The very idea upset Robert Cohen so much he decided to write a novel about it. He's calling it "Hammond's Choice."
The title refers to "Sophie's Choice," the 1982 movie in which Meryl Streep's character must choose which of her children to give up to the Nazis an impossible decision. Cohen addresses another anguishing, though less extreme, choice some parents in Virginia face today.
In his book, Ruth and Larry Hammond's emotionally disturbed son, Tommy, has become too violent to live at home. Parents, doctors and social workers all agree Tommy needs to go to a residential psychiatric facility to get better, but the cost soars to nearly $200,000 far too high for the Hammonds, who have nearly depleted their savings looking for other solutions. Insurance won't cover it, either.
After another dead-end treatment meeting, a grizzled old social worker corners the Hammonds and tells them there is another option, but it comes at a very high price: The state will pay for Tommy to live at a psychiatric hospital, but to access those funds, the family must surrender their custody of him to the state.
The Hammonds' story, yet to be published, ends 300 pages later. But for many Virginia families, the ordeal continues in real life.
Cohen encounters the situation at his job as vice chair of Virginia Commonwealth University's department of psychiatry. He says he wrote the book as a way to raise awareness about the issue.
As recently as last week, state officials seemed to be pushing for change. Gov. Tim Kaine announced that $750,000 in state money would be allocated to programs helping troubled youth in their homes, before residential care is necessary. The largest portion $196,691 is earmarked for Richmond.
Also in December, Attorney General Bob McDonnell released an advisory opinion that forcing parents who are not negligent or abusive to give up their children for state-funded care infringes on their constitutional rights, and that "it is inconceivable that the best way to provide such services to a child and his family is by an interpretation that tears the family asunder."
It's difficult to say how many families are in such a position. When parents relinquish custody, their children become wards of the state, a process that routes them through the Department of Social Services (DSS), the same agency that handles foster care. It's estimated that 8 to 25 percent of the children in the foster care system enter the program under these circumstances. (An agency spokesperson says the system for tracking those specific cases won't be operational until December 2007.)
But families and state officials say no matter what the number is, it's too high. The thrust of McDonnell's opinion is that local DSS offices may use their funds to provide residential treatment for children without requiring parents to give up custody.
"This has been part of the bread and butter of what I've really wanted to have happen for years," says Trudy Ellis, a mother who became actively involved in the issue when she narrowly avoided having to relinquish custody of her son in order to secure the psychiatric care he needed. Still, she's cautiously optimistic.
"There are at least 23 things that are still going to need to happen," she says, "but one thing is that there be some court cases that make rulings based upon the [attorney general's] recommendations. That would move us away from using custodial relinquishment and still get the child services."
The kind of case Ellis hoped would set precedent involving a Roanoke family seeking to regain custody of their daughter came a week after the attorney general's opinion was released Dec. 6.Three years ago the daughter had begun cutting herself and threatening to commit suicide. After four hospital visits in as many months, her family and doctors decided residential treatment was the only choice, and giving up custody was the only way the family could pay for the treatment.
Late last year, administrators determined she was well enough to leave the program. The local DSS agreed the daughter could live at home, but declined to immediately restore legal custody to the parents. The judge at the December hearing ruled custody would remain with the state.
Others in the mental-health community share Ellis' assessment that the attorney general's opinion is an encouraging sign of moral support, but it will need to be buttressed by further policy changes and funding commitments before it becomes a reality.
"While this opinion is a wonderful thing, it does not create new funding for children, nor new services, nor does it train any new people to work with those kids. Those are things we really need to change," says Brian Meyer, executive director of the Virginia Treatment Center for Children and chairman of the panel responsible for making recommendations to the legislature about state aid for children's mental health.
Meyer echoes the sentiment of mental-health professionals who say providing lower-level services to children early on, such as day programs and counseling, helps stem larger problems that make it unsafe for the child to live at home. That, in turn, keeps children out of residential care and saves the state money. (The grants announced by Kaine will go to those lower-level services.)
It can cost about $1,000 for a child to spend a single day in a psychiatric hospital. A state review of Virginia's residential services released Dec. 11 determined that in 2005 it cost the state $2,200 to help a child in his own home for a year, compared with $22,907 in a group home and $43,775 in a psychiatric facility.
The report also contains troubling news about the security of such state-run residential facilities, citing 12 incidents in the past five years in which children living in them died of "unnatural causes." It concludes that "Virginia's regulatory environment does not appear to adequately protect the health and safety of children" in residential facilities, and it encourages state licensing bureaus and regulatory bodies to address the problem.
The study also underscores the importance of streamlined care. Families who relinquish custody for care go through the Office of Comprehensive Services, whose staffers are supposed to help navigate the bureaucracy, customize a program for the child using resources from various agencies and keep the child near his home. The study reports that when a coordinator from the office is involved, expenditures drop $14,000 per child, and children average 14 fewer days in residential care annually.
Activists say the General Assembly should address funding this session in order to make further progress. Delegate Bill Fralin (R-Roanoke), who requested the opinion from McDonnell, hopes to put $3.8 million in the state budget, an amount he estimates would pay for a year of residential service for 200 troubled children and youth. S