Legal Issues of Pediatric Bipolar Disorder

Families of children with bipolar disorder often face legal issues related to their child's illness. These issues might involve obtaining health insurancecustody issuesallegations of abuse, encounters with the juvenile justice system, consent for medical treatment, and disclosure of medical information.

There may be times when you need the assistance of an attorney or an advocate to protect your child's rights. We have provided Legal Resources and Links to help you locate a qualified attorney in your state and links to resources to help you research legal issues, as well as guidelines on finding an attorney.

Your child's rights are protected under a variety of federal and state laws, and as the parent of a child with bipolar disorder, you may need to be a strong advocate for your child's rights. The sections that follow touch upon the legal issues that families most frequently encounter.

Disclaimer

Families with legal problems are urged to hire a capable local attorney licensed to practice in the state in which the family resides. The Balanced Mind Parent Network (The Balanced Mind Parent Network) is unable to provide you with legal advice and The Balanced Mind Parent Network’s attorneys are unable to represent you.

The information on this web page is not a substitute for legal advice. It is intended to be general in nature. The laws of each state are different.The law is always changing. The information here may not reflect the latest legal developments. NO WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, IS GIVEN AS TO THE ACCURACY OF THIS INFORMATION. 


Back to top.


Health Insurance

While health insurance policies may cover hospital costs for treatment of "physical disorders," many exclude or severely limit coverage for psychiatric treatment. Some states require insurance carriers to provide the same coverage and benefits for severe psychiatric disorders that they provide for any other illness. These laws are called "parity laws." The American Academy of Child & Adolescent Psychiatry maintains a listing of parity laws by state.

Some judges have ruled that bipolar disorder constitutes a physical disability and must be covered the same as other disabilities.Children can be insured separately from their parents when a family is unable to afford private family insurance. The United States Department of Health and Human Services has information on this program at http://www.insurekidsnow.gov/. If you have a low income, your child may qualify for Supplemental Security Income and Medicaid.

A diagnosis of bipolar disorder may affect a child's ability to obtain individual (non-group) medical insurance in the future. Federal law prohibits an insurance company from denying coverage under a group plan due to a pre-existing condition if the person can establish that he or she has been continually insured for at least two years before applying for the new policy. Some states have protections for people with pre-existing medical conditions. For more information on your state laws, visit www.insure.com/health/lawtool.cfm.

Even with private insurance, the insurance company may refuse to pay for expensive services such as hospitalization. The insurance company may take the position that hospitalization is not necessary, or its guidelines may require the hospital to release patients before they have stabilized.

Some families that appeal denials of coverage manage to get the necessary services covered even though the language of the plan excludes them. Payment of claims is often discretionary and an insurance company, or an employer who is self-insured, may choose to extend coverage once they learn the facts and hardships the family is facing. A Consumer Guide to Handling Disputes with Your Private or Employer Health Plan can be found atwww.kff.org/consumerguide. A listing of each state's external review process for appealing denials of service by insurance companies or managed care plans is at: www.kff.org/consumerguide/states.html.

If you are having severe difficulties, consult an attorney for information on whether the insurance company has violated the laws of your state, or has breached your insurance contract.

Some families must have their child hospitalized on an involuntary or court-ordered basis in order to require the insurance company to pay. Similarly, families whose children are discharged from the hospital before they have stabilized may have no choice but to allow the child to be released until the next obvious dangerous act on the part of the child — and then proceeding with involuntary commitment. If you have an older teenager, you may wish to consult an attorney to institute guardianship proceedings that will allow you, rather than the child, to decide whether hospitalization is necessary.

A child who is a danger to others should qualify for a 72-hour evaluation for an involuntary hold, which can be extended if necessary.

Many hospitals are designated as 72-hour detention facilities and can initiate a "hold" order themselves. Otherwise, a police officer can initiate the hold proceeding and take the child to a designated facility for mental health treatment. It may be necessary to take your child out of the hospital to stay with someone else temporarily until the child threatens self-harm or injury to others, and then call the police.

