Maternal Custody Status and Living Arrangements of Children of Women with Severe Mental Illness

Historically, psychiatric treatment of women patients in public hospitals was consistent with Test and Berlin's (1981) assertion that mental health professionals tend to regard individuals with severe or serious mental illness (SMI) as "almost genderless" (p. 136). Hospital administrators and staff denied or ignored the sexuality of the women patients and quietly managed the births of forbidden children by placing them in foster homes or arranging for their adoption (Apfel & Handel, 1993; Sands, 1995). The transformation of mental health care delivery from public psychiatric hospitals to community-based services and advancements in psychopharmacology, have increased opportunities for women with SMI to pursue normal life developmental tasks such as sexual relationships, childbirth, and parenthood (Miller, 1997; Nicholson & Blanch, 1994; Oyserman, Mowbray, & Zemencuk, 1994). In fact, fertility rates for women with a severe mental illness are estimated to equal those of women in the general population (Apfel & Handel, 1993; Miller; Nimgaonkar, Ward, Agarde, Weston, & Ganguli, 1997; Saugstad, 1989). The changing times challenge social work practitioners to increase their understanding of women with SMI who are parents. This article, based on data from a pilot study of 20 women with SMI who have at least one biological minor child, aspires to contribute to knowledge about patterns of care for the offspring of SMI mothers. Echoing earlier strains of ignorance and denial about the sexuality of women with a persistent mental disability, today's mothers with SMI frequently receive little or no support from community mental health providers for pregnancy, postpartum, and parenting concerns (Mowbray, Oyserman, Zemencuk, & Ross, 1995; Oyserman et al., 1994). This lack of assistance is crucial because mothers with SMI are also likely to be single parents, to experience poverty, and to be victimized (Lam & Rosenheck, 1998; Mowbray et al., 2000; Mowbray, Oyserman, & Ross, 1995; Oyserman et al.). Given that the psychiatric community has been late in incorporating parenting as a mental health issue, the welfare system has been the default social services resource for mothers with SMI and their children when a crisis occurs. (Blanch, Nicholson, & Purcell, 1994; Nicholson & Blanch, 1994; Nicholson, Geller, & Fisher, 1996). Thus, the children of mothers with SMI often enter emergency foster placements when a psychiatric episode requires the mother's hospitalization or when there are suspicions of child neglect or abuse (Blanch et al.; Nicholson et al., 1996). Because of this breach in mental health services, women with SMI frequently lose custody of, and in some cases all contact with, some or all of their children (Nicholson, Geller, Fisher, & Dion, 1993; Nicholson et al., 1996). This pattern commands even more attention from social workers because of nationwide changes in child welfare administration ushered in by the Adoption and Safe Families Act of 1997 (P.L. 105-89). By mandating that states exert greater efforts on adoption for children in foster placement, this law, in many cases, would expedite the filing of actions to terminate parental rights (Minuchin, Colapinto, & Minuchin, 1998). As the research discussed in this article demonstrates, children of mothers with SMI, like other children, live in a wide range of settings. The indepth mapping of the 20 separate families about which this article reports offers a vivid illustration of the complexity of the family constellations and suggests important implications for social work practice with mothers with SMI. The increasing recognition of the needs and challenges of mothers with SMI and the context created by changes in the child welfare laws suggest that practitioners working with women with SMI, their children, or caregivers for the children could benefit from a better understanding of the size and shape of these families. …