Social psychopathy,social distress,family breakdown,and custody disputes in the 1990s: Implications for mental health professionals

The decade of the 1990s will probably contain more challenges to the role of the mental health practitioner in child custody cases than ever before in history. Because of increasing social stress and family disintegration, custody disputes are destined to become more frequent, bitter, and traumatic for all parties. Mental health professionals, in particular, need to develop a coherent structure regarding their own participation in this process. Issues of moral changes among our leadership and our citizenry are examined and guidelines for the behavior of the mental health practitioner in the courtroom are formulated and illustrated as they pertain to custody decisions. Particular attention is paid to custody decisions as an art rather than a science, the role of empirical research, the need to anticipate certain unintended circumstances, the need for the application of mental health principles on an individual case-by-case basis, the nature of the mental health professional's expertise, and the problems with the concepts of parental unfitness and the use of psychiatric diagnosis as a way of defining such alleged unfitness.     

Risk,Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination, and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. Therefore it is argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery-based approaches, which promote supported decision-making and inclusion; and the assessment of a person's ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.     

Child custody placement outcomes for mothers

Internationally there is a broad literature on risks for child custody placements. In contrast, very little is known about their outcomes on parents. The topic is relevant not only for parents themselves but also for children placed outside their homes, as many children keep contact with their birth parents or return to live with them. In a retrospective cohort study setting we analyze child custody placement outcomes (social assistance receipt, unemployment and work disability) for mothers whose children had been taken into custody between 1997 and 2004 in Finland. Data from a child placement register were merged with several administrative social insurance registers. Comparison groups of population mothers are included in the study. The procedure yielded an internationally unique database. According to the results of our study, mothers whose children are taken into custody are more often unemployed and in need of social assistance than mothers in the comparison group. Furthermore, they are also more often on a disability pension, due to mental health problems in particular, than mothers in general. While considering the results, we examine family policy and general welfare policy implications of support to families whose children have been taken into custody.     

Practice Guidelines In Child Custody Evaluations for Licensed Clinical Social Workers

Child custody evaluations and decisions are often complicated and emotionally charged. The following guidelines are offered as a framework for clinical social workers who are asked by the judicial system to undertake these evaluations. The historical background of child custody and the theoretical considerations that have guided the courts are reviewed. The traditional areas of consideration and the empirical data related to these areas are examined. The guidelines present pertinent information regarding ethical considerations, parent–child relationship, parenting style, gender issues, parental conflict, parental alienation, domestic violence, race, religion, sexual preferences, geography, parental psychopathology, substance abuse, child’s preference, physical health of the child, and behavioral health of the child. A format for the evaluation process is described and includes the role of the clinician, confidentiality, fees, and review of documents, interviewing, home visits, psychological testing, and the actual written report. Making recommendations to the court regarding child custody is an area of practice that clinical social workers encounter in ever-increasing numbers. Clinical social workers are called upon to give recommendations regarding child custody in neglect or abuse cases, in termination of parental rights proceedings, and in the area divorce and of guardianship. In an effort to provide clinicians with scientifically grounded parameters for rendering these recommendations, the following guidelines are recommended. These guidelines provide a framework of scientific principles, along with established and accepted clinical practice, to enhance the practitioner’s decision making in these challenging and complicated cases. The guidelines are specifically designed for clinical social workers doing custody evaluations in cases of marital divorce and are restricted to that area of practice.     

Substantiation of Sexual Abuse Allegations

Professional practices and decision-making procedures in investigation of child sexual abuse were studied by interviewing child protection professionals in the southeastern U.S. regarding 175 allegations of abuse. Investigation procedures used, factors associated with the decision to substantiate, and the child protection workers' degree of confidence in their decisions were recorded for each allegation. It was found that substantiated cases: (a) involved significantly older children; (b) were more likely to involve intrusive types of abuse and children of minority race; and (c) were less likely to involve a visitation or custody dispute. Characteristics of the child's disclosure served as the primary basis for substantiation decisions, although medical evidence and affective and behavioral indicators also contributed to the decisions. Case workers were less certain of their decisions when allegations involved young children and adolescents and when allegations were made in the context of custody disputes. In terms of investigatory procedures, anatomical dolls and drawings were rarely used, alleged offenders were interviewed in fewer than one quarter of the cases, and medical and law enforcement consultations were obtained at a higher rate than mental health consultations.     