Other ways you may be able to get help include contacting your County Mental Health agency or requesting a judge to issue an order telling a residential treatment center to give your child the next available bed.


Back to top.


Child Custody Issues

Custody issues can play a major role in determining a child's treatment for bipolar disorder. It's important to know your child's rights and your own rights as a parent, as both could be placed in jeopardy in cases of extreme financial need or divorce.

Relinquishing custody to the state

When parents cannot afford the costs of extended hospitalizations or residential treatment for their child, they may be told they must give up custody of their child to the state's child welfare or juvenile justice agency in order for their child to receive the needed treatment.

If an insurance company, health care provider, school district, or state or federal agency has told you that you should give up custody to obtain treatment for your child, contact an attorney for immediate assistance. You may not have to relinquish custody to get medical treatment.

Parents with limited income may be able to obtain treatment services through state or government assistance programs such as Medicare.  See Supplemental Security Income You may also wish to contact NAMI, the National Alliance for the Mentally Ill. An article on NAMI's Web site,  "The Tragedy of Custody Relinquishment," addresses this wrenching issue.

Bazelon Law Center provides information for families who face giving up custody to obtain mental health services for their children. Some states have passed laws that prohibit child welfare agencies from requiring parents to relinquish custody.

If you have exhausted all other options and you are forced to surrender custody of your child to the state, it is possible the state may make treatment decisions regarding your child without allowing you to participate. Furthermore, a court order would be necessary to return custody of your child to you, and there is no guarantee you will be successful in obtaining such an order.

Treatment issues when parents are separated or divorced

When parents, who are married, are living together or separated, the consent of either parent for medical treatment is usually sufficient. The divorced (or never married) parent with sole legal custody generally makes decisions unless ordered otherwise by a judge.

When parents disagree concerning necessary medical treatment, the parent whose wishes are being disregarded may need to bring a motion before a judge to order (or oppose) the treatment. The court will hear expert testimony and issue a court order in the best interests of the child, and this order can be made a part of the child's medical record. Such an order may be necessary to obtain cooperation from schools and medical providers. Check the Family Law Codes of your state; parents confronted with this problem should seek advice from an attorney familiar with family law.


Back to top.


Allegations of Abuse

Children with bipolar illness can, and often do have episodes of aggressive outbursts or hypersexual behavior that are symptomatic of the illness.  Fortunately, these symptoms usually respond to proper medical treatment. Due to the child's sometimes alarming behavior, teachers, babysitters, social workers, well-meaning acquaintances and other adults who are not familiar with the disorder may suspect the child has been the victim of abuse.  Therefore, they may feel compelled to report parents to authorities for investigation. The parents may have done nothing at all to cause the child's behavior and may have been trying to stop the behaviors for months or years.

The Balanced Mind Parent Network has received increasing reports that parents (especially mothers) of children diagnosed with bipolar disorder have been accused by social workers or teachers of fabricating the child's symptoms and thereby harming the child (Factitious Disorder by Proxy or Munchausen's Syndrome by Proxy). This happens because the symptoms of  bipolar disorder, and how it can lead to unfounded allegations of child abuse has been slow to reach the community and the courts. As a result, some families have been unnecessarily torn apart by abuse allegations.

A child with bipolar disorder may express his or her overwhelming feelings at school, or may express them only at home. The target of the child's outburst is often a family member, most frequently the parent to whom the child feels closest. The episodes of aggression are usually not of a predatory nature but are triggered by a hyperaroused stress-response system (part of the physiology of people with the disorder) and a feeling of being attacked or frustrated. A child or teen with impulsive aggression needs medical treatment to gain self-control, and should be referred to a doctor.

Hypersexual behavior occurs in nearly 25% of prepubertal children with mania and 70% of adolescents with mania, as reported in the work of Barbara Geller, M.D. and colleagues (see B. Geller article) . A child with hypersexual behavior due to mania needs medical treatment to gain self control, and should be referred to a doctor.

