JAN YOCUM deCalderon's daughter Tina was a handful. Afflicted with cerebral palsy, prone to narcissistic outbursts, she suffered from depression. Over the years, mother and daughter had managed to tame the girl's rage. But on a May afternoon three years ago, 16-year-old Tina lashed out at her mother, beating her about the legs. The assault led to a choice Ms. deCalderon never imagined she would have to make.

Police arrived and Tina ended up in a Howard County psychiatric hospital. When the hospital tried days later to discharge Tina, Ms. deCalderon resisted. Her daughter couldn't possibly be ready to come home; besides that, the single mother was to undergo heart surgery. And there was the safety of her three other disabled children to consider. Ms. deCalderon eventually had a choice: take Tina home without help or face giving up custody of her daughter to the state.

It was a decision Jan Yocum deCalderon didn't want to make. It is a choice no parent should have to make.

But it is one faced by dozens and dozens of parents across Maryland. Just ask Denise Leachman, who faced a similar decision when a Towson hospital wanted to discharge her 11-year-old son who had threatened suicide. Or Diana Miller, whose 12-year-old daughter Erica suffers from bipolar disease.

In a report to be released today, the Maryland Coalition of Families for Children's Mental Health says more than 200 families annually have in fact surrendered their children to the state to get them the mental health services they critically need. And that number may be low: Maryland's social services agency doesn't have the technological capability to identify the number of these children in its system.

But, regardless of the numbers, the report, "Relinquishing Custody -- An Act of Desperation," raises a salient point: The parents of these children aren't abusive or neglectful, but they often must bear that stigma to ensure that their children receive treatment.

Ms. deCalderon had to go to court to have her name removed from a registry of neglectful parents. Unable to care for her daughter at home without assistance, she relinquished custody of Tina to the state. Today, Tina remains in a therapeutic foster home on the Eastern Shore under a system that provides foster families with the kind of in-home help Ms. deCalderon desperately sought.

But as a medical assistance recipient, Ms. deCalderon couldn't get those services. In many custody-related cases, parents are dealing with private insurers over the treatment of their mentally ill children.

When a crisis hits, a parent often is caught between a child's needs and an insurer that won't pay. Then the family finds itself at the mercy of an overburdened system with too few facilities and options to care for critically mentally ill children. Health care providers operate under managed care, which can exacerbate a situation. Often, the result is that a child is placed in the custody of a state agency whose primary mission is the well-being of abused and neglected kids, not mentally ill ones. And officials, in turn, face a myriad of federal and state regulations that can frustrate their efforts to get children the care they need.

Should any family with a child in such distress, with such dire needs, have to confront these hurdles?

Of course not, say state officials. No, they shouldn't, say social workers and mental health counselors. Absolutely not, say child advocates. But if everyone is in agreement, then what's the problem?

Plenty.

Start with the lack of parity in health care benefits for physical and mental health needs. The system is geared toward expensive in-patient mental health care when assistance at home could help keep children with their families.

Then there's the lack of community-based programs for children with these special needs. Add to that a lingering dispute over which state agency is best equipped to oversee the needs of these kids.

And the problem isn't exclusive to Maryland; everyone agrees on that.

In Maryland, the problems of these children came to the attention of state officials as long ago as 1996, only then the issue was the confinement of kids in psychiatric facilities. Over time, there have been work groups and meetings, roundtables and reports trying to deal with this matter.

The bureaucrats have focused on the immediate needs of children and quick remedial fixes to fill in service gaps. But what's really needed is a systemic change in policy.

On the campaign trail, Rep. Robert L. Ehrlich Jr. pledged to abolish the practice of parents having to relinquish custody of their children to get them help. But a signature on an executive order won't provide needed facilities or funds for this problem. It won't persuade the federal government to relax its rules to include more children in its safety net or expand services for them. And, more important, it won't change the bureaucratic culture that often contributes to the problem.

Electing to systemically change the way Maryland deals with these special-needs children is a decision Maryland leaders must no longer put off. They must do it for Tina, they must do it for Erica, they must do it for us all.