Janis Adams, an electric company employee in Waynesville, Mo., knows her local mental-health system well. Her sib Caleb Quesenberry, who has been diagnosed with bipolar disorder, has been in and out of hospitals for a decade. Caleb, know 14, would routinely visit the hospital for a week or so, be stabilized and then go home. But in the fall of 2001, after he grabbed two knives and threatened to kill himself and his mother when she asked him not to watch a cartoon, Adams realized that Caleb needed more intensive care. She contacted residential treatment centers in her area, but administrators told her that Medicaid insurance would not cover the services she needed. The only way they could take Caleb, they said, would be to persuade the state to fund his treatment. And to do that, Adams would have to relinquish custody of her son to the state's child welfare system. "I didn't want to give him up to get him the help he needed, but I couldn't protect him from himself," Adams says. "I had to do something, and as awful as it is, this was the only thing I could do." Adams is not the only parent who has been forced to make this wrenching choice. Though the exact number of children affected is unknown, scores of families in at least 26 states have had to cede legal guardianship-that is, give up the authority to make decisions concerning their child's residence and care-in order to qualify for services. This often involves removal from the home, either to a facility or to the custody of a trained foster family where the child receives intensive care somewhere in the community. Child advocates estimate that 1 in 5 families with mentally ill children in the U.S. has surrendered custody in exchange for treatment of a child with bipolar or other disorder, including ADHD, schizophrenia or depression.

"Custody relinquishment has been a well-kept secret to the public, but

(Continued on page 2)