The Sacrifice Wrought by a Costly and Fragmented Mental Health Care System: Parents Forced to Relinquish Custody to Obtain Care for Their Children

Article excerpt

Introduction

The Supreme Court has repeatedly held that parents (1) have a fundamental constitutional right to direct the upbringing of their children. However, thousands of parents are forced to sacrifice this right and relinquish custody of their children so they can obtain desperately needed mental health services. Although legislation is being introduced to address this mental health services crisis, greater efforts are needed to redress this American tragedy.

Scope and Nature of the Problem

A study conducted by the United States General Accounting Office (GAO) estimated that in fiscal year 2001, parents relinquished custody of at least 12,700 children because they could find no other way for their children to access mental health care. (2) The report stressed that this number underestimated the magnitude of the problem because officials in the District of Columbia and 31 states, including five states with the largest populations of children, did not provide data for the study.

Another study found that 23% of families of children with a serious mental illness were told they had to relinquish custody of their children to obtain much needed mental health services, and 20% said they did so to get this care. (3) The GAO study identified several reasons why parents relinquish custody, including the financial strain of paying for needed services, an inability to access suitable treatment, and the emotional strain of the child's mental illness on the family. (4)

Financial Strain. Key factors that compel parents of children with a mental disorder to relinquish custody are the high cost of mental health care, limits on the coverage provided by their health insurance plan or a lack of insurance, ineligibility for publicly funded services, and parents' inability to personally finance treatment.

The ability to finance a child's mental health care is essential for accessing treatment. A single outpatient therapy session can cost more than $100, while it can cost up to $250,000 a year for a child to live in a residential treatment facility. (5) Private insurance, when available, often runs out relatively quickly, leaving many parents unable to afford the intensive treatment and care their children require.

While stays in residential treatment are generally limited due to the emphasis given rapid stabilization and discharge in the managed care era, residential care remains an often-needed but expensive therapeutic intervention that few insurance policies cover fully or for any extended period. Moreover, treatment costs increase for children with a serious, difficult-to-treat mental disorder or for children who have a disorder that makes them prone to criminal or destructive behavior such as drug addiction, sex offenses, fire-setting, or other violent behavior. (6) Expenses can grow to more than $1,000 a day, reflecting treatment, medication, and room and board costs. (7)

These expenses make it imperative for parents to find means of financing their child's mental health care. About 68% of the children in the United States are covered by private health insurance plans (i.e., employer sponsored or individually purchased insurance), 19% are covered by public health insurance programs (e.g., Medicaid and the State Children's Health Insurance Program (SCHIP)), and 13% have no coverage. (8)

Private sector insurance is dominated by managed care organizations (MCOs) that try to provide cost-effective health care by imposing various coverage limitations. (9) MCOs place many restrictions on mental health care coverage. High co-payments, benefit limits, and diagnostic exclusions service limitations serve as substantial barriers to needed mental health care. (10)

High co-payments increase out-of-pocket costs for parents and, particularly for parents of children with serious, long-term mental disorders, ultimately make mental health care unaffordable. …