When Parents With Severe Mental Illness Lose Contact With Their Children: Are Psychiatric Symptoms or Substance Use to Blame?

Abstract

This study compared parental psychiatric symptom severity, and the absence or presence of severe substance abuse, as predictors of contact with minor children for a representative sample of adults with diagnoses of serious mental illness (N = 45). Child contact and psychiatric symptom severity were measured during regularly scheduled 6-month research interviews over a total 30-month period following each participant's entry into the project. Severe substance abuse was documented as present or absent for the 6-month interval preceding each interview. Results revealed that incidence of severe substance abuse was repeatedly associated with less frequent parent-child contact, even after controlling for psychiatric symptoms, diagnosis, gender, age, ethnicity, and socioeconomic status. Neither psychiatric diagnosis nor symptom severity predicted frequency of child contact when substance abuse was taken into account. Mental health agencies offering parenting classes for adults with serious mental illness should incorporate substance use interventions to reduce loss of child custody and strengthen parent-child relationships.

Funding for this study was provided by the Substance Abuse and Mental Health Services Administration (Grants SM-51831 and SM-51823) and the National Institute of Mental Health (Grants MH-060828 and MH-01903), with institutional review board approval from McLean Hospital in Belmont, Massachusetts. We extend gratitude to our NIMH project monitor, Ann Hohmann, for her invaluable guidance and support throughout the project.

Notes

Note. Substance abuse mean difference (df = 43): proximity, t = 2.78, p < .01; frequency, t = 3.25, p < .01. Mothers only (df = 28): proximity, t = 2.85, p = .008; frequency, t = 3.38, p < .01. Fathers only: proximity, ns; frequency, ns. Mean difference for gender (df = 43): proximity, t = 2.18, p < .05; frequency, ns. Gender by substance abuse interaction: proximity, ns; frequency, ns.

^a Scores were averages for each participant's youngest child across all available interviews.

^b Residential proximity: same house or apartment (6), same neighborhood (5), less than hour away (4), a few hours away (3), a day's ride/drive (2), more than a day's ride/drive (1).

^c Frequency of contact: every day (7), several times a week (6), once a week (5), a few times a month (4), once a month (3), a few times a year (2), once a year or less (1).

^a Mean frequency of contact equivalent to at least one contact per week.

Note. Contact category by substance abuse: χ² = 8.33, df = 3, p < .05. Mothers only: χ² = 10.23, df = 3, p < .05. Fathers only: ns. Contact category by parent gender: ns.

^b Mean frequency of contact equivalent to less than once a week.

Note. Dependent variable: self-reported frequency of contact with youngest child at each interview. Cell values: standardized beta coefficients.

^a Any incidence of severe substance abuse during the preceding 6-month interval.

^b Total score for the Positive and Negative Syndrome Scale (PANSS): higher scores = more severe symptoms.

∗p < .05.

∗p < .05; ∗∗p < .01.

Additional information

Notes on contributors

Danson Jones

Danson Jones has been an administrator and researcher in educational and medical settings that serve disabled persons for over 30 years. He is currently director of institutional effectiveness for the Wharton County Junior College system in Texas.

Rosemarie Lillianne Macias

Rosemarie Lillianne Macias is a member of the research division of the Department of Family and Community Medicine at the University of Texas. She has worked in rehabilitation programs for adults with severe mental illness, and is currently conducting research on community health disparities.

Paul B. Gold

Paul B. Gold served on the faculty in the Department of Psychiatry and Behavioral Sciences of the Medical University of South Carolina during the course of this study.

Paul Barreira

Paul Barreira was deputy commissioner of mental health in Massachusetts during the study. He now holds a faculty position at Harvard Medical School and is director of behavioral health and academic counseling at Harvard University.

William Fisher

William Fisher is a professor of psychiatry at the University of Massachusetts Medical School and associate director of the Center for Mental Health Service Research. His research interests focus on mental health services for persons with severe mental illness in a variety of systems and settings.