster Care.

Data from Family Court reveal that when city child abuse and neglect
investigators suspect a parent has a mental illness, the children are
far more likely to be removed from their home and placed in foster care.
This fact points to the enormous consequences of mental health
assessments on the lives of New York families and children. Attorneys
who represent parents in Family Court estimate that as many as one-fifth
of all abuse and neglect cases include a parent's mental health
diagnosis.

But a diagnosis, by itself, is not an effective way to determine who is
capable of being a good parent. Many women and men with mental illness
are competent parents, particularly if they have lots of support at home
and are willing to accept professional help. Others may be unfit
parents, even if they have no psychiatric problems. 

To have influence in abuse and neglect proceedings, Family Court judges
and the city's Administration for Children's Services (ACS) should
obtain high quality, team-based evaluations that assess parenting
competence. Dr. Laura Miller, a psychiatrist at the University of
Illinois and an expert on mental illness, has set up guidelines for just
such an assessment. 

For example, a mother who is aware of her own mental illness is more
likely to be an adequate parent than one who denies she has problems. A
mother who has realistic ideas about what can be expected from children
at certain ages is less likely

to mistreat a child than one who has unrealistic expectations. A mother
with a strong social support network of family and friends is less
likely to mistreat a child than a mother who is socially isolated. The
child welfare system should consistently use criteria such as these,
developed by Miller and other experts, to determine who is a fit
parent-and not merely stigmatize mothers with diagnoses of mental
illness that are too easily used to justify a child's placement in
foster care.

 

Mental Health Evaluations Ordered By Family Court Or By The
Administration For Children's Services Should Be Thorough And Unbiased.

In New York City, there is no standard for how these evaluations should
be conducted. Some observers consider them inherently biased because
they are frequently performed as part of an adversarial court
proceeding. They can be highly subjective and separate evaluations
routinely offer contradictory diagnoses.

They tend to be based on cursory one-time examinations, often without
the children present, rather than a thorough review of a mother's
medical and family history and an observation of her parenting ability.

Moreover, lawyers representing mothers in Family Court say evaluations
are requested far more often than necessary, even in cases in which
there is no mental health allegation. The court should limit requests
for evaluations to cases in which there is an indication of unresolved
mental health issues and not order evaluations indiscriminately.

In addition, the city should set standards for these evaluations.
Miller, a psychiatrist who helped set standards for mental health
evaluations in Illinois, recommends that evaluations be carried out by a
team that includes a psychiatrist, a psychologist and a social worker,
rather than by one clinician as is now typically the case. She says they
should include a thorough look at a family's medical history and social
support network, an observation of the parent interacting with the
children, and a review of pertinent documents such as school records or
any criminal records. A neutral party should pay for the evaluations to
minimize the risk of bias. Such evaluations are initially more
expensive, but they can save money in the long run: they put a stop to
the duplicative assessments that routinely occur in Family Court cases,
and they provide detailed information necessary for a child's permanency
planning, which can shorten lengths of stay in foster care.

 

Family Court, The Administration For Children's Services And Service
Providers Should Use Mental Health Evaluations To Provide Services For A
Mother Not To Punish Her.

Too often, mental health evaluations are used to vindicate the child
welfare system's decision to remove children from their home or
otherwise make demands of a parent. A better model would be to use
mental health evaluations the same way the school system is supposed to
use Individualized Education Plans (IEPs) for children with special
needs. Just as IEPs outline services that might benefit a child in
school, so mental health  valuations should be used to determine exactly
what kind of supports a parent needs, and then to obtain those services.
For example, the evaluation might state that a mother needs a homemaker
to visit daily to help her organize her household and a weekly visit to
a therapist to work on anger management. This is already standard
practice at some agencies, but it should be the standard by which all
use of evaluations is measured.

 

Family Court Judges, Lawyers And Child Welfare Workers Need To Be Better
Informed About Mental Illness

Many of the people who routinely make judgment calls about parents'
mental stability are not clinically trained. Some confuse parents'
reactions to the trauma of having children removed with genuine mental
illness. Others are unaware of how to fairly determine whether a parent
with mental illness can care for her children.

The Urban Justice Center recently launched the Parents with Psychiatric
Disabilities Legal Advocacy Project, which provides representation,
information and advice to parents in Family Court and educates court
officials on issues facing parents with mental illness. Training and
ongoing coaching around mental health issues should be a routine element
of child welfare work for frontline ACS staff, court officials and
caseworkers in foster care and preventive agencies.

Similarly, to prevent children from receiving inappropriate diagnosis
and treatment, the psychiatrists and therapists evaluating children must
be skilled at differentiating between a child who has been
traumatized-from, say, being removed from their family-and a child with
a genuine mental illness.

