Parenting With a Serious Mental Illness: What Clinicians Need to Know

As I deteriorated with my mental health over a couple of years when my daughter was 2 and 3 years old, I was in constant therapy, sometimes twice a week with intermittent phone calls. Yet, I was not getting any parenting advice, even though I was clearly struggling. First, I was never warned I may have some issues with parenting because of my mental illness. Then, when I started having issues, I was afraid to share them with my therapist because I feared losing my child to state custody.

One day in therapy, I made a statement that made my therapist fear for the safety of my child. She said I must call Department of Family and Children’s Services (DFACS) right then or she was going to call and file a complaint. This totally freaked me out. Did she not understand I could really lose my child to the state? She made me call in front of her. The hotline let you leave a message, I did. I told my therapist I would find somewhere else for my daughter to stay for a while, while I worked with DFACS.

I called a friend and had my daughter stay with her, and I waited for my phone to ring to see what the fate would be for me and my daughter. The call never came, so I called again and left a message. Over the course of a week, I made three calls to no avail. I called my therapist several times to no avail. I was so scared my therapist was going to file a complaint and this was going to end much worse for me.

A week had passed, and I sat down again with my therapist. I asked her why she had not called me back. She stated she did not know what to say to me. She had not had a patient respond like I did to her fears about their child. I told her to never leave me hanging again. Even if she had nothing to say, say that.

We moved on from reporting me to DFACS. I brought my daughter home, and I went on parenting as sick as I was. I never got guidance on how to care from her while I was struggling. I was just told early on I could never raise her in my condition, and she should be put with another family.

In my experience, clinicians are not taught how to help their patients parent in school. They draw on their own experience as a parent or take continuing education classes if they are interested in the specialty. But typically, a trauma therapist is not an expert and can do more harm than good trying to help their parenting client. I could have used help instead of threats. Brainstorming how I could get that help and support to make that happen. I could still have my child today if my treatment team had done their job.

My therapist and psychiatrist were not prepared to help me parent with a serious mental illness (SMI). The American Psychological Association is just now taking up this issue and will soon issue guidance to their clinicians. You can find a draft here by Lauren Mizock, et. al.

Historically, parenting by women with SMI has been seen as a bad idea and should not be pursued, and the Supreme Court so much as said so. The U.S. Supreme Court voted 8–1 in 1927 that compulsory sterilization of individuals held in asylums was constitutional. In medical journalist Rob Whitaker’s book “Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill,” he reports that by 1945, over 21,300 individuals in mental hospitals had undergone such sterilization procedures, with another 4,000 sterilized in the 1950s. Such practices, which were sanctioned by the majority of the American public in the 1930s, made it physically impossible for women with SMI to have children.

There are additional challenges for mothers with SMI such as:

• Single parenthood
• Unemployment and poverty
• Homelessness
• Substance abuse
• Risk of abuse/neglect & custody issues
• Battles with family members for guardianship

The needs of mothers with SMI are great, and include:

• Help preventing and coping with custody issues
• Maintaining relationships
• Balancing discipline and affection
• Managing pregnancy and mental health effects
• Looking through a biomedical vs. sociocultural lens
• Supported parenting  (mothers and fathers/co-partners)

“Custody loss rates for parents with mental illness range as high as 70-80 percent, and a higher proportion of parents with serious mental illnesses lose custody of their children than parents without mental illness.” This is not right and these parents’ rights are being violated and there is little attention to this matter.

The following efforts by advocates as maintained by Mental Health America can help families living with mental illness maintain custody and stay intact:

1. Legal assistance and information would help parents know their rights and protect them.

2. Safety planning could be done and self-care plans drawn up to help parents improve their parenting and get the support they need if their plan is not working out.

3. Keep the child in contact with the parent even if that parent is hospitalized. That kind of connection must be maintained for the health of the parent and the child.

4. Better training of DFACS on parenting with a mental illness and how to protect the rights of these parents. The go-to plan should not be removal. If removal is warranted, contact should be maintained for the health of the parent and the child. There are options other than total severance of contact to protect the child.

5. The legal system is lacking in knowledge about mental health and how it affects parenting and that there is a way to successfully raise a child, even with SMI.

6. Advocating for increased specialized services should be foremost, so clinicians, DFACS workers, and attorneys can all work in the highest interest of the family.

In the end, we must do better by parents with SMI. What my clinician did not know about parenting with SMI hurt me and risked my family being separated. There is now more awareness about parenting with a mental illness, but stigma is still prevalent, even in the therapeutic and social services environments. More needs to be done to educate these service providers to protect children and their parents. The most important issue is child safety. Helping a parent with SMI achieve stability will lead to child safety and the maintenance of the family unit which should be in the forefront of everyone’s mind. Preservation of the family is key however that needs to happen.

I would have benefitted from my therapist knowing more about parenting with SMI. I may have been able to maintain rights as it relates to my child or a least have made sure I had access to her after the adoption. Clinicians should get educated. The profession must do better. Children’s lives are depending on it.

It is important you find a clinician who can help you navigate parenting with a SMI. Without this help, there can be dire consequences. Read my story here and learn more about what I recommend for people with SMI, clinicians, and loved ones.

You are a Mighty parent, you can do this.