The Lingering Debate Over the Parental Alienation Syndrome Phenomenon

ABSTRACT

It's been more than a quarter century since the Parental Alienation Syndrome (PAS) phenomenon was first observed yet it remains a highly debated concept in the legal and mental health professions. In the years since its inception, judges have relied on PAS to make both short and long-term decisions in custody and visitation cases. Those who support PAS claim that there is scientific evidence to prove its existence, while those who oppose it suggest that it is pseudoscience and should not be relied upon in court to make binding decisions in custody and visitation cases. The critics believe that other factors must be considered in these cases and that PAS is too simple an explanation for complex behaviors seen in parents and children during custody and visitation proceedings. This paper presents both sides of the argument and suggests that the PAS debate lingers on and remains unsettled. It presents the position that there is scientific evidence to support a clinical claim that PAS is observed in some cases, and it presents the argument that not enough rigorous experimentation has been done to prove once and for all that PAS is a diagnosable phenomenon.     

An Integrated Approach to Child Custody Evaluation

This paper provides an integrated approach to child custody evaluations through utilizing the "best interests" of the child and family systems frameworks. Although these frameworks differ in their basic orientations to conceptualizing the process of evaluating child custody cases, this article proposes that each model contributes to a comprehensive understanding of the complexities related to such conditions. In addition, these two perspectives offer a basis for making differential decisions based on the unique aspects related to a particular child custody case. The underlying assumptions and theoretical orientations of both models are identified and explored. Based on a discussion comparing and contrasting the two models, this paper offers a framework for utilizing both perspectives as well as a method for selecting the most appropriate approach to employ depending on the unique aspects of a child custody case. Recognizing the significant interplay between the legal and mental health professions, the authors identify the various issues that often impede successful collaborative efforts between these professional groups. In addition, guidelines are offered that can enhance the likelihood that these professions can work more effectively together.     

No One Theory of Suicide: The Experience of a Cancer Patient Who Killed Himself

More than a million people worldwide die by suicide annually, and more than 30,000 of them in the United States. Cancer patients are two to four times more likely to die by suicide than the general population. The purpose of this article is to use the results of a phenomenological psychological autopsy to (1) illustrate the interplay of the interpersonal and intrapersonal circumstances of one colon cancer patient’s struggle and ultimate suicide, and (2) demonstrate that health and mental health practitioners need to use more than one theory of suicide to inform their assessment of risk. The findings present a telling picture of the struggles of the decedent, and the authors recommend how the results inform health and mental health practitioners’ practice, policy, and research related to suicide prevention.     

Exhausted,Stressed, and Disengaged: Does Employment Create Burnout for Social Work Students?

Although burnout is a known risk for practitioners, some social work students may experience burnout in the classroom as a result of role conflict from balancing academics with employment. Higher rates of burnout occur in other disciplines in employed students, even higher than in professionals, because of the stress of shifting priorities between workplace and collegiate responsibilities. Employment can decrease collegiate engagement and academic competence and deter persistence to degree, all of which lead to the reduced competency associated with burnout. Additionally, physical and mental health factors are associated with role conflict, leading to a higher risk of burnout for employed students and resulting in burnout for social work students in the classroom even prior to becoming a practitioner.     

THE ROLE OF THE MENTAL HEALTH PROFESSIONAL IN CONTESTED CUSTODY:

Two different roles for mental health professionals in contested custody cases are presented. The first, the evaluator of competence model, is the more traditional one; its underpinnings are individually-oriented concepts: the clinician is a diagnostician and evaluator, making a recommendation to the court, and the family's input in the decision-making is minimal. The second role, a facilitator of change, comes out of family therapy theory; its focus is on helping the family to change and resolve their issues so that custody can be decided fairly: it is evaluative only secondarily, that is, if the family is unable to resolve the dilemma themselves. When working with contested custody cases, which are really unresolved family problems, the second approach is more promising.     

Securing Children’s Best Interests While Resisting the Lure of Simple Solutions

The best-interest-of-the-child standard for child custody policy and decisions has benefits and hazards, the latter related to the exercise of judicial discretion in custody disputes. This article examines alternatives to the status quo, including the primary parent presumption, the approximation rule, shared parenting, an exact even split of custodial time, sole custody for couples labeled as in high conflict or those with young children, the friendly parent presumption, and decisions that defer to children’s stated preferences. Each alternative promises simpler paths to securing children’s welfare, but some have more support than others in the social science literature.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Legal capacity and the mental health social worker role: an international comparison

ABSTRACT

New capacity laws have been introduced to many jurisdictions over the last decade. These laws have substantially changed the way in which mental health social workers and other professionals approach decisions about, and for, clients. Most notably, there is now an expectation that mental health social workers engage more in supported decision-making to prevent the need for substitute decision-making. This article describes the legal and policy drivers that have led to these changes in practice, with a particular emphasis on the significance of the United Nations Convention on the Rights of Persons with Disabilities (the UNCRPD) and the importance of recovery approaches in mental health services. It then uses selected literature to explore the efficacy of the laws and decision-making in this area. The second part of the article identifies the role that mental health social workers can play in supporting legal capacity, drawing from the authors’ experience and knowledge of mental health social work and law in four jurisdictions: Victoria, Australia; Ontario, Canada; England and Wales; and Northern Ireland. It is concluded that mental health and other social workers need to refine skills, knowledge and values to accommodate this paradigm shift in law, policy and practice.     