Today, ACS field offices and some foster care agencies have skilled
clinical consultants who support frontline staff on these issues. Yet
there is still much work to be done to clear up misconceptions around
mental illness and help the courts and child welfare workers make more
informed decisions when working with and planning for families affected
by mental illness.

The city should preserve funding for services that allow mothers and
their children to get help at home, reducing the need for foster care
and psychiatric hospitalizations.

Parents with mental illness may be able to care for their children at
home if they receive services such as psychotherapy, child development
classes, help with anger management, a homemaker and a social worker to
call in an emergency.

When they are successful, these services prevent children from going
into foster care. State and city funding for nonprofit run preventive
family support services has increased substantially during the last four
years, yet providers still speak of severe difficulties obtaining
adequate supports for parents and children who need intensive help.
Budget makers in the current fiscal crisis have so far largely spared
ACS-contracted preventive services, but the outlook for government
funding over the coming years is grim. Targeted funding of services for
parents with mental health needs who would otherwise lose their children
to expensive foster care will not only help families, it can save money 

 

The Paterson Administration should preserve programs that offer mental
health services for children in the community.

Both the state Office of Mental Health (OMH) and Office of Children and
Family Services (OCFS) have expanded community based services in recent
years, in the hopes that children can receive treatment before their
conditions deteriorate to the point where they need institutional care.
Federal regulations permit states to use Medicaid money to pay for
intensive, ongoing outpatient services-not just hospital care-under a
program called the Home and Community-Based Services waiver. In New York
City alone, the mental health residential support services component of
this program has grown from 64 slots for young people in 1996 to 510
slots in 2007. Statewide, the program has grown from 125 slots in 1996
to 1,506 slots in 2007, according to OMH.

Another program, Bridges to Health, supported by OCFS, puts specially
trained staff of community mental health clinics in the neighborhood
offices of foster boarding home agencies. This improves the quality of
care, strengthens case management and increases access to services. This
program also offers foster parents long-term extra help dealing with
children who have severe emotional problems. For example, if a child has
a serious emotional outburst, the foster parent can call a special
caseworker who will come to the home immediately to help them cope. The
potential payoff is tremendous: foster children are a tightly targeted
group that experience a high rate of trauma and other emotional issues.
The long-term benefits of proper care at an early age are clear. This
program is budgeted to serve 610 children at a cost of $9.166 million
this year, double the number last year.

 

The Paterson Administration Must Use Money Saved By Shrinking Or Closing
Institutions For Children To Provide Alternative Forms Of
Community-Based Care.

The governor's Fiscal Year 2010 budget recommends closing or shrinking
the size of juvenile justice facilities with a savings estimated at
$16.4 million. This savings should be reinvested in alternatives to
incarceration, which help keep children out of institutions.

Similarly, as the state closes children's inpatient psychiatric
hospitals, foster care residences and inpatient drug-treatment
facilities, the money should be redirected to community-based mental
health services and supports for foster families. These services help
keep families together at a fraction of the cost of institutional care.

 

The State Should Make Funding For Children's Psychiatric Services More
Flexible And Rational.

Foster children with severe mental health issues often bounce between
psychiatric hospitals and residential foster care institutions, moving
back and forth as their conditions improve or deteriorate. Part of the
problem is that each institution serving children has rigid requirements
of who can be admitted and who will pay for it. Foster care
institutions, supported by the child welfare system, frequently aren't
equipped to handle a child who is violent or aggressive, acting out
sexually or addicted to drugs.

However, that same child may not be eligible for intensive inpatient
psychiatric services offered at a residential treatment facility funded
by the state OMH. As a result, a child may be hospitalized for a brief
period, then sent back to foster care.

Moreover, beds paid for by OMH receive rich funding-more than $400 a
day-while hose in the child welfare system receive much less, about $200
a day. The value and quality of resources a child or family receives
should be based on need, not on whether or not the child is in foster
care.

The state OMH and OCFS should survey all the beds available for children
in institutions (including those in foster care, juvenile justice,
mental health, and the Office of Mental Retardation and Development
Disabilities), assess where the need is greatest, and  adjust the
funding and services accordingly.

For example, instead of creating more inpatient psychiatric beds, the
state might broadly expand recent efforts to install clinical mental
health services inside foster care agencies to ensure that psychiatrists
are available to treat more children-especially those in residential
treatment centers that have inadequate clinical and round-the-clock
staff support. 

More foster care institutions might be funded to designate some beds as
"crisis" or "respite" beds, in which children would receive intensive
services without being hospitalized. There have been recent, admirable
state-backed experiments with greater flexibility, yet the current
inflexible rate structure still contributes to instability in the lives
of fragile children.

 

http://www.newschool.edu/milano/nycaffairs/documents/CWW-vol17.pdf 

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