Last fall, a 15-year-old foster child in Kansas took his own life. According to a local news report, the boy’s foster family “immediately called for help when they discovered the teenager, but paramedics couldn’t save him.”
The Kansas City Beacon reported that the agency that was overseeing the placement, KVC Kansas, did not meet the state’s guidelines for providing mental health treatment for the children under its supervision who needed it. According to the Beacon, the agency came closer than many others that operate in Kansas, but the mental health needs of foster youth are so substantial that many states struggle with the problem — sometimes with tragic results.
A new study from the Institute for Family Studies sheds some light on what is happening. According to the report, “Families Matter to Kids’ Mental Health” by Nicholas Zill, there are about 8 million children in the U.S. who need psychiatric attention each year, 82% of whom received it, but children in foster care need a lot more.
The need for treatment, Zill notes, varies significantly across family structure.
“Children who lived with both their married birth parents were least likely to need or receive counseling” — only about 14% needed it and 12% were getting it. Kids living with single mothers needed more mental health help. But it was children and adolescents who lived apart from both parents who fared the worst. Of those living with relatives besides grandparents or living in foster care, 37% were getting care and another 7% needed it.
What is happening in the lives of these kids? The benefits of living with two biological parents have been documented many times. But what is it specifically that leads to mental health problems when that situation is not available? When parents split up, the stress and anxiety that kids feel will inevitably increase. But as Zill points out, “most are able to adjust and do reasonably well.” But for other kids, Zill suggests there may be “longer-term maladjustment.”
This can manifest in criminal behavior, substance abuse, and premature sexual involvement and parenthood, as well as dropping out of school and unemployment. The abuse and neglect experienced by children before they enter foster care is, of course, the primary trauma that may be producing these results. Children who don’t know whether their parents will care for them, whether they will leave them for long hours without supervision, or whether they will physically or sexually abuse them do not know how to form the kind of relationships necessary for stable adulthood.
And foster care cannot fix much of this, particularly if kids have been left in abusive or neglectful homes for long periods of time or if, once in foster care, they jump from home to home. Mental health treatment is an important part of the equation. But there is a significant provider shortage in this country. Even middle-class and well-off parents who just want their teens seen by a therapist often find that providers don’t take insurance or that waiting lists for appointments are miles long. For foster kids who are on Medicaid, it can be even harder. Keeping the same provider even while they go to different foster homes can also be difficult. Some foster parents have told me they have paid out of their own pockets to make sure the kids in their home have access to mental health treatment.
In too many cases, foster children’s behavioral problems (like those of other children) are treated very quickly with drugs. Not only is therapy more costly and harder to arrