Addressing the Mental Health Effects of Foster Care

When President Ronald Reagan established May as National Foster Care Month in 1988, he emphasized prioritizing the well-being of children in foster care and promoting placements that represent holistic care in all its forms (including mental health), not just custody. But despite the increase of children placed in foster care annually, Reagan’s vision of a system that provides safe, stable, and nurturing homes has yet to materialize fully.

The emphasis in foster care must be on the well-being of the child, and public policy must serve to promote alternative placement that represents actual care and not mere custody. — Ronald Reagan, Proclamation 5820

This year, the Children’s Bureau has dedicated this National Foster Care Month to ringing the alarm on the unique mental health challenges individuals with a history of foster care placement face. Their “Strengthening Minds, Uplifting Families” campaign trumpets support for the largest unmet health need for children and youth in care: mental health. Because youth in foster care often lack access to social support and mental health resources, state policymakers, child welfare leaders, and advocates must prioritize adopting a culturally responsive, trauma-informed, and holistic approach to supporting the needs of individuals with lived foster care experience (FCE).

For the more than 600,000 children that the foster care system serves annually, being removed from one’s family, school, and all that is familiar is a traumatizing event. Moreover, extensive periods of family separation, multiple losses, and uncertainty further erode children’s emotional and social well-being. And it’s no secret that these children are diagnosed with mental health illnesses at higher rates, 30 to 80 percent compared to approximately 22 percent, and are three-to-four times more likely to be diagnosed with a mental health disorder. Notwithstanding these disturbing trends, mental health continues to be the greatest unmet need for individuals with lived FCE — highlighting the need for a renewed focus on the holistic well-being of this underserved group.

If left untreated or undiagnosed, mental health challenges in children or young adults can deteriorate and become a greater risk to their physical and psychological health. For example, chronic exposure to maltreatment and a history of physical abuse are commonly found among children entering foster care — which directly correlates to suicide ideation or contemplation being more prevalent among children under state care. Moreover, approximately 26 percent of those in care reported a previous history of suicidal ideation, a rate nearly five times higher than their counterparts.

The good news is that there are practical steps that state policymakers and others can take to improve mental health among young people with lived FCE.

State policymakers should begin by requiring child welfare agencies to identify a mental health provider who can perform well-being screenings and assessments on every child and older youth in care. However, having a trained pediatric mental health professional conduct any mental health screening before prescribing psychotropic medication is crucial. During my decade-long research on college-going students with lived FCE, it was not uncommon to come across a young person who felt that they were mislabeled with a mental illness or disability and given medication they did not need.

“Policymakers … must prioritize adopting a culturally responsive, trauma-informed, and holistic approach to supporting the needs of individuals with lived foster care experience.”

Progress is underway in addressing mental health challenges in the foster care system. In my home state of Illinois, Governor J.B. Pritzker signed legislation in 2022 to tackle this issue. An amendment to the state’s Children and Family Services Act, HB4306 established a task force that prioritizes the input of individuals with lived FCE in developing targeted policies for mental health needs.

Several states have adopted a “foster care bill of rights” to center the voices and needs of young people, ensure they receive the advocacy they need, and combat the abuse and mistreatment that happens during foster care. For example, Arizona’s Bill of Rights grants youth under state care the right to be “free of unnecessary or excessive medication.” However, only about a third of states and Puerto Rico have enacted similar bills to promote equitable treatment. This statistic highlights the need for similar legislation nationwide.

Regardless of whether medication is needed to treat their needs, it is also vital that young people have access to trauma-informed care. And because most educators are unfamiliar with the unique and specific challenges young people in foster care face, more college and K-12 school district leaders should leverage unspent COVID relief funds to provide training and professional development opportunities to increase awareness, eliminate stigmas, and disrupt unconscious bias.

With the increased awareness of the cultural needs of BIPOC communities, the Child Welfare Information Gateway has curated numerous helpful resources to guide advocates in providing culturally responsive care and services. Improving access to culturally appropriate services are crucial given the overrepresentation of BIPOC communities in foster care and their oft-limited access to medical professionals with similar cultural backgrounds. This represents an urgent need for medical professionals trained in culturally responsive approaches to care.

Closing the gap in holistic care for young people with lived FCE necessitates ongoing advocacy and systematic policy changes. By implementing practical solutions such as mental health screenings and state-level foster care bills of rights, we can promote equitable treatment and ensure that young people receive the compassion, investment, autonomy, and advocacy they deserve. These are important steps but there is so much more to do. Together, let’s strive towards a foster care system that provides safe, stable, and nurturing homes for all children.

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