Depending on jurisdiction, time period studied, and specifics of the population, approximately 50 percent of mothers who suffer from schizophrenia lose custody of their children. The aim of this paper is to recommend interventions aimed at preventing unnecessary custody loss. This paper reviews the social work, nursing, psychology, psychiatry, and law literature on mental illness and custody loss, 2000–2011. Recommendations to mothers are to (a) ensure family health (b) prevent psychotic relapse, (c) prepare in advance for crisis, (d) document daily parenting activities, (e) take advantage of available parenting resources, and f) become knowledgeable about legal issues that pertain to mental health and custody. From a policy perspective, child protection and adult mental health agencies need to dissolve administrative barriers and collaborate. Access to appropriate services will help mothers with schizophrenia to care appropriately for their children and allow these children to grow and develop within their family and community. 1. Intervention to Prevent Child Custody Loss in Mothers with Schizophrenia A psychotic illness can, but does not need to, interfere with an individual’s ability to be a good parent. Given well-timed, appropriate, and adequate education and resources, many individuals with psychotic illness succeed in parenting their children. This is not always recognized by child welfare workers who may continue to be influenced by outdated views of psychotic illness as intractable and parenting with schizophrenia as impossible [1]. Without effective intervention, parents who suffer from psychotic illness too often lose custody of their children [2], an unfortunate outcome that can be avoided by early intervention [3–5]. The emphasis in this clinical review is on mothers with a diagnosis of schizophrenia (because there is very little literature on fathers and effects on children merit a separate paper). 2. Method This paper used the following grouped search terms in Google Scholar (which includes MEDLINE, EMBASE, PsycINFO, and SOCINDEX, as well as the nursing and legal literature) for the years 2000–2011: schizophrenia/diagnosis/custody; schizophrenia/impact/custody; schizophrenia/postpartum/custody; schizophrenia/termination parental rights. Following the literature review and case illustrations (from which identifying facts have been removed), recommendations are made for mothers, care providers, and policy makers. 3. Prevalence of Custody Loss in Mothers with Psychosis Studying reports published in the last ten years, it appears that
References
[1]
S. E. Mason and R. Miller, “Stigma and schizophrenia: directions in student training,” Journal of Teaching in Social Work, vol. 26, no. 1-2, pp. 73–91, 2006.
[2]
C. Mason, S. Subedi, and R. B. Davis, “Clients with mental illness and their children: Iimplications for clinical practice,” Issues in Mental Health Nursing, vol. 28, no. 10, pp. 1105–1123, 2007.
[3]
A. Reupert and D. Maybery, “Programmes for parents with a mental illness,” Journal of Psychiatric and Mental Health Nursing, vol. 18, pp. 257–264, 2011.
[4]
C. A. Clark, P. R. Smith, and P. Smith, “Promoting collaborative practice for children of parents with mental illness and their families,” Psychiatric Rehabilitation Journal, vol. 33, no. 2, pp. 95–97, 2009.
[5]
B. R. Hinden, K. Biebel, J. Nicholson, A. Henry, and J. Katz-Leavy, “A survey of programs for parents with mental illness and their families: identifying common elements to build the evidence base,” Journal of Behavioral Health Services and Research, vol. 33, no. 1, pp. 21–38, 2006.
[6]
R. Gewurtz, T. Krupa, S. Eastabrook, and S. Horgan, “Prevalence and characteristics of parenting among people served by assertive community treatment,” Psychiatric Rehabilitation Journal, vol. 28, no. 1, pp. 63–65, 2004.
[7]
L. M. Howard, R. Kumar, and G. Thornicroft, “Psychosocial characteristics and needs of mothers with psychotic disorders,” British Journal of Psychiatry, vol. 178, pp. 427–432, 2001.
[8]
L. D. Hollingsworth, “Child custody loss among women with persistent severe mental illness,” Social Work Research, vol. 28, no. 4, pp. 199–209, 2004.
[9]
H. Dipple, S. Smith, H. Andrews, and B. Evans, “The experience of motherhood in women with severe and enduring mental illness,” Social Psychiatry and Psychiatric Epidemiology, vol. 37, no. 7, pp. 336–340, 2002.