If the child's outbursts include physical assault, the parent may need to physically restrain the child to prevent injury to family members, a family pet or someone else. At times, such use of restraint has resulted in criminal charges against the parent that can lead to loss of custody by the parent of all of their children.

Poor judgment and delusional thinking can cause a child to feel out of control.  In some cases, the child may even call 911 to report a parent who has not in fact been abusive.Altered thought patterns are not unusual in children with bipolar disorder, and the child may not understand the dire consequences of a false report. The family's local child protective services agency may become involved and threaten to remove, or actually remove, the child and perhaps other children from the home.

Every instance of child abuse and allegation of child abuse, even those with little or no evidence apart from the child's statements, must be investigated. These investigations are usually performed by a social worker and may lead to a judicial hearing to determine if the child should be placed in protective custody. A social worker representing a state agency may come to your home to look for signs of a harmful environment for the child. These investigators are influenced by the appearance of your home, its orderliness, the availability of nutritious food, and their perception of how well you meet your child's fundamental needs in a nurturing way. If you are concerned that your child's behaviors might prompt an investigation of your family, be sure you protect your rights as a parent in the following ways: Have your doctors, psychiatrists and therapists keep written records of your child's problem behaviors. Keep a well-organized notebook that details your child's medical history and treatment, school accommodations, and other significant information. Write and date letters or memos to your treatment team documenting behaviors that concern you — for example, sexually provocative and other manic behaviors such as not sleeping, giddiness and risk-taking activities. Keep copies should you need to defend yourself against abuse allegations.

Families faced with unfounded charges of child abuse are advised to obtain the services of a local attorney with expertise in this area to represent their interests. (See Finding an Attorney or Advocate). Because your parental rights are being challenged, you may qualify for a court-appointed attorney. The legal interests of the child and the parent are different, and therefore, if you are charged with child abuse, you should seek an attorney to represent your own interests regarding retaining custody of your child. Your rights as a custodial parent are in jeopardy, and good legal representation is extremely important. Accusations of Munchausen's by Proxy are extremely serious and it is important that any parent (usually the mother) accused of Munchausen's Syndrome by Proxy obtain representation by a competent criminal law attorney. These allegations can result in the loss of custody of every child in the home, before any charges are filed, and it is very difficult for an innocent parent to clear her name. The National Child Abuse Defense & Resource Center is an advocacy organization for parents falsely accused of child abuse, including Munchausen's Syndrome by Proxy. The book Munchausen's Syndrome by Proxy Reconsidered, by Eric G. Mart, Ph.D., is an excellent handbook for parents and attorneys involved in these cases.

Any attorney who represents you needs to be well informed about bipolar disorder. It will be crucial for your attorney to establish that a child with bipolar disorder is not explosive as a result of bad parenting or insufficient parental controls, but rather as a result of mood swings caused by a brain disorder. Children with bipolar disorder are often less in control of their behavior at home, where they feel safest. An expert witness may be extremely useful at a custody or abuse hearing. Your attorney may be able to locate such an expert by contacting the psychiatric department of medical centers at major universities. Attorneys have access to national services providing expert witnesses, but early-onset bipolar disorder may be too new and specialized an area to be included in the listings. The expert should be someone such as a professor of child psychiatry from a university school of medicine or a child psychiatrist who has recognized national credentials in the field of early-onset bipolar disorder. In addition to a nationally recognized "outside" expert, a child psychiatrist who has evaluated your child may be able to provide helpful testimony.


Back to top.


The Juvenile Justice System

If your child is prone to impulsive or aggressive acts, you should be prepared for the possibility of an encounter with law enforcement. We all hope that it will never happen to our children, but some teens with bipolar disorder at times lose control and break the law.  This is especially likely when he or she refuses to take medication, uses street drugs and alcohol, has a co-morbid conduct disorder, or becomes unstable and displays poor judgment.

Some parents find it helpful to meet in advance with the social worker assigned to the local police station to discuss their child's condition and develop an "emergency plan" for taking the child to a hospital rather than a detention center, if need should arise.