Divorce,Custody, and Visitation:

This paper discusses children's perceptions of the divorce experience. Specifically, it illuminates children's perceptions of divorce, custody, and visitation. Custody and visitation arrangements have been made on the basis of what is believed to be in the best interests of the child. However, the viewpoint of the child is seldom considered in decisions concerning custody and access. Moreover, a negligible amount of empirical research has explored the child's interpretation of custody and visitation. This paper is an attempt to redress this imbalance. Findings based on in-depth interviews with 40 children and teenagers reveal a preference for the post-divorce family structure and more flexible visitation arrangements. Moreover, the feasibility of father and joint-custody is addressed.     

Bridging gaps between mind, body, & spirit. Healing the whole person.

Fifty percent of visits of primary care providers are for psychiatric problems making it desirable to screen for mental, addictive, or behavioral disorders at the level of primary care. Psychiatric/mental health nurses prepared at the master's level to practice in the blended clinical specialist/nurse practitioner role are well placed to treat or collaborate in the treatment of people who present with symptoms of physical or psychological problems. The role of the clinical specialist/nurse practitioner is evolving in response to changes in health demographics, epidemiology, scientific and technological advances, and changes in managed care. Advanced practice nursing education must continue to anticipate and meet on-going changes and challenges.     

Pop Goes the Woozle: Being Misled by Research on Child Custody and Parenting Plans

Mental health professionals, lawyers, and judges whose work involves child custody decisions are often presented with social science research on issues related to which parenting plan is in the children’s best interests. Unfortunately, this research can be misrepresented in ways that mislead these professionals and the children’s parents, leading to child custody decisions that are not the most beneficial for the children. The process of misrepresenting the research in ways that create myths and misconceptions has been referred to as woozling. This article describes how social science data can be woozled, illustrating this with examples related to parenting plans for children under the age of 5 whose parents have separated.     

Abusers gaining custody in family courts: A case series of over turned decisions

Abstract

This article presents findings and recommendations based on an in-depth examination of records from 27 custody cases from across the United States. The goal of this case series was to determine why family courts may place children with a parent that the child alleges abused them rather than with the nonoffending parent. We focused on “turned around cases” involving allegations of child abuse that were at first viewed as false and later judged to be valid. The average time a child spent in the court ordered custody of an abusive parent was 3.2?years. In all cases we uncovered the father was the abusive parent and the mother sought to protect their child. Results revealed that initially courts were highly suspicious of mothers' motives for being concerned with abuse. These mothers were often treated poorly and two-thirds of the mothers were pathologized by the court for advocating for the safety of their children. Judges who initially ordered children into custody or visitation with abusive parents relied mainly on reports by custody evaluators and guardians ad litem who mistakenly accused mothers of attempting to alienate their children from the father or having coached the child to falsely report abuse. As a result, 59% of perpetrators were given sole custody and the rest were given joint custody or unsupervised visitation. After failing to be protected in the first custody determination, 88% of children reported new incidents of abuse. The abuse often became increasingly severe and the children's mental and physical health frequently deteriorated. The main reason that cases turned around was because protective parents were able to present compelling evidence of the abuse and back the evidence up with reports by mental health professionals who had specific expertise in child abuse rather than merely custody assessment.     

Social Inclusion as an Agenda for Mental Health Social Work

Summary

Following New Labour's election to office in the UK in 1997, policy initiatives have proliferated relating to mental health. Much of this policy innovation emphasises the social dimensions of mental health and distress, with an emphasis on employment and social inclusion. Paradoxically, this modernization of the mental health agenda comes at a time when mental health social work is struggling to establish its role and contribution within recently integrated health and social services. The paper considers whether New Labour's flagship programme, Mental Health and Social Exclusion, constitutes a “New Deal” for mental health, and whether it provides a perspective that will help mental health social work to define its distinctive contribution to integrated services.     

Role incongruence and gender variation in the provision of prison mental health services

Correctional administrators are equipped with a variety of responses to manage problematic inmate behavior. The forms of these responses range from subtle coercion in the context of everyday prison life to segregative placements that include protective custody, disciplinary confinement, and mental health residential services. Using logistic regression, the present study examines the disproportionate placement of female inmates in mental health facilities. The results suggest that placement differences for male and for female inmates reflect both psychiatric need and differential responses to role-incongruent behavior.