Child Custody Vs. Health Care

For two years, Donna Uhlmansiek tried to get her 10-year-old son admitted to a state mental hospital. Finally a health care worker suggested she go to court and give custody of the boy to the state.

Uhlmansiek was horrified by the idea.

Instead of giving up her son, she became part of a national movement to change state laws that encourage desperate parents - unable to afford mental health care for their children - to relinquish custody.

A dozen states recently have changed their laws to allow children to more easily receive mental health treatment without their parents having to relinquish custody, according to the Bazelon Center for Mental Health Law in Washington. Other legislatures are considering such changes.

In Missouri, legislation would prohibit courts from taking custody away from parents when the only issue is the child's need for mental health care.

Legislation in Nebraska would allow the state health department to provide treatment without taking custody of a child.

Middle-class families like the Uhlmansieks are most likely to relinquish custody of their children, experts say. That is because they earn too much to qualify for Medicaid but cannot afford doctors and hospitals when insurance falls short.

The Uhlmansieks, whose son suffers from manic depression and is mildly retarded, had private insurance. But like most plans, it provided only 30 days of inpatient care. That had already run out.

"We had no place to go. We had exhausted every agency, every place that we were aware of. We were hopeless," Uhlmansiek recalled with a quavering voice.

Ultimately, the Uhlmansieks decided they had no choice but to give up their son. But on the day they went to court two years ago, they met a juvenile court officer at the courthouse. And the officer pulled some strings to get the boy into a state mental hospital.

Unlike the Ulhmansieks, Barbara French of Beulah, Mo., decided to relinquish custody of her teen-age granddaughter, who was later diagnosed as manic-depressive and suicidal. "I had no choice in order to get her into treatment," French said. "I just had to do it."

Parents who give up custody lose any say over their child's upbringing. And if the child is ultimately released from the mental hospital, the youngster can be placed in a foster home or another institution.

Often, parents are encouraged to give up their children by hospital employees or social workers.

"People are floored when they hear this - they have no idea that people are asked to relinquish custody of their kids in order to get services for their kids," said Darcy Gruttadaro, an attorney for the National Alliance for the Mentally Ill, based in Arlington, Va.

A nationwide study by the organization found that about 20 percent of families with children with severe emotional problems turn their youngsters over to state custody.

The Missouri Division of Family Services, for example, estimated that 500 children are in its custody solely because their families could not otherwise obtain mental health care.

In many states, for parents to relinquish custody, a judge must decide that they are unable or unwilling to provide proper care. While the steps vary, typically this involves a parent petitioning the court; in some states, like Missouri, parents who take such a step also run the risk of being charged with abandonment or neglect.

"We love our child," Uhlmansiek said. "I was so angry that me and my husband would have to be charged with a crime just to get our son the care he needed."

Children's advocates said state legislatures should provide more money to mental health efforts that would keep children at home. But with many states facing budget deficits, that is unlikely to happen.

In Missouri, the state Department of Mental Health said it can afford to treat just 20 percent of the 53,000 children it estimates would qualify for services.

"No parent should have to make the decisions to give up their child just to get them the help that they need," said Uhlmansiek, who lives in suburban St. Louis. "Things need to be changed."