Concerns Persist Over Child Welfare Cases Involving Mental Health

A few years ago, Jessica Marcus, a Brooklyn-based family law attorney, took on a client who was mildly mentally retarded and fighting charges that she abused and neglected her three sons. Because the woman was also depressed, her doctor gave her an anti-depressant. Initially, this pleased her case worker at the city's Administration for Children's Services, but as time passed, the case worker became frustrated with what he perceived as the mother's lack of progress. Because the caseworker didn't understand the difference between mental illness and mental retardation, he assumed that the anti-depressant would cure her of both.

It's a common misconception, within New York City's child welfare system, says Lauren Shapiro, the executive director of Brooklyn Family Defense Project, where Marcus works. "There's a total lack of understanding of the difference between the two," Shapiro says. "They're really not equipped to deal with mental health issues."

Parents who actually do have mental illness sometimes get mishandled too, Shapiro says, by a system that assumes it's impossible for them to be fit parents simply because they have a diagnosis. "We see insensitivity toward our clients, laughing at behaviors that are a result of mental health issues," Shapiro says. "What we see is that parent's conditions also really deteriorate when they come into the ACS system."

Shapiro's perception is one that is shared by several child welfare advocates and echoed by a winter 2009 Child Welfare Watch report that documented systemic problems with the child welfare system's management of mental health issues. The report found that mental health evaluations "are requested far more often than necessary, even in cases in which there is no mental health allegation."

Often the evaluations were based on a single period of observation of a parent without the children present, the report says. Because there is no standard for conducting mental health evaluations in New York City, repeated evaluations of the same person routinely yield contradictory diagnoses, the report says.

"Some players in the child welfare system confuse parents’ reactions to the trauma of having children removed with genuine mental illness," the report said."Others are unaware of how to fairly determine whether a parent with mental illness can care for her children."

A spokesperson for Family Court Mental Health Services (FCMHS), a city agency that conducts some of the mental health evaluations, says the report significantly mischaracterizes their work. Evelyn Hernandez, the spokesperson, says FCMHS does not over-diagnose people or overly rely on the diagnosis of other clinicians during its evaluations. "We make diagnoses based on independent analysis of diverse data that we obtain from our direct and intensive examination of clients as well as from collateral sources," she wrote in an e-mail.

Moreover, FCMHS evaluations are suitable for the court's purpose, she says. "They never have been intended as absolutely final, all-encompassing assessments –they are limited to addressing specific legal issues, at specific points in court proceedings, and to act as guides, not mandates, to the Court in determining next steps in the legal process, including the ordering of additional psychosocial assessments and treatments by other providers."

Since the publication of the Child Welfare Watch report, there have been signs of progress within FCMHS (which Hernandez says weren't inspired by the report) and within ACS. FCMHS now offers evaluations earlier in the child welfare case, allowing some parents to use it to demonstrate fitness, Hernandez says. Evaluations now incorporate more sources of information, including contact with treatment providers and relatives and parent-child observations, she says.