[10]
I. Savvidou, V. P. Bozikas, S. Hatzigeleki, and A. Karavatos, “Narratives about their children by mothers hospitalized on a psychiatric unit,” Family Process, vol. 42, no. 3, pp. 391–402, 2003.
[11]
B. J. Ackerson, “Parents with serious and persistent mental illness: Issues in assessment and services,” Social Work, vol. 48, no. 2, pp. 187–195, 2003.
[12]
A. Diaz-Caneja and S. Johnson, “The views and experiences of severely mentally ill mothers—a qualitative study,” Social Psychiatry and Psychiatric Epidemiology, vol. 39, no. 6, pp. 472–482, 2004.
[13]
R. G. Sands, N. Koppelman, and P. Solomon, “Maternal custody status and living arrangements of children of women with severe mental illness,” Health and Social Work, vol. 29, no. 4, pp. 317–325, 2004.
[14]
N. R. Matevosyan, “Pregnancy and postpartum specifics in women with schizophrenia: a meta-study,” Archives of Gynecology and Obstetrics, vol. 283, no. 2, pp. 141–147, 2011.
[15]
S. N. Vigod and L. E. Ross, “Epidemiology of psychotic symptoms during pregnancy and postpartum in women with schizophrenia,” Current Women's Health Reviews, vol. 6, no. 1, pp. 17–21, 2010.
[16]
M. Lagan, K. Knights, J. Barton, and P. M. Boyce, “Advocacy for mothers with psychiatric illness: a clinical perspective,” International Journal of Mental Health Nursing, vol. 18, no. 1, pp. 53–61, 2009.
[17]
A. Monds-Watson, R. Manktelow, and M. McColgan, “Social work with children when parents have mental health difficulties: acknowledging vulnerability and maintaining the ‘rights of the child’,” Child Care in Practice, vol. 16, no. 1, pp. 35–55, 2010.
[18]
I. Brockington, P. Chandra, H. Dubowitz, et al., “WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders,” World Psychiatry, vol. 10, pp. 1–10, 2011.
[19]
R. Kuersten-Hogan, C. Benjet, and S. T. Azar, “Evaluating the parental fitness of psychiatrically diagnosed individuals: advocating a functional-contextual analysis of parenting,” Journal of Family Psychology, vol. 17, no. 2, pp. 238–251, 2003.
[20]
M. V. Seeman, “Cross-cultural evaluation of maternal competence in a culturally diverse society,” American Journal of Psychiatry, vol. 165, no. 5, pp. 565–568, 2008.
[21]
G. Llewellyn, D. McConnell, and L. Ferronato, “Prevalence and outcomes for parents with disabilities and their children in an Australian court sample,” Child Abuse and Neglect, vol. 27, no. 3, pp. 235–251, 2003.
[22]
S. Strega, C. Fleet, L. Brown, L. Dominelli, M. Callahan, and C. Walmsley, “Connecting father absence and mother blame in child welfare policies and practice,” Children & Youth Services Review, vol. 30, no. 7, pp. 705–716, 2008.
[23]
D. Jones, R. L. Macias, P. B. Gold, P. Barreira, and W. Fisher, “When parents with severe mental illness lose contact with their children: are psychiatric symptoms or substance use to blame?” Journal of Loss and Trauma, vol. 13, no. 4, pp. 261–287, 2008.
[24]
L. Lewin and A. Abdrbo, “Mothers with self-reported axis I diagnoses and child protection,” Archives of Psychiatric Nursing, vol. 23, no. 3, pp. 200–209, 2009.
[25]
L. B. Kundra and L. B. Alexander, “Termination of parental rights proceedings: legal considerations and practical strategies for parents with psychiatric disabilities and the practitioners who serve them,” Psychiatric Rehabilitation Journal, vol. 33, no. 2, pp. 142–149, 2009.
[26]
A. Busch and A. D. Redlich, “Patients' perception of possible child custody or visitation loss for nonadherence to psychiatric treatment,” Psychiatric Services, vol. 58, no. 7, pp. 999–1002, 2007.
