When I met Sarah* last winter, her 14 year old son Logan had already been in therapeutic foster care (TFC) for almost 6 months. Our support group for parents of children with mood disorders has been a life-changing source of support for Brian and me, but sometimes, witnessing the chaos and pain in the lives of families whose children are adolescents is more than a little frightening.
Through Sarah and Logan’s story (among others), I’ve learned that in New Mexico, TFC is much more widely used for kids who need out-of-home placement than are residential treatment centers.
Don’t let the words foster care trip you up, though. This is not protective custody whereby children are removed from neglectful and/or abusive parents. Parents whose children are in TFC have not lost or relinquished any of their parental rights; their child lives in the home of specially trained adults, but custody remains with the child’s parents. The child receives care from a psychiatrist and the child and family see a therapist regularly.
Far from an ideal system, but for a child who can be safe in a home environment, it’s a more natural solution than an institution.
Sarah and her husband didn’t make the decision to send Logan to TFC lightly. Just the opposite, in fact; Logan went to TFC when his mom and stepdad felt like there were no other options. When they were no longer able to keep Logan, his little sister, or even themselves safe, and after several hospitalizations in a short period, they took the best option available to them: TFC.
After being matched with an inappropriate family, a return home, and yet another hospitalization, Logan was placed with a TFC family that suited him well, and he was there for nearly a year.
During that year, Logan had ups and downs, but overall, his progress was positive. He bonded with his foster family. His psychiatrist (the same doctor who treats Carter) found a good combination of medicines and Logan had longer and longer periods of stability. The family was progressing in therapy and Logan slowly, gradually, began to have more time at home. The psychiatrist, therapist, TFC parents, and Logan’s parents agreed that sometime in late fall or early winter, Logan would be ready to move back home.
And then in mid-summer came the bomb: Logan had gone several months without any significant episodes, and he had to go home.
Who made that decision? Was it someone who knew Logan, who loved him, or at least cared about him? Was it someone who understood his unique challenges and limits? Was it someone who knew that Logan was starting high school in late August and that the dual transitions of the move home and the new school would likely be too much for him? Was it someone who knew his history?
Was it someone who gave a shit?
It wasn’t someone at all. It was something – a list of rules or a computer program or a flow chart thumbtacked to a cubicle wall. No person made that decision, because all the people knew it was the wrong thing. The psychiatrist and the therapist, the foster parents and Sarah and her husband all knew the time wasn’t right. Logan wasn’t ready, and neither was his family.
They all begged and were granted just a few more weeks. Logan was released from TFC within a few days of his first day of high school, sent home after not yet having had a full weekend-long visit home.
Within a week, he was acutely ill. He left school and Sarah didn’t know where he was. They brought him home; he disappeared again.
Tonight, Logan will sleep at the psychiatric hospital. He’s been there for over a week. The list of rules that said he had to go home several months before he was ready? It saved some money, probably thousands of dollars. I don’t know the cost of a night in the psychiatric hospital compared to a night in TFC, but my best guess is that one night at the hospital costs about as much as half-a-month to a month in TFC.
Our society will pay for our mentally ill children. There isn’t a way around that; we parents can’t lock them up at home so you don’t have to deal with them. They are not well, and just as no parent of a child with cancer or muscular dystrophy or any of a thousand other serious illnesses can bear the whole cost on their own, neither can we.
The difference between mental illness and other illnesses is this: people with serious mental illness who don’t get adequate treatment are very likely to end up in prison.
I get that some people don’t want to pay for treatment. I do. I don’t agree, but I understand. What I want everyone to understand is this: we are making a choice, and that choice is not between paying or not paying. It is a choice between paying now and minimizing suffering, or paying later with maximum suffering.
Prison cells are expensive.
The removal of huge numbers of caregivers (like me) from the pool of working (and therefore tax-paying) adults is expensive.
The absence of huge numbers of people who are mentally ill who could, with appropriate treatment and support, enter the pool of working adults, is expensive.
Ambulance rides and psychiatric inpatient treatment that could be avoided with appropriate treatment (including outpatient, in-home, therapeutic school settings, and a host of other possibilities) are expensive.
There are so many other ways that lack of treatment (or inadequate treatment) ends up costing vastly more than good treatment would have cost in the first place, but it doesn’t even begin to touch on the human side of the issue.
We parents of kids who have behavioral, developmental, and emotional challenges want the same things for our kids that every parent wants: we want our kids to grow up to have fulfilling, joyful lives full of love. Our kids need lots more support to get there, and those lives might look very different than the lives of neurotypical children, but that’s what we want.
We have bent our expectations because of our children’s issues; should we also bend them because people balk at the cost of treatment?
Who cringes at the price of caring for premature babies? Who would deny them the specially trained physicians, devoted nurses and therapists, and state-of-the-art intensive care units that give them the best chance at a healthy life? No one says, “Hey, it’s not fair that those kids get so much!”
We parents of kids who have behavioral, developmental, and emotional challenges hear that often. I’ll tell you this about fair: we’ve mis-defined it. There’s nothing fair about making sure that everyone gets exactly the same thing. Fair is when everyone gets what they need.
Logan didn’t get what he needed, and there’s just one reason for that: our cultural priorities are seriously warped.
Tragically, devastatingly, criminally warped.
Here in the US, we’re playing a zero sum game. For Logan to get what he needs, someone else has to get less. For Carter to get the services he needs in public school, other children have to learn in a more crowded classroom. We are continually shuffling a few dollars back and forth, trying to make them cover more than they can cover.
More and more, we funnel those dollars into prisons because we’re scared that taking care of our neediest citizens will start us on a long, slow slide to…what?
What are people so afraid of that is somehow worse than what Sarah and her family is facing now?
A flowchart and a budget say that Logan is disposable. Nothing will be OK for kids like Logan and Carter until people take those decisions back and we, collectively, acknowledge that people matter more than dollars.
For more information about how mentally ill Americans (who are less likely than average to be violent, and more likely than average to be victims of violence) end up in prison, watch this, read this, this, and this, and if you really want to know about this issue, pick up a copy of Crazy: A Father’s Search Through America’s Mental Health Madness by Pete Earley.
Life in a prison cell is not the goal I have for my little boy, and it’s not what Sarah wants for Logan. We can’t keep them alive and help them arrive at fulfilling and happy lives by ourselves.
Join me and write some notes to your state and federal representatives. Send them this message: there are no disposable people.
*I have Sarah’s permission to share a bit of their story here, but Sarah and Logan are pseudonyms.