Some parents have resorted to filing criminal charges against their children in order to change out-of-control behaviors. The Balanced Mind Parent Network does not advocate this approach. Until a child or teen is receiving appropriate medical treatment, punitive approaches have little effect or negative effects on the child's behavior. Once in the juvenile justice system, the child is more likely to receive punishment than treatment.

A few innovative juvenile courts have established juvenile mental health court diversion programs. These programs are still extremely rare. In these programs, a juvenile with a diagnosed, treatable illness and a nonviolent offense may be placed in a mental health treatment program instead. The Balanced Mind Parent Network strongly endorses juvenile mental health court diversion programs.

If your child is arrested, you will need immediate access to a competent criminal law attorney in your community. We strongly recommend that you locate such an attorney before you need one. Keep the attorney's phone number in an accessible place. Children who are "different" or who exhibit problem behaviors are often targeted for attention by school officials and law enforcement. Many schools have a police officer on staff to prevent, investigate and help prosecute criminal behavior at school. Police are often called first, not last, for any school-related misconduct. Students and parents must realize that the police officer who works in the school has the same authority as an officer who pulls you over in your car.

  • Mental Health America has a publication for families called "When Your Child is Behind Bars: A Family Guide to Surviving the Juvenile Justice System."

To order this publication, please contact MHA's Resource Center at (800) 969-NMHA (6642) or order online at https://secured.nmha.org/secure/store/Results.cfm?category=2

If a school police officer questions a student at school, that student has the same rights as if the questioning occurred in the community. Parents need to inform their children how to most effectively respond to authorities so that their rights are protected and they don't incriminate themselves. Before they ever find themselves dealing with the police, kids should be taught what their constitutional rights are and how to be advocates for themselves.

A child who is approached by a police officer or by the school's administrative staff should:

  • Be polite, but insist on calling his or her parents before answering any questions. Minors should politely but firmly decline to answer questions unless a parent or an attorney is present.
  • Never run, be aggressive or resist arrest in any physical way.
  • Never "talk back" or use verbally abusive language directed at the police. This will be seen as provocative conduct that can escalate the situation.
  • NEVER write or sign a statement or give an oral confession to any act or behavior that could result in criminal liability.
  • If a police officer is present, Miranda warnings may or may not be given. Frequently, schools will use the dean or another administrator to question a student while the police officer quietly listens. Advise your child to wait until you arrive before answering any questions by any official.

If your child is arrested or charged

If your child is arrested or charged with a crime, hire an attorney who is familiar with juvenile court and understands mental health issues and their impact on conduct. Do not try to manage this serious situation on your own. With your attorney:

  • Come up with a plan to address the problem behaviors. Courts are more receptive to working out a solution if they are given assurance that the problem will not reoccur.
  • If your child's bipolar illness was a factor in the conduct, be sure to get the treating psychiatrist to write a letter describing the relationship of the illness, or perhaps its treatment, and the undesirable conduct. For example, were there recent medication changes that might have been a factor? If necessary, this may be the time to get a new psychiatric evaluation.
  • Decide as a team how to best present these issues. Courts are ambivalent about mental health issues. The court is influenced by the following factors:
    • Is this the child's first time in court?
    • How serious is the offense?
    • Was anyone hurt?
    • Is it likely to happen again?
    • What supports does the child need to stay out of court and in compliance with the law?

Fitness/Competency to Sstand Trial

In some states, a defendant who is found incompetent to stand trial may be diverted out of the criminal system and into mental health care. The issue of fitness or competency with respect to children and adolescents comes into play prior to trial or if a minor confesses to a crime.

Once the issue of fitness or competence has been raised, the Court may order a psychological or psychiatric examination by a qualified expert to assess the fitness/competence of the defendant. It is now the burden of the prosecutors to prove that a defendant is fit to stand trial.

When a child makes a confession, the court wants to know: Did the child confess "knowingly" and "voluntarily" waive his or her Miranda rights? If not, should the confession and any other "tainted" evidence obtained as a result of the child's statements be excluded from the trial proceedings?