[27]
J. Monahan, A. D. Redlich, J. Swanson et al., “Use of leverage to improve adherence to psychiatric treatment in the community,” Psychiatric Services, vol. 56, no. 1, pp. 37–44, 2005.
[28]
J. Nicholson, “Use of child custody as leverage to improve treatment adherence,” Psychiatric Services, vol. 56, no. 3, pp. 357–358, 2005.
[29]
S. K. Kahng, D. Oyserman, D. Bybee, and C. Mowbray, “Mothers with serious mental illness: when symptoms decline does parenting improve?” Journal of Family Psychology, vol. 22, no. 1, pp. 162–166, 2008.
[30]
M. W. Wan, S. Moulton, and K. M. Abel, “A review of mother-child relational interventions and their usefulness for mothers with schizophrenia,” Archives of Women's Mental Health, vol. 11, no. 3, pp. 171–179, 2008.
[31]
A. E. Reupert, K. T. Green, and D. J. Maybery, “Care plans for families affected by parental mental illness,” Families in Society, vol. 89, no. 1, pp. 39–43, 2008.
[32]
E. A. Craig, “Parenting programs for women with mental illness who have young children: a review,” Australian and New Zealand Journal of Psychiatry, vol. 38, no. 11-12, pp. 923–928, 2004.
[33]
M. V. Seeman, “Parenting issues in mothers with schizophrenia,” Current Women's Health Reviews, vol. 6, no. 1, pp. 51–57, 2010.
[34]
P. D. Zeanah, J. A. Larrieu, N. W. Boris, and G. A. Nagle, “Nurse home visiting: perspectives from nurses,” Infant Mental Health Journal, vol. 27, no. 1, pp. 41–54, 2006.
[35]
R. A. P. van der Zanden, P. A. M. Speetjens, K. S. E. Arntz, and S. A. Onrust, “Online group course for parents with mental illness: development and pilot study,” Journal of Medical Internet Research, vol. 12, no. 5, article e50, 2010.
[36]
A. Reupert and D. Maybery, “Families affected by parental mental illness: a multiperspective account of issues and interventions,” American Journal of Orthopsychiatry, vol. 77, no. 3, pp. 362–369, 2007.
[37]
M. Han, S. Carnochan, and M. J. Austin, “The challenges to promoting collaboration between child protection services workers and court professionals: an exploratory study of case records,” Journal of Public Child Welfare, vol. 1, no. 3, pp. 115–131, 2007.
[38]
Y. Darlington, J. A. Feeney, and K. Rixon, “Practice challenges at the intersection of child protection and mental health,” Child and Family Social Work, vol. 10, no. 3, pp. 239–247, 2005.
[39]
M. L. Kessler and B. J. Ackerson, “Wraparound services: an effective intervention for families impacted by severe mental illness,” Journal of Family Social Work, vol. 8, no. 4, pp. 29–45, 2005.
[40]
N. C. Winters and W. P. Metz, “The wraparound approach in systems of care,” Psychiatric Clinics of North America, vol. 32, no. 1, pp. 135–151, 2009.
[41]
E. J. Bruns and J. S. Walker, “Defining practice: flexibility, legitimacy, and the nature of systems of care and wraparound,” Evaluation and Program Planning, vol. 33, no. 1, pp. 45–48, 2010.
[42]
S. Hodges, K. Ferreira, N. Israel, and J. Mazza, “Systems of care, featherless bipeds, and the measure of all things,” Evaluation and Program Planning, vol. 33, no. 1, pp. 4–10, 2010.
[43]
J. Cook and P. Steigman, “Experiences of parents with mental illnesses and their services needs,” Journal of National Association for the Mentally (NAMI) California, vol. 11, no. 2, pp. 21–23, 2000.
[44]
L. Weinreb, J. Nicholson, V. Williams, and F. Anthes, “Integrating behavioral health services for homeless mothers and children in primary care,” American Journal of Orthopsychiatry, vol. 77, no. 1, pp. 142–152, 2007.
