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Child abuse is not uncommon and has long-term detrimental effects.
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In America, physicians including psychiatrists are legally mandated to report suspicions of child abuse.
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Almost one-half of patients with serious mental illness are parents, and psychiatrists should ask about parenting.
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Studies that purport to demonstrate a higher risk of child maltreatment by parents with mental illness often have methodologic limitations.
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Mental illness should be treated, and should be considered a dynamic risk
Violence by Parents Against Their Children: Reporting of Maltreatment Suspicions, Child Protection, and Risk in Mental Illness
Section snippets
Key points
Definition of child abuse
According to the Federal Child Abuse Protection and Treatment Act (CAPTA) (42 U.S.C.A. § 5106g), as amended by the CAPTA Reauthorization Act of 2010, child abuse and neglect are a minimum set of acts defined as:
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“Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation”; or
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“An act or failure to act which presents an imminent risk of serious harm.”
Although CAPTA includes specific definitions of
Mandatory reporting of suspicion of abuse
In 48 states, mental health professionals are one specific group that are mandated to report their suspicion of child maltreatment to an appropriate agency; in New Jersey and Wyoming, all persons are required to report.8 In America, health professionals contribute to 8% of reports to CPS.9 The circumstances under which a mandatory reporter must make a report varies between states. Generally, a report must be made if the health professional (in their official capacity) suspects or has reason to
Psychiatrists as reporters
Psychiatrists are mandated reporters of child abuse, yet are often reluctant to breach confidentiality. Therapists who do not report are most commonly concerned with the loss of the treatment alliance with the potentially abusive parent. However, compliance with mandatory reporting in many cases “contributes positively to the therapeutic process.”14 Despite limited research, in one study, Watson and Levine found that one-half of reports of child abuse were filed during the first 3 months of
Parents with mental illness
Mental health professionals do not always ask if their patients are parents.17, 18 A survey of psychiatrists found that 69% asked their female patients if they were mothers 90% to 100% of the time, and 10% asked less than one-third of the time or never.17 Yet, one-half of women with serious mental illness are parents19 and 10% to 20% of women with serious mental illness are actively parenting dependent children in their home.20, 21 Between 5% and 30% of children have a parent afflicted with
Is mental illness a risk factor for child maltreatment?
Parental mental illness is often considered a major risk factor for violence against children. In reality, most parents with mental illness do not abuse their children, and most parents who abuse their children are not mentally ill. Despite a dearth of literature, the idea that all persons with mental illness are at risk of child maltreatment is a prevalent view. This implies that, considering the frequency of mental illness (by the various definitions used in the various studies),
Summary
Stigmatizing mental illness may lead to lower rates of help-seeking behavior among parents experiencing symptoms of mental illness, for fear of loss of custody. Rather, the large number of parents with mental illness need support, understanding, and encouragement to continue in their treatment. Substance abuse is a known serious and independent risk factor for all kinds of violence. Yet, often, studies lump together serious mental illness with substance abuse. Studies that purport to
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2022, Journal of Interpersonal Violence
Disclosures: None.