Expert: Libby Bonner - 3/18/2004

Question
My husband's cousin is 19 & I'm not sure when she was diagnosed with Schizophrenia.  Last July, 2003 she gave birth to a daughter, of whom my husband & I share joint custody with the Mom & the biological father.  At present she isn't taking her medications as prescribed & has recently stopped attending counseling.  She's threatening to return to court in order to gain full custody of her daughter - who has lived with us since leaving the hospital.  I've been documenting her visiting,or lack thereof.  At present, she's staying with her marijuana-smoking brother & his girlfriend, but is hoping to get SSI & have her own place.  She has a low Reading level, with no Comprehension; is incapable of housekeeping duties; and at times is lacking in hygiene. Her counselor has advised the Grandmother (my hubby's Aunt) that she shouldn't be left alone with her daughter, because they can't get a handle on where her brain is.  What, if anything do you suggest we do to protect this child who we love with all our heart ?  The biological father has basically removed himself from the picture - he hasn't visited/contacted us regarding his daughter since the Oct., 2003 court date.  Thank you for your help.  

Answer
I read your question quickly this morning and wrote an answer throughout the day, which follows.  Most of my remarks are directed to custody issues, but upon re-reading I see the your main concern right now is safety, which I have addressed as well.

The only other thing that occurs to me upon re-reading is whether the father's shared custody should be revoked now - so that future horrible issues don't surface years from now.  However, sometimes letting sleeping dogs lie - in this case the cousin - might be very wise.  As you will read in my remarks, my general feeling is that no apple-carts should be upset, or even tipped gently, until all the karma is good w/ the cousin....until friendly feelings have developed among you.  [But alternatively, she is bound to end up in the hospital or in jail soon, and then, when she is rather out of the picture and very obviously not altogethr competent, might be your opportunity to try to revoke her custody.]

And the remarks of the counselor to the aunt are too true: when she is psychotic, she might be a danger to any of you.

Following are my original remarks, to which I have tucked in a new comment or two.  Also, be warned:  you need expert, local help on this.

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We have a similar situation here in my NAMI group, and it's very very difficult.

You are doing a wise thing now in documenting visits, but I would encourage you to document everything that she says or does that is meaningful – whether she does or doesn't take meds and why; what she says about the baby, about responsibility.  These must be things either of you witness directly, not told to you by a third person.  But you certainly can document common knowledge – where she lives and w/ whom, arrests, times that she can't be located.

It's very hard for judges not to give custody to parents, when requested to do so.  I am thinking that your log, your record, might be more useful as a means of proving competence, legal competence.  If she if not competent, it might mean she needs a guardian, or she may need to be under commitment [if your state permits] to see that she complies w/ treatment orders.  It might be harder for her to get full custody in these circumstances.

Alternatively, there are two other ways to proceed.  One would be to seek sole custody NOW….the earlier this is clarified, the better for everyone.  But that's a gamble.  You, or an atty, might get useful info on the mentally ill and custody at www.bazelon.org or www.psychlaw.org [or maybe it's psychlaws]

The other, perhaps more successful thing to do is to befriend her.  She is likeliest to try for custody when she feels threatened [or when she is super-sick] – so I would be her friend.  I would not berate her for missed visits, I would try to give her honest help when you can, I would speak kindly of her, I would compliment her for dealing well w/ the baby.  “Kill her w/ kindness.”  She is far less likely to seek custody if she feels included in extended family and if she has access [maybe monitored access] to the baby.  -----When she is really sick and hearing voices or is delusional, she should not be alone w/ the baby…how you accomplish that, I don't know.

Also, I would get as many family members as possible working together for your cousin's welfare, the baby's, and your own family's.  Taking sides, have feuds, alienating this confused sick woman, blaming - none of this helps anyone.  [I don't get any impression that this is ocurring; I merely advise...]

Here is the book you need to help in ALL of your communications w/ her – life really will get better when you have some of these skills.  Author is Woolis; title is When someone you know has a mental illness.  Everyone dealing w/ her needs access to a copy.  Her mother definitely does.  [Book also deals w/ setting limits and w/ dangerousness.]

It may help you also to use info at the NAMI website, www.nami.org.    IF there is a good affiliate where you live, do attend for awhile and DO, at your first opportunity, take the free 12-week NAMI course Family to Family.  It will change your life.  [The aunt as well.]

You do need NAMI.  You need an atty, and NAMI may be able to recommend one.   You need the Woolis book and mental health info:  try www.mentalhealth.com and the NAMI site.  

Here is my only other idea – see what people at NAMI think or what an atty thinks:  at a time when things are going well , perhaps a mediator could help the you all create some binding guidelines, guidelines designed w/ the understanding that sometimes she will be more well than others.  AT THAT TIME it would be extremely desirable to start her on a process of making a Psychiatric Advance Directive – see the bazelon site for a model copy.  I think if you had a signed Directive and the recommendations of a mediator, you would be well-positioned for various circumstances that are likely to arise in the future.

The mediator could certainly put in conciliatory language: that her wishes will always be sought [sought, not necessarily  followed] about important life events, etc.

Re the advance directive: if that can't happen, then try to get her to sign releases w/ all providers so that some family member has her permission to discuss her care and her symptoms w/ her doctors, social workers, etc.  Also, IF SHE WILL let a family member go w/ her to doctor appts, you probably will improve her level of care, may improve her willingness to take meds, may understand her illness and her view of her illness better.  Also, the doctor will have the benefit of information that a patient sometimes – often – honestly forgets to provide.

Last of all - what's happening here w/ family planning?  If nothing, there will be more babies, as I'm sure you know.  Again, a very thorny issue....almost tougher legally than the whole custody thing.

Pls write again if you need clarification, or if things change significantly.  I wish you the best and hope that some of the ideas will have good results.