In most cases, unless a child is extremely limited cognitively or extremely mentally ill, the child's confessions are not excluded by the Court and can be used as damaging evidence during trial.

Defense against criminal charges

The options available for a defense strategy that is based on the youth's mental illness depend on the state in which the trial is held. A child or teen who commits a criminal act because of lack of treatment or improper treatment for bipolar disorder should be defended in a way that highlights this.

The defense should include a complete evaluation for bipolar disorder and may include expert testimony of a recognized expert in the field of early-onset bipolar disorder, as well as testimony by a treating psychiatrist.

If the attorney representing your child is not well informed about bipolar disorder, you may need to give the attorney specific reference materials and information. For example, an attorney representing a youth charged with shoplifting needs to know that shoplifting may be a manifestation and symptom of mania, which can be controlled with medication.

Court-appointed psychiatric assistance may be available to defendants who qualify for court-appointed counsel.

The "not guilty by reason of insanity" defense is being disallowed by a growing number of states. Even when it is available, its use may not be advantageous to a defendant. Entering such a plea may result in a long incarceration at a state psychiatric facility where state-of-the-art treatment may not be available.

In place of using the "insanity" plea, a defendant might enter a guilty plea and receive a short jail sentence or youth detention, followed by treatment or probation conditioned upon obtaining treatment. An article by William H. Reid, M.D., M.P.H., a forensic psychiatrist, discusses the problems with the insanity plea.

The "guilty but mentally ill" plea may well be the least desirable of the available alternatives, as this is not a defense. It may give a juvenile access to treatment while incarcerated, but does not necessarily provide this right. Adopting this strategy also does not guarantee that the juvenile will be separated from other criminal offenders.

A defendant can enter a plea of guilty but mentally ill when:

  • he or she has undergone an examination by a clinical psychologist or psychiatrist and has waived his or her right to trial; and
  • the judge has examined the psychiatric or psychological report or reports; and
  • the judge has held a hearing on the issue of the defendant's mental health and, at the conclusion of the hearing, is satisfied that the defendant was mentally ill at the time of the offense.

A plea of guilty but mentally ill can result in commitment in a mental health facility, although a hearing on this issue is not automatic as is the case with an insanity plea. Thus, it is advisable to use this strategy only if a prison term is imminent. Otherwise, a person may be subject to involuntary commitment in a mental health facility, whereas a straight guilty plea might result in probation. Counseling and/or other mental health services can always be included as a condition of probation.

Sentencing and right to treatment

Some minors accused of criminal violations may be eligible for court diversion programs. Under such a program, a child may be required to perform community service or participate in a treatment program in lieu of incarceration in a juvenile facility.For a child with bipolar disorder, a diversion program requiring treatment may be especially appropriate and beneficial. When the juvenile successfully completes the requirements of the diversion program, the pending charges may be dismissed.

A few innovative judges have been experimenting with Mental Health Courts as an alternative to the criminal justice system. A Mental Health Court may allow eligible individuals to participate in treatment and supervised community services in lieu of incarceration. However, proceeding under the jurisdiction of a Mental Health Court may involve waiving certain rights or making other concessions that may not be in a child's best interest.

Not all treatment and treatment centers are helpful for these children. "Survival" or military camp methods may not be appropriate for children with behavioral outbursts caused by bipolar disorder, epilepsy, diabetes and other biochemical imbalances. Behavior modification programs that use punishments for undesired behavior have not proven to be effective in treating children with bipolar disorder and may be harmful. Appropriate treatment for children with bipolar disorder should include psychopharmacology combined with cognitive or supportive therapy.

Incarcerated children have a constitutional right to receive necessary treatment. This right, guaranteed in the U.S. Constitution's Eighth Amendment, has been interpreted differently in the many states, but it may help a child with bipolar disorder in detention who is being denied any treatment.

In addition, juvenile detainees may have the right to be screened by the city and police officials for suicidal tendencies. However, children may lose certain rights in cities where a District Attorney can charge a youth as an adult for serious offenses. Be aware if your teenager is being charged as a youth or an adult.

