In sickness and in health

The pressure is on to find more adoptive
parents in the run-up to new adoption legislation hitting the
statute book. But, asks Natalie Valios, will this mean agencies
accepting people who they would previously have rejected, people
with health problems and perhaps mental health problems?

If you believe everything you read,
politically correct social workers have rejected thousands of
prospective adoptive parents purely on the basis of weight, age and
smoking. But professionals argue that there’s always more to a
rejection than that.

Now, the publication of the Adoption Bill last
month has paved the way for the government’s push to increase local
authority adoptions by 40 per cent by 2005. People willing to adopt
– particularly to adopt older children or children with problems –
have always been scarce, so how and where are local authorities
going to find enough to meet these new targets?

And if it’s going to be a desperate scramble
to attract and retain families, are health issues such as smoking
going to be deemed less important when professionals make their
final decision? What about people with mental health problems, or
who have a reduced life expectancy as a result of cancer or
inherited diseases?

The government has, so far, been enigmatic
about what it expects to happen. The white paper gives weight to
one myth when it states: “There have been cases where potential
adopters have been told they can’t adopt solely because they are
too old or because they smoke. Blanket bans of this kind are unjust
and unacceptable. Each case should be judged on its merits and the
needs of children considered – the important thing is to ensure
that adopters can offer children a safe, stable and loving home
through childhood and beyond.”¹

And while the national adoption standards
state that people should not be automatically excluded on age or
health grounds, the decisions are left to medical advisers who will
inevitably differ in their opinion of what is an “acceptable”
health risk and what is not.

This variation is already endemic in the
system. Maureen Crank is chief executive of After Adoption, an
agency offering support to children, adopters and birth families.
She knows of one couple who were turned down because one partner
had dwarfism. A different adoption panel accepted their
application. Another couple was rejected because the man had
suffered several heart attacks – again another panel approved
them.

But as Mary Mather, chairperson of British
Agencies for Adoption and Fostering’s medical group, points out in
the organisation’s latest journal: “Parenting involves more than
good health.”² Medical reports given to panels to assist
in the matching of prospective parents with vulnerable children
must not be used to exclude all but the very fit, she argues.

Social workers may also bear in mind that the
stress that a couple is put through when one partner has an illness
such as cancer could lead to a strengthened relationship, which
could prove invaluable in a future parenting role, Mather suggests.
But it could also be a destructive experience, leaving the couple
emotionally vulnerable and searching unrealistically for a solution
to unresolved personal issues through adoption.

Social workers and medical advisers need to
consider carefully the “illogical situation” of rejecting a
healthy, well-motivated applicant because of health problems in
their partner, she warns.

At Nottinghamshire Council, the practice is to
look at people’s capacity to parent before scrutinising issues
related to their health, says adoption manager Meg Staples.

Occasionally, there are clear cut reasons for
ruling out potential adopters. One couple wanted to adopt because
one of them had cancer and just six months to live. They felt that
a child would cement their last few months together. It was obvious
the child’s needs were not paramount, says Staples, and they were
sensitively turned down.

Children being placed for adoption have
already experienced the loss of at least one birth parent, Staples
argues, and if they have also been frequently moved they will have
had to cope with additional losses. If an adopter has a short life
expectancy, putting a child through the trauma of that placement
would not be considered. But, as she points out, you can’t protect
children from every kind of loss – in the past year, one of
Nottinghamshire Council’s adopters was killed in a road accident
and another developed breast cancer.

If the reasons for turning down adoption
applicants aren’t clear cut, medical advice is sought at the
beginning of the process. This is the case for candidates with
significant neurological illnesses including multiple sclerosis, or
those with complex medical needs and disabilities.

With less complicated health issues applicants
attend an adoption preparation group before having a medical.

“We wouldn’t cancel out on age, smoking or
health alone unless they were seriously impacting on lifestyle.
Although they wouldn’t necessarily affect approval, they would
affect the kind of child that would be placed with them and how
they would meet that child’s individual needs,” says Staples.

During their assessment, individuals are
questioned about their attitude to their health difficulties, and
how they respond to them. The family’s support networks are
explored rigorously to ensure that a child has others to turn to
should they be needed.

An audit of Nottinghamshire Council’s adoptive
families last year found that 13 per cent had significant weight or
health issues, including spina bifida, diabetes and heart disease.
They are all managed, rather than chronic, conditions. Some had
mental health problems, including stress and anxiety attacks, and
some were on medication to maintain good mental health.

Not long ago a mental illness such as
depression would have been a valid reason for turning a potential
adopter down, says Jeanne Kaniuk, head of adoption for Coram
Family, an independent adoption agency. But nowadays, many people
who suffer from depression are maintained on anti-depressants so
the policy has changed accordingly.

“You would have more confidence in somebody
who has the forethought to notice they are feeling under the
weather, seek medical advice and follow it, than in someone who
thinks they can manage without appropriate help,” says Kaniuk.

Where people with health problems might have
been turned away a few years ago, this now happens less frequently.
It doesn’t reflect a drop in standards, she says, but an
advancement in medical science that has improved people’s outlook.
“I have no reason to think that local authorities are less
vigilant, they seem to be extremely responsible in the way they
look for potential adopters.” Kaniuk says there is no indication
that social services will accept people they would previously have
rejected as a result of the drive to find more adopters.

In Nottinghamshire, Meg Staples acknowledges
that social workers are worried that families with health problems
could be second best. But she insists it has to be the first
choice. “We have to challenge our own values about what constitutes
a good family. There are all sorts of variations and this is just
one.”

A child needs to be well prepared if the
decision is taken to place them in a family that is perceived to be
“different”. Adoption panels need training to think about the
possibilities of families they may not normally have
considered.

“At the end of the day we are talking about a
balance of risks. I don’t think anybody would want to place
children where risks would automatically lead to a disrupted
placement or poor parenting,” says Staples.

But she believes it can occasionally be worth
taking a risk because it offers the chance of a good family to a
wider range of children. And sometimes, an illness can be a
positive linking factor, say if an asthmatic or diabetic adopter
takes on a child with the same illness. In fact, Nottinghamshire’s
13 per cent of adopters with their own health needs took a higher
proportion of children with complex needs than adopters with no
health issues.

As Staples says: “If the assessment is sound,
the child is well-prepared and the matching is well-founded in
matching both needs, but primarily the child’s, then the placement
becomes a positive first choice.”

¹ Department of Health,
Adoption: A New Approach, Stationery Office,
2000

² Mary Mather, “Health
issues for substitute carers”, Adoption and Fostering, British
Agencies for Adoption and Fostering, Autumn 2001