SOCIAL ISSUES : Helping the Mentally Ill Keep Their Families Intact : New York program helps those with children retain custody. Services include parenting classes and living arrangements.

Florence E., 31, is a diagnosed borderline personality with a history of depression, self-mutilation and cocaine abuse. She’s also a mother.

Child welfare authorities removed her daughters from her care and placed them in foster homes in 1988. Two of her other children were adopted shortly after their birth. But Florence always kept in touch with her children, and last year finally regained custody of her two eldest daughters, now 9 and 10.

Florence attributes her second chance at parenthood to policies implemented by New York’s public mental health authorities that are designed to aid parents suffering from psychiatric illnesses--with services ranging from parenting skill classes to permanent living arrangements for a fortunate few.

Florence now resides with her children in a new Brooklyn group home with 16 apartments set aside for mentally ill women and men with children. The residence offers 24-hour supervision and help with issues from disciplinary matters to baby-sitting.

“It’s given me a chance to learn how to be a parent again,” she said.

New York’s new policies come as a result of a 1993 state task force report on mentally ill parents with young children which found that authorities were woefully unprepared to handle the demands these families placed on the system. For example, mentally ill women with children often experience problems finding a place to live, since the vast majority of group homes do not make provisions for offspring. As a result, many families find themselves in homeless shelters.

New York authorities estimate that 16% of all children in the state’s foster care system have at least one parent suffering from a psychiatric illness.

When the majority of mentally ill women lived in institutions, their parental rights would almost always be terminated immediately after the birth. Beginning in the 1960s, however, more and more people suffering from mental illnesses began to receive primary care in out-patient settings--the result of deliberate deinstitutionalizing policies. Over time, mental health authorities began noticing that many of the patients being treated in community settings were forming families.

Mentally ill people “aspire to many of the same things many others in the community aspire to, and having a child is one of those ‘normal’ activities,” said Joanne Nicholson, assistant psychiatry professor at the University of Massachusetts Medical School.

Nicholson co-authored a 1990 study investigating the provisions that different jurisdictions across the country utilized when working with mentally ill parents. She discovered that only 16 states routinely asked about parental responsibilities when someone sought treatment at a state facility, and only four state mental health agencies--including California’s--even knew of housing facilities within the state that catered to these families.

“What still happens is people in public sector agencies make plans for kids or adults, but they don’t consider families as a unit,” Nicholson said. “There are reports of some women running from provider to provider with complex service plans, but others are falling through the cracks and their needs aren’t being met,” Nicholson said.

New York authorities are not advocating that all mentally ill parents be able to keep custody of children. In some cases, authorities say, a parent is simply too ill to provide a safe setting. But other times, state officials say, all someone needs to be an effective parent is help and guidance.

“Mental illness isn’t a separate category that should make society take children away from their mothers,” said Lucinda Sloan-Novesky, executive director of the Mental Health Assn. in Orange County, N.Y.

However, critics of New York’s mental health system say authorities must keep an extremely close eye on programs reuniting mentally ill parents with their children.

“It’s a good intention, but unless the moms and kids are carefully monitored, it could be a total disaster,” said Sally Satel, a psychiatrist at Yale University School of Medicine who recently argued in the Manhattan Institute’s City Journal that New York fails to properly supervise many of its mentally ill residents. “Unless folks are put in a program where there’s special funding or an explicit commitment to this program, it’s risky.”

New York authorities are paying for the new programs through a variety of sources, from federal government housing grants to state and local mental health and child welfare dollars. However, there is growing fear among mental health providers that budget cutters will imperil many services catering to their patients.

Andrea Blanch, director of community support systems for the New York Office of Mental Health, points out that the variety of funding sources for programs leaves mentally ill parents particularly vulnerable. It only takes a budget cut at one agency to limit or even end a program, she said.

“Many of these are new programs and, like it or not, it’s often last up, first cut,” Blanch added. “My real fear is the social safety net being ripped apart underneath moms.”