Bill Seeks to Reverse Trend Of Parents Ceding Custody

A new bill in Congress will alleviate some of the pressure on parents to relinquish custody of children to obtain necessary mental health services. Sens. Susan Collins (R-Maine) and David Pryor (D-Ark.) and Reps. Patrick Kennedy (D-R.I.) and Fortney “Pete” Stark (D-Calif.) plan to introduce the Keeping Families Together Act this month.

The bill calls for establishing a six-year, $55 million federal-matching grant program for states to create a coordinated system of services and supports for children with serious mental or emotional disorders.

States could use these funds to expand public health insurance to cover mental health treatment for eligible children and families; provide outreach and public education programs and training and professional development for personnel working with children with mental illness; help the state develop a system to track children who enter the child welfare system solely to obtain mental health treatment; and provide individualized services for children and their families, according to a press statement from Collins’s office.

Collins, chair of the Senate Government Affairs Committee, held two days of hearings in July on the reasons parents give up custody of their children with mental illnesses (Psychiatric News, August 15). Recommendations by mental health advocates and officials from the General Accounting Office (GAO) who testified at the hearings were incorporated into the legislation. Collins, Stark, and Kennedy commissioned a GAO report earlier in the year on the reasons for parental relinquishment of custody (Psychiatric News, June 6).

States Need More Resources

Mental health advocates recommended that Congress provide states with additional resources and guidance to implement home- and community-based services for children with mental disorders.

Tammy Seltzer, a staff attorney at the Bazelon Center for Mental Health Law in Washington, D.C., told the committee, “The single, most important obstacle that pushes families into giving up custody of children is a lack of access to appropriate and timely mental health services and supports for children in the public and private sectors.”

States Ban Custody Relinquishment

Trina Osher, coordinator of policy and research for the Federation of Families for Children’s Mental Health, testified that “the practice of states requiring parents to relinquish custody to obtain essential mental health services for their children must cease. However, a ban needs to be combined with providing increased access to mental health services for children.”

Thirteen states have already banned parental-custody relinquishment solely to obtain mental health services for children, according to Stark, who testified at the hearing along with Kennedy. The federal legislation does not require states to ban child-custody relinquishment, but says that federal matching funds will help states eliminate the practice.

Families with private health insurance quickly exhaust their mental health benefits due to a lack of insurance parity, said Osher.

She and Seltzer urged Congress to pass the Senator Paul Wellstone Mental Health Parity Act cosponsored by Kennedy in the House and Collins in the Senate. The bills (HR 593, S 486) would require private health insurance plans with mental health benefits to provide the same number of inpatient days, outpatient visits, and copayment and deductible amounts as provided for other health care benefits.

“Most children return home from hospitals or residential treatment programs without any follow-up services or supports, simply because they have reached the maximum number of days for which insurance will pay. Typically, these children were not stabilized in the first place, and no links to school and community-based mental health services and home-based supports were made on discharge,” said Osher.

Osher recommended that Congress increase the appropriation for state mental health block grants by 20 percent and mandate that all funds be used to develop family-driven support services and expand effective community-based treatment services for children with psychiatric disorders and for their families.

“Our families also find themselves between a rock and a hard place trying to balance the conflicting mandates, requirements, and demands of several different services or systems,” complained Osher.

She recommended that state agencies be required to develop effective interagency working agreements so that services are coordinated and funding is combined from all child-serving agencies. “The goal is for children with mental health problems and their families to have affordable and convenient access to a comprehensive array of supports and services,” she said.

Seltzer testified that “Congress has legislation before it that would take two giant steps toward preventing custody relinquishment.”

The new legislation should streamline the current system by requiring the creation of a federal interagency task force, as recommended by the GAO, to foster cooperation, examine problems of mental health care in the child welfare and juvenile justice systems, and assist states in implementing the grant program.

The Family Opportunity Act (S 622), cosponsored by Sens. Charles Grassley (R-Iowa) and Edward Kennedy (D-Mass.), would expand Medicaid coverage to children whose families would not otherwise be eligible and give states greater flexibility to use the Home and Community-Based Services Waiver to serve children with serious psychiatric disorders.

States Bypass Program

“This critically important tool has not been taken advantage of by most states because of obstacles that Congress has the power to eliminate. Only Vermont, Kansas, and New York have used this waiver,” Seltzer told Congress. “They found that the costs of serving these children in the community are half of what would be spent on institutional care.”

The Kansas home- and community-based waiver for children with serious psychiatric disturbances has, for example, reduced custody relinquishment and led to positive outcomes in schools, said Seltzer. “More important, the waiver allows families to remain intact.”

Federal Law Lags Behind

Federal law has not, however, kept up with changes in practice. The “level of care” a child must meet under the existing statute to qualify for services under the waiver includes care in hospitals, intermediate care facilities, or nursing homes.

Many children are cared for, however, in psychiatric residential treatment centers, an institutional level of care not covered by the statute, Seltzer explained. “Congress needs to modify the statute to allow children receiving or needing inpatient psychiatric services in a residential treatment center to receive services in the community.”

Collins vowed to pursue passage of three bills in Congress this year—the Family Opportunity Act, the Sen. Paul Wellstone Mental Health Parity Act, and the Child Healthcare Crisis Relief Act, which includes incentives such as scholarships to help recruit and retain child psychiatrists and mental health professionals.

The legislation cited in this article can be accessed on the Web at http://thomas.loc.gov by searching on the respective bill number. ▪