First step: a promise kept

January 26, 2003

ROBERT L. Ehrlich Jr. kept his word to Jan Yocum deCalderon. In his second day on the job, Governor Ehrlich signed an executive order aimed at easing the burden of parents, like Ms. deCalderon, who reluctantly relinquish custody of their mentally ill sons and daughters to the state to ensure that they will receive the treatment they need.

While campaigning for governor, Mr. Ehrlich made a promise to help parents who face that cruel choice - and he made good on that promise. The executive order addresses a complex problem that pits desperate families against health care providers, insurance companies and bureaucrats in an overburdened and underfunded system.

But it's only a first step. The order establishes a council that will explore the issue of forced relinquishment of custody and present recommendations to the governor by September. It also requires Maryland social service agencies to appoint a staffer to manage the cases of children forced into state care because of their mental illness.

For too long, state agencies have studied this problem with little to show for it. If Mr. Ehrlich's action signals his intention to marshal the power of his office toward resolving this problem, then he will have done more than fulfill a campaign pledge.

More than 200 parents a year make the untenable choice of relinquishing custody of their children to get them treatment, according to a 2002 survey by the Maryland Coalition of Families for Children's Mental Health. Parents do so primarily because they have neither the ability nor the means to care for their children without help.

These children, who suffer from severe and chronic mental illnesses, can pose a threat to themselves or others. Often they require lengthy stays in psychiatric hospitals or residential treatment centers that insurance companies won't pay for. But once they become wards of the state, their treatment isn't contingent on a parent's ability to pay or the terms of an insurance policy - state and federal funds pay the tab.

For parents, the price of giving up their children can't be measured in dollars and cents. Some parents are accused of dumping their children. Their children alternately feel abandoned and neglected.

This issue is not Maryland's alone. States across the country are grappling with how best to serve children with severe mental illnesses. In an effort to keep children with their families, Kansas, New York and Vermont, for example, sought permission to use federal Medicaid funds to pay for home- and community-based services.

In Maryland, advocates are returning to Annapolis this year with a legislative package that they contend would expand the pool of federal dollars available to treat those children and remove the stigma borne by their parents.

One bill is modeled after a Missouri law that allows judges to order the state to provide mental health services to kids without requiring families to give up custody.

Another would seek federal reimbursement for the therapy provided to these children in out-of-home facilities, a practice in place in 20 states.

The governor deserves time to study this issue and to rely on the advice of experts to address the problem. But that doesn't absolve his administration from the obligation to actively support the proposals in the General Assembly.

Given the state's fiscal crisis, it's clear that finding ways to gain additional federal dollars should be a priority, especially since state fiscal analysts estimate that more than $10 million could be recouped. Tapping those resources would go a long way toward helping Maryland families, as the governor put it, "in a meaningful way."

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