A significant proportion of the children who come into state child welfare systems have mental health disorders – between 40 and 60 percent have at least one psychiatric diagnosis and about a third have three or more mental disorders. Mental health service use by children in foster care is eight times higher when compared with other low-income youngsters on Medicaid. Use of mental health services increases with age, and fully 90% of youth in foster care receive mental health services. Moreover, these young people often receive multiple psychotropic medications, and heavy psychotropic medication use among very young children in foster care is very high in certain states.
While some degree of psychological distress is likely to result from placement in foster care (and moving repeatedly from one foster home to another), a substantial subset of these children have serious mental disorders that are manifest before placement. In some cases, their parents have relinquished custody or signed a voluntary agreement for the placement. In 2001 the General Accountability Office (GAO) documented over 12,000 cases of children being placed in child welfare or juvenile justice systems only for the purposes of accessing needed mental health services that their families could find no other way. Of these, nearly 4,000 were placed in child welfare systems.
The Bazelon Center believes that children should, wherever feasible, stay with their own families and receive an intensive array of effective mental health services. Unfortunately, such an array is generally only covered by Medicaid and many of these children are in families that do not qualify. An expansion of states’ child mental health services is desperately needed, along with improved coverage of the most effective services in Medicaid for children who qualify for that program. Private insurance should also cover not only therapy and hospital services for these children, but also intensive in-home services, therapeutic foster care and other wraparound services in the community.
For more information on services for children in the welfare system, see Therapeutic Foster Care and Wraparound Services.