The Center for Public Representation has compiled a comprehensive, annotated list of federal cases relating to Treatment for Persons with Psychiatric Disorders in Jails and Prisons with assistance by the Prisoners' Rights Project, Legal Aid Society, New York. Visit their website to obtain more information. http://www.centerforpublicrep.org/home

Educating judges, social workers, and others involved in the juvenile court process about bipolar disorder is essential. The Balanced Mind Parent Network is currently pursuing various efforts to help court personnel become more knowledgeable about bipolar disorder. See Suggestions for Workers in the Juvenile Justice System.


Back to top.


Consent for Treatment

Parents and legal guardians generally have the right — as long as they are not acting irresponsibly — to give consent for their minor child's medical treatment. In some cases, preteen and teen children are asked or required to give their "assent" to medical treatment. This is a lesser standard than informed consent; it indicates simply that they have been told about the treatment and agree to it.  "Informed consent" is a legal term referring to the right of individuals to make medical decisions only after full disclosure of relevant information.

Consent by teenagers who are minors is complex and raises numerous legal issues. A state-by-state listing of laws governing assisted treatment is available at www.psychlaws.org/LegalResources/ATCriteria.htm. In some states, under certain conditions, the laws treat a teenager the same as a younger child, giving parents and guardians the right to give consent for their teenager's medical treatment. But there are numerous exceptions to this general rule. For example, some states have laws that:

  • set an age under 18 at which a teen may refuse medication or treatment.
  • set an age under 18 at which a minor can obtain, without parental knowledge or consent, treatment for substance abuse (a condition that may coexist with bipolar disorder).
  • give teens over a particular age the right to psychological treatment by a therapist without the parent or guardian's knowledge or consent.
  • restrict the authority of a treating facility to use force to return a runaway teen to the facility.

The rights of a minor to refuse treatment vary by state. In some states, the parent or guardian can consent to the child's treatment. Other states permit minors to refuse treatment once they reach a specific age. Teenagers with bipolar disorder may have distorted thought processes in which they are unaware that they have any illness at all (this symptom is called "asonognosia"), or they may pronounce themselves "cured." They may strongly resist treatment even while their behavior is out of control. Such teens may not be competent to make their own medical decisions.

Minors treated in residential treatment facilities may or may not be forcibly returned to the facility if they run away. State laws, regulations and policies vary greatly. For example, in California minors who have reached age 14 are entitled to a hearing to determine if their parent can require them to remain in inpatient treatment. Before admitting your teenager to a facility, find out what rights minors in your state have should they want to be discharged.

If your child is at or near the age of majority, consider the use of an advance directive. This is a legal document in which a patient specifies what is to be done if that person is unable to make sound judgments concerning his or her own health care. It usually names another person to make decisions on that person's behalf. An attorney in your state should be consulted to prepare this document. A sample psychiatric advance directive is provided on the website of Bazelon Law Center, www.bazelon.org/advdir.html.

The enforceability depends upon state laws. In some states, consumers can revoke the directive at any time, including 


Back to top.


Disclosure of Medical Information

States have their own specific laws defining when medical information can be released. In the usual case, written consent of the patient is required. For a minor, the written consent of the parent or guardian may be required. The state in which you live may limit a parent's right to access his minor child's mental health records. In some states, a parent is not entitled to inspect or obtain copies of a minor's patient records if the minor is authorized by law to consent to his own medical treatment. Also, a parent is not entitled access to a minor's patient records if the treatment provider determines that access to the records would have a detrimental effect on the provider's professional relationship with the minor patient or on the minor's physical safety or psychological well-being. Some states may have more restrictive provisions regarding release of information about a patient involuntarily detained for treatment. For example, a patient involuntarily detained may not be able to access his or her own medical records if the treating physician deems such disclosure to be potentially harmful. There may be circumstances in which disclosure to third parties is required even without patient consent. In most states, a psychiatrist is required by law to warn a third party of a patient's substantial likelihood to cause that person imminent serious harm or death.


Back to top.


Finding an Attorney or Advocate

Important rights are at stake in the legal issues discussed here, and the outcome of these situations can have profound implications for your family and for your child's future. An attorney can be a valuable consultant; if you have not obtained the desired results through your own efforts, skilled legal representation will almost always help your cause.

You can hire an attorney either for an entire matter or as a consultant for a limited number of hours. Following is basic information on this process.

Q: Does hiring an attorney mean I'm going to be involved in a lawsuit?

A: Not necessarily. Legal disputes can often be resolved without litigation. Sometimes all that is needed is a phone call or letter from an attorney, clearly and authoritatively presenting the facts in light of your (or your child's) legal rights. If that doesn't work, mediation can be the next step to finding a resolution. If you do not want to sue, a responsive attorney should do everything possible short of litigation to advocate for you.

Q: What kind of attorney should I hire?

A: Always hire an attorney specializing in the particular area of your concern, such as juvenile law, family law, special education, insurance, employment, or civil liberties.

Your attorney should be trustworthy, accessible and easy to communicate with. Ideally, you should retain an attorney who is knowledgeable about pediatric bipolar disorder. Realistically, many attorneys will need to be educated about psychiatric illnesses, particularly in children.

Finding an attorney who is capable, knowledgeable about your local court system, and respected by peers is of utmost importance. If you find a skilled and reputable attorney willing to learn about bipolar disorder and its implications for your child, then you have made a good start. Regardless of the attorney's specific qualifications, all cases must be researched, and therefore an attorney's overall skill and experience is more important than having this specialized knowledge at the outset.

Q: How do I find a good attorney?

A: If your family can afford to hire a private attorney, here are some steps you can take to locate someone who is qualified.

  • Get a recommendation from your family attorney or another practicing attorney in your community.
  • Get a recommendation from another parent who has faced a similar or related legal problem.
  • Contact your local bar association. Many state and local bar associations have lawyer referral and information services that will provide listings of appropriate lawyers. Again, ask for a referral to an attorney with the specific expertise needed. Be aware, however, that referrals from the local bar association are sometimes simply listings of those attorneys practicing in the geographical area meeting certain minimal requirements and are not necessarily "recommended."
  • Contact a local nonprofit organization dealing with disability, mental health, or juvenile rights. Often such organizations serve as community resources for attorneys practicing in those areas of the law, and staff may be able to provide referrals.
  • The Martindale-Hubbell Law Directory lists more than 900,000 lawyers and law firms in the United States. Visit the Martindale-Hubbell Lawyer Locator at http://www.martindale.com/.

Q: What if I can't afford to pay for an attorney?

A: If your child is facing criminal charges where a jail sentence is a possibility and your family can't afford a private lawyer, your child or you may be entitled to free legal defense through a court-appointed attorney. This usually is done at the defendant's first court appearance, typically either an arraignment or a bail hearing. You may be able to get a pro bono attorney (fees are waived) through Justice Denied - Pro Bono Attorneys.

If you as a parent are facing a proceeding to terminate your parental rights and you cannot afford a lawyer, the court may, depending on the circumstances of your particular case, appoint an attorney to represent you at no cost to you. In civil matters, free representation for those families unable to afford an attorney may be available through the local Legal Aid office. See www.rin.lsc.gov/rinboard/rguide/pdir1.htm.

Q: Do I have any alternatives to an attorney appointed by the court?

A: Some attorneys and law firms will offer some services pro bono (for free, for the public good) or at reduced fees. You may wish to meet with qualified attorneys and ask if they would be willing to represent you or your child in a particular matter pro bono or at a reduced rate. In addition, many locallegal services agencies provide pro bono services to clients who meet certain case and income guidelines. A listing of such programs in all fifty states is available at http://www.lawyers.com. Such programs can be good referral sources, even if they cannot take your case.

Q: What exactly is an advocate, and how can I locate one?

A: Although not a substitute for an attorney, a trained parent advocate can help keep your family's legal expenses more manageable. A parent advocate is an interested layperson (often another parent of a child with a disability) who is trained to help you maneuver through any legal process involving your child. You can find a listing of parent advocates at the Web site of the Council of Parent Attorneys and Advocates (COPAA).

Each state runs a Protection and Advocacy Agency for Persons with Developmental Disabilities funded by the Federal Center for Mental Health Services. These agencies advocate for the rights of people with mental illnesses and ensure the disabled full access to educational programs, financial entitlements, health care, accessible housing and productive employment opportunities. A state-by-state listing of advocates is available at http://www.protectionandadvocacy.com/aboutus/PA_CAP.htm. Additional advocacy programs and resources can be found at http://www.bazelon.org/what.html

Q: What should I expect and how do I prepare for my initial consultation with an attorney?

A: It is common, but not universal, practice among lawyers to provide an initial consultation at no cost. You can use this meeting to both outline the situation with which you need assistance and to determine if the lawyer is someone you want to handle your case. Ask about the lawyer's knowledge of mental health issues in general and specific experience with the type of legal problem you need help with. Find out the lawyer's initial impression regarding possible approaches to the matter, and the possible outcomes.

Inquire about rates, an estimate of the total bill, whether the attorney will handle the matter personally or involve associates, and how the attorney typically communicates with clients (email, letters, telephone) about the progress of the case.

If you have any correspondence or other documents concerning your particular situation, your attorney will need to see them, so it is a good idea to bring copies or send them before the initial consultation.

Because attorneys usually bill by the hour, you can save money by helping your attorney find resources for learning about pediatric bipolar disorder. Refer him or her to the The Balanced Mind Parent Network Library for information and references or provide materials printed from this Web site. You may also want to give or loan your attorney relevant reference books. To the extent you can, educate yourself about the legal issues of your situation. The more background you acquire, the less time your attorney will need to spend educating you.


Back to top.


Legal Resources and Links

Student Mental Health and the Law
This guide is geared towards college faculty and staff, but provides information helpful to students transitioning to or currently attending college, and their parents. Provides clarification of FERPA, disability law and other legal issues colleges face. Incorporates the most recent pieces of legislation that impact student mental health:  the Americans with Disabilities Act (ADA) Amendments Act of 2008 and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

International Survivors Action Committee
ISAC is a watchdog organization, focused on exposing abuse, civil rights violations and fraud perpetuated through privately-owned facilities for juveniles.


Back to top.


Suggestions for Workers in the Juvenile Justice System

Suggestions for Workers in the Juvenile Justice System

  • Suspect bipolar disorder in all children who come through the system, particularly those that carry diagnoses of conduct disorder and substance abuse.
  • Learn how to recognize symptoms of pediatric bipolar disorder. Request a psychiatric work-up with a child psychiatrist who specializes in pediatric bipolar disorder and forensic psychiatry.
  • Understand that the child's behavior may not be deliberate or malicious, but instead may be a symptom of the disorder.
  • Be aware that the child's negative behavior may become exacerbated under the stress of being in the juvenile court system.
  • When considering sentencing recommendations, understand that placement in a jail or a juvenile detention center is not in the best interest of a child with bipolar disorder. In fact, many psychiatrists believe that this type of punishment is inhumane. A child with bipolar disorder needs treatment and care rather than punishment.
  • When assigning community service to teenagers with bipolar disorder, consider the physical limitations of the condition such as heat intolerance, frequent migraines, and anxiety.
  • Keep in mind that "one size fits all" probation requirements often don't work with youths with bipolar disorder. This is especially true when the requirements involve academic performance. Probation requirements need to be customized for each child.
  • If a child is taking medications for bipolar disorder, be aware of the need to continue medication while in detention.
  • Be selective in your treatment and treatment facility recommendations for a bipolar child. Options such as behavioral modification and survival camps, even if successful in altering behavior of other juvenile offenders, may not be effective with, and may be quite harmful to, children with bipolar disorder. These children often need to have their condition stabilized with a combination of several medications and cognitive therapy.

Back to top.