The Central Adoption Resource Authority (CARA) recently issued a memorandum under which children whose guardians are found to be “unfit” due to mental illness, among other conditions, are to be brought into the adoption pool. It is in keeping with Section 38(3) of the Juvenile Justice Act, 2015, and Regulation 6(18) of Adoption Regulations, 2022. Emotional and social gains for the child and adoptive parents are innumerable. We only find the label of ‘unfit guardian’ problematic and worry that vulnerable people, particularly mothers with low social capital, may suffer irreconcilable loss.
A global meta-study suggests 12–45 percent of mental health service users have children. While the exact number is yet to be determined, it is likely to be significant, considering the overall prevalence of mental health conditions is estimated at around 14 percent. We are also a young nation and it is likely that the parents of several young people may rely on mental health services.
Because such voices should be at the heart of policy-making, we draw lessons from Abirami (name changed), a mental health service user who now works as a psychologist and peer leader. When she entered The Banyan’s acute care service, she was separated from her 3-year-old son, who stayed with relatives since hospital environment was not conducive for him. She shares this period was an emotionally devastating experience and the thought of permanent separation was terrifying; equally, access to her child through visits immensely helped. Now, 15 years later, she believes living with her son after coming out of the institution—with supports like respite care, access to education and livelihood, cash transfers, and conflict resolution—played a significant role in recovery.
Abirami’s son, endorsing this view, rejects the idea that parenting barriers are exclusively linked to mental illness; instead, he focuses on prejudice, discrimination and impact of deprivation. “While some situations may be challenging, it is important for the child to be close to the parent to feel a sense of belonging and grow up with confidence and stability,” he adds.
For us, Abirami’s experience raises few concerns in the context of the memorandum. While the intent to support distressed children in finding stable homes as early as possible and transition them out of child care institutions (CCIs) is meritorious, we argue the criterion outlined to classify parents as unfit may require deeper deliberation. Consumers of mental health services are a heterogeneous group and could include parents with severe mental illness, homeless people, single parents who experienced intimate partner violence and migrant workers. Each group has unique challenges to be overcome, and unique capabilities to be an effective parent.
Privileging either child or parent rights adversely affects both groups and does not contribute to societal well-being. Rather than immediately contemplate removal, we can explore alternatives.
When a parent experiences a mental health issue, different scenarios are possible. First, the parent and child may only need short periods of respite and support, including access to stable housing, kinship care and psycho-education, resilience building and problem solving through support groups, bibliotherapy and adaptive coping trainings, following which they may be able to sustain gains. Second, the parent may need a longer recovery period. During this time, the child requires an environment that is nurturing, trauma-informed, alongside options of kinship care. This might require a relook at facilities currently available outside CCIs and expand the base to include hostels or group homes, with support provided to the parent so co-habitation may be possible.
The third scenario might involve the parent being completely unable to care for the child, or opting not to, or the child opting to not sustain the relationship. This scenario requires that alternative long-term care be made available to the child outside institutional facilities, but also requires nuanced dialoguing, drawing from experiences of parent-child dyads and professionals. Since people with mental health conditions display varied trajectories of recovery and needs, imposing a common stipulated time is perhaps not pragmatic.
The availability of respite care facilities for parents needing temporary support, access to mental health care to help kids better understand their situation, and access to peer networks are crucial. Interventions are also integral from a systems level. For instance, schools require stronger training to understand parental mental illness. Drawing from frameworks that underscore the importance of ‘protective factors’ such as connections and competencies, and asset-building approaches to spotlight training programmes and multi-systemic therapeutic options, greater investments are called for to strengthen childcare systems.
Towards this, a ‘wraparound’ approach to care is recommended that promotes convergence between various departments such as health, housing, social welfare and education, especially in the background of disadvantage and structural barriers.
Responses to these complexities must centre on the people most affected by these implications. After all, we do not want well-intentioned initiatives to alter societal perceptions around ‘fitness’ and infuse feelings of fear in parents living with severe mental illness or their children.
With inputs from Ramesh Raghavan, professor at the NYU Silver School of Social Work, and Vaishnavi Jayakumar, co-founder, The Banyan
(Views are personal)
Deepika Easwaran | Psychologist and lead, Child and Adolescent Mental Health Centre, The Banyan Academy
Vandana Gopikumar | Co-founder of The Banyan who has worked with children of parents with mental illness