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The New York Times

Thousands of parents have given up custody of their children under pressure from states in order to obtain treatment for the children’s severe mental illnesses, federal investigators say, but some states have not lived up to their end of the deal.

Federal officials said they had found deplorable conditions in many state institutions where children were supposed to receive treatment.

For example, investigators from the civil rights division of the Justice Department recently found “significant and wide-ranging deficiencies in patient care” at Metropolitan State Hospital in Norwalk, Calif., near Los Angeles. The hospital provides patients ages 11 to 17 with “woefully inadequate” treatment and unnecessary medications, exposing them “to a significant risk of harm and to actual harm,” the department said.

Nora A. Romero, a spokeswoman for the California Department of Mental Health, said the state disagreed with some of the findings but was taking steps to improve care.

The Justice Department also said children with mental disorders had been subjected to “unhealthy, inhumane and unlawful” conditions at two state training schools in Mississippi. Federal officials said children with mental disorders were not even supposed to be at the schools, Columbia and Oakley.

The Mississippi Department of Human Services said it would work with the state’s Department of Mental Health to provide “alternative placement” for children found to be mentally ill at the schools.

In a survey of state and local officials, the General Accounting Office (news – web sites), an investigative arm of Congress, found that parents had placed more than 12,700 children in the child welfare or juvenile justice systems so the children could receive mental health services.

But those figures came from just 19 states, so the nationwide number was probably much higher, said Cornelia M. Ashby of the accounting office. The other 31 states did not respond to the survey or could not provide any data, Ms. Ashby said.

In desperation, parents say, they have sent their children to foster homes, state mental hospitals, juvenile jails and other institutions where the children were supposed to receive treatment.

Cynthia Yonan of Glendale Heights, Ill., said local health officials “directed me to turn my twin sons over to the state to secure treatment” for bipolar disorder and other mental health problems.

Patricia Cooper of Fayetteville, Ark., said state officials had suggested that she give up custody of her 12-year-old son so he could get mental health care that was not available under her insurance policy.

Senator Susan Collins, Republican of Maine, said, “Custody relinquishment is a symptom of a much larger problem: the lack of available, affordable mental health services for these children and their families.”

Representative Pete Stark of California, the senior Democrat on the Ways and Means Subcommittee on Health, said he and Ms. Collins were drafting legislation to halt “this barbaric practice.”

The bill would offer $55 million in federal grants to states to improve services for mentally ill children, so parents would not have to give up custody.

Many states, facing the worst budget problems since World War II, have cut Medicaid and mental health programs in the last two years. Medicaid finances the care of many mentally ill children in state custody.

A federal advisory commission appointed by President Bush (news – web sites) recently reported that the nation’s mental health system was “in shambles.” The 22-member panel, the President’s New Freedom Commission on Mental Health, expressed alarm at the practice of trading custody for care.

“When parents cede their rights in order to place their children in foster care or in a program for delinquent youth, they may also be inadvertently placing their children at risk for abuse or neglect,” the commission said.

The commission said that 5 percent to 9 percent of all children in the United States at least four million had serious emotional disturbances. A survey by the National Alliance for the Mentally Ill, an advocacy group, found that parents give up custody to get care for about one-fifth of such children.

When states take custody of children, they are generally required to provide medical care, including mental health services.

“Foster parents can get mental health services that the biological parents could not get for their children,” said Tammy Seltzer, who has represented children as a lawyer at the Bazelon Center for Mental Health Law in Washington.

Theresa A. Brown of Westbrook, Me., said she had been told by state officials that her daughter, Heather, “would have to be in state custody in order for her to get treatment for her behavioral and emotional problems.”

Since giving up custody, Ms. Brown said, “I’m no longer treated like a parent.” She said she was generally not consulted about her daughter’s treatment and had only limited visiting privileges.

Peter E. Walsh, acting commissioner of the Maine Department of Human Services, said “we want to try to help” Ms. Brown. Part of the problem, he said, is that “the federal government has never put up any real money for children’s mental health services.” Maine, he said, is trying to provide more services to children at home, so they can stay with their families.

The accounting office said even parents with private health insurance had difficulty paying for treatment of children with severe mental disorders. “One outpatient therapy session can cost more than $100,” Ms. Ashby said, “and residential treatment facilities, which provide 24 hours of care seven days a week, can cost $250,000 a year or more.”

Private insurance plans usually set stricter limits on mental health care than on treatment for physical illnesses like diabetes and cancer.

Congress is considering legislation that would require insurers to cover mental illness in the same way they cover a physical illness. But insurers and employers have resisted the proposal, saying it would increase costs.

Fourteen states have laws that prohibit child welfare officials from insisting that parents surrender custody to get mental health services for their children.

But such laws, by themselves, do not increase the supply of mental health services. In some of those states, officials said, they can still suggest that parents voluntarily give up custody.

The National Mental Health Association, an advocacy group in Alexandria, Va., says 29 states have cut spending on mental health care in the last year.

In Texas, mental health benefits in Medicaid and the Children’s Health Insurance Program have been significantly reduced. Michael M. Faenza, president of the National Mental Health Association, said the Texas cuts would “virtually eliminate mental health benefits” under the Children’s Health Insurance Program.

Ms. Seltzer said that if states provided more community mental health services, parents would not have to relinquish custody and states could save money.

Experience in New York, Vermont and Kansas shows that community care at home, in school and at community mental health centers costs about half as much as care provided in hospitals and other institutions, Ms. Seltzer said.

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