March 01, 2011

Mother’s Bipolar Disorder Placed Newborn at Risk

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

In re Noah Jeremiah J., 2010 WL 5156425 (N.Y. App. Div.).

Mother who suffered from bipolar disorder and had a history of failing to take her medications was unable to properly care for her newborn who had special medical needs. Mother’s mental illness placed her newborn child at imminent risk of harm due to concerns about mother’s ability to take her own medication and administer her son’s medication on a strict schedule.

A mother who suffered from mental health disorders and drug addiction became involved with the child welfare system in 2006 after her two sons were adjudicated neglected and placed in foster care. The mother was then ordered to participate in mental health services, drug treatment, and vocational and education training. She became pregnant with a third child in mid-2007.

The mother’s third child, a son, was born low birth weight and HIV-positive and required special medical care. The child welfare agency filed a neglect petition on behalf of the infant, claiming the mother’s mental illness prevented her from caring for the child and placed him at risk of neglect.

The agency further claimed the mother failed to take her prescribed medications, the infant’s siblings had previously been found neglected, and the mother had not complied with the court’s prior order.

At the fact-finding hearing, the mother’s psychiatrist testified about the mother’s bipolar disorder. He described periods of major depression followed by periods of hypomania that are common symptoms of bipolar disorder. He testified that the mother’s bipolar disorder made her irritable, impulsive, unable to make decisions, and difficult to interact with.

The psychiatrist also described how failing to take medication would worsen the mother’s condition by making her moody, impatient, and susceptible to major depression—all of which would affect her ability to care for her child. He described two times when the mother had stopped taking her medication and how it caused her to become distressed. He also noted that while her mood swings were stable, she would not be able to care for the child when she was not on medication.

A child protective specialist also testified about the agency’s concerns that the mother would not be able to administer the child’s antiretroviral medications. Even with home-based support, the specialist felt the mother would not be able to keep up with the child’s strict medication schedule. She cited the mother’s own trouble taking her prescribed medication as well as other indicators, such as trouble getting up in the morning and keeping required appointments.

The court found the mother’s ability to care for the child was impaired and the child was “at risk.” The court entered a disposition of neglect and placed him in the custody of the child welfare agency. The mother appealed.

The New York Supreme Court, Appellate Division, First Department affirmed. The mother claimed the agency failed to establish by a preponderance of the evidence a causal connection between her mental health condition and potential harm to the child. She claimed that with appropriate services the child could be returned to her care without placing him at risk.

The court explained that a parent’s mental condition may be the basis of a neglect finding when it is shown by a preponderance of the evidence that the condition placed the child in imminent danger. The record showed the mother’s mental illness and her inability to manage her medication increased the likelihood that if the child were discharged to her care, he would not receive adequate care. If the mother failed to administer the child’s HIV medication, he would be in imminent danger.

The mother’s bipolar disorder, if unmedicated, would prevent her from caring for the child. Her psychiatrist testified that missing just one dose would render the mother less able to respond to a newborn’s demands. Even with the medications, the psychiatrist was uncertain that the bipolar disorder was under control to enable the mother to properly care for the child. The psychiatrist also said that the mother’s history of not taking medication on two occasions increased the chance that she would repeat the behavior, either failing to take her medication or failing to administer her son’s medication.

The court noted the child’s “exceptional fragility” and the extra care he required. Even an occasional lapse in administering his medication would be harmful. Nothing in the record showed that the effects of the mother’s mental illness had been resolved or she had improved in complying with her medication so she could care safely for her child.