For the last twenty years the Child and Adolescent Services Systems Program (CASSP) principles have laid the groundwork for creating a system of care for children in need of mental health treatment that is child-centered, family-focused, community-based, multi system and culturally component. However, a practice that threatens the very foundation of the family unit often plays out at the local level- families are being told to relinquish custody of their child to access mental health treatment. When we answered the Families Together statewide helpline we were not prepared for the despair and complexity these families experience. Each family’s situation was unique; their heartache tangled in policies and restrictions that left them little choice. Families were told to relinquish custody, or custody was taken away, from the local hospital to the local school district, from the Office of Mental Health to the Office of Children and Family Services, from, from Juvenile Justice to county level Department of Social Services programs and family support providers. We cannot possibly comprehend the depth of the anger and frustration these families encounter.

Mary met with a team of providers and county level officials regarding the emergency need for residential placement of her fifteen- year old daughter Karen. Karen had been diagnosed with mental health problems for years and had been engaging in dangerous sexual activity. She was verbally abusive to her family, taking drugs, and refusing to take her medications. Mary filed a PINS petition (Person In Need of Supervision) as a desperate measure to regain control while seeking counseling and case management services for Karen.
Then Karen was in crisis. All providers felt it was unsafe for her to return home. Karen was in a temporary emergency placement and had exceeded the weekly limit. There was a great pressure to find another placement immediately, and no potions shy of mom relinquishing custody to get into a DSS operated facility. Karen did not qualify for a Home and Community Based Waiver or an Office of Mental Health placement because she did not have previous hospitalizations.

Mary was told, “this is simply the way the system is, we don’t make the rules. To obtain placement in a DSS facility you must relinquish custody so DSS can pay the contracting agency.” Given the ultimatum Mary refused to surrender custody of her daughter. Advocates working with Mary pieced together a variety of alternatives, with a volunteer parent advocate providing direct support and intervention. Today Karen is home with her family, seeing a new therapist, and is on a new medication that has stabilized her moods.

Jessica was not so lucky. Her 14 year-old daughter, diagnosed with Oppositional Defiance Disorder and Post-Traumatic Stress Disorder from sexual abuse, began to act out in inappropriate ways. Jessica was given an ultimatum to either relinquish custody in order to get residential placement for her daughter (which her insurance would not pay for), or be charged with neglect of her nine year-old, who the county felt was in danger as long as her fourteen year-old remained home.
“My God, they made me pick which one of my children I was going to let down” she said. The school filed a PINS petition on their daughter due to truancy. When she continued to act out and violated the PINS, DSS placed her daughter in a foster home. Jessica continually struggles to be kept informed of her daughter’s status and needs. “I’m being treated like a burden rather than a parent,” she said.

Deborah also lost custody of her 11 year-old son who was diagnosed with bipolar disorder, Oppositional Defiant Disorder (ODD), and had a history of violence. After her son had been hospitalized on numerous occasions and used up his mental health benefits under Child Health Plus, she was told to surrender custody so DSS could pay for residential placement.

It took Deborah months to get custody back after the provider agency implemented a policy of no contact with the family for 20 days. The county stressed the need to “go along and cooperate” if she wanted to see her son. She was not informed of medication changes, medical needs or treatment plans. The anguish and guilt she experienced over the year almost destroyed her family.

Robin was 14 years-old and suffered from anorexia nervosa. She has required repeated hospitalizations to force-feed her to gain weight. Health insurance covered the force feedings, but severely limited treatment for the eating disorder because that was viewed as mental health treatment. After 21 days in the hospital, she was sent home. To remain in treatment, the family would have to come up with $2000 a week. The family was given an option, either keep their daughter home for a month until the new year began which entitled her to another brief stay in the hospital, or relinquish custody of Robin.

Tracy’s 11 year- old son Corey had a history of violence and has been diagnosed with oppositional defiant disorder, attention deficit hyperactivity disorder, bipolar and conduct disorder. After two inpatient hospitalizations, one lasting nine months, Corey returned home.

Before Corey’s discharge from the hospital, the school district recommended a Residential Treatment Center (RTC) placement through the Department of Social Services (DSS). The psychiatric facility where Corey was temporarily placed applied for a Residential Treatment Facility (RTF) placement through the Office of Mental Health (OMH). Corey was on waiting lists for both placements. Corey improved, and returned home. He was on the Home and Community Based Waiver for community services but his condition declined and he was hospitalized again. Tracy discovered that the school district had failed to submit the required documentation. He was not on the TRC list! The day treatment program that he had been attending stated that he could not return home because he was too violent.
At a meeting with the school, district officials refused to put Corey in an out of state TRC because of the cost. A DSS social worker informed Tracy that the “fastest” way to get Corey placed was to relinquish custody to DSS. She suggested that they “boost up” charges on Corey through probation- this would “help” Corey get the placement he needed. Tracy refused to relinquish custody.

Tracy desperately tried to find a placement, as Corey was ready to be discharged from the psychiatric facility. Then Tracy discovered that Corey wasn’t on the waiting list for RTF either. An administrator had failed to file the paperwork! Families Together intervened on Tracy’s behalf to OMH officials. Corey was transferred to an RTF within the month. She did not have to relinquish custody. He has shown improvement in the RTF setting and has begun to make day visits home. Corey’s family hopes that he will return to them in the near future.

While there are differences and similarities in the stories presented, the common thread is the resilience of the family unit to persevere and advocate for their child. It is time for our policymakers to listen to our voice, share our pain, and put themselves in the family’s shoes. When we sit at the table and are presented with relinquishing custody of our children, please keep in mind our hearts cannot rationalize policies and procedures. We are fathers and mothers, grandmothers and grandfathers, and sisters and brothers who love our children.

These stories are true. Names (except Tracy and Corey) have been changed to protect the family’s privacy.