Sunday, October 25, 2009

Only Perfect People Should Keep Their Kids

As a followup to Dinah's post about people with mental illnesses having children, one anonymous commenter mentioned a heartbreaking story about a child in the care of a woman with schizophrenia who also abused drugs and alcohol. The anonymous commenter wondered why the child wasn't taken away from this woman, why her parental rights weren't terminated and why weren't the rights of the child considered.

This prompted my first post in a while because I was just writing about issues like this yesterday for Chapter 7 of the book. (Yes Dinah, as soon as I'm done with this post I'm going to finish up Chapter 7!).

There are a lot of reasons why the child may have been left in the care of the mother. Juvenile courts terminate parental rights only as a VERY last resort. I've been impressed by the almost exhaustive efforts courts will make to keep a family united. There are a lot of reasons for that---foster families are few and far between, adoptive families even more rare, and the children in the juvenile services system themselves often have special needs or problems that make placement a challenge.

The anonymous commenter wondered if anyone was considering the best interests of the child. That phrase rang with me because, as a forensic psychiatrist, we are sometimes asked to determine arrangements for child custody and visitation based upon the child's "best interests". It's a legal term of art that transends definition. Too often the 'best interest' is a non-scientific standard out of necessity---we don't know what makes certain parent-child pairs good or bad, we have no way of predicting which arrangement will work out the best over the long term, and lots of things can happen along the way to effect the custody situation that have nothing whatsoever to do with either the parent or the child. If the economy tanks and the custodial father has to move out of state with the child to follow his employment, that affects visitation. If the non-custodial parent's house is hit by a tornado, that will affect visitation. There are too many hypotheticals to consider them all. The presence of a mental illness is just one more factor to consider in the mix.

And to answer someone's backchannel email (and to add my own one cent's worth to Dinah's post), mental illness alone is not a bar to child custody or parental rights. It just all depends. Does the parent take responsibility for his or her illness? How long has he/she been in remission? Can the parent recognize when he is getting sick and what does he do about it? What does the child know about the illness and what's his understanding of it (depending upon the age of the child, this could vary greatly)? If the child is an older teen, is there role-reversal present? Is the parent relying on the custody arrangement to keep a caretaker (the kid) in the home?

So you see, there are lots of things to be considered in these cases and no one single factor is determinative. And it's cases like this that make me very glad that I'm not the judge who has to make the decision.

Addendum:

This is completely unrelated, but this week I will be attending the American Academy of Psychiatry and Law conference. In the past I've put up a series of posts entitled "What I've Learned" to summarize some of the lectures I've attended. This year, if I can get free wifi access, I will be live-Tweeting the event. You can follow me at @clinkshrink. Ignore any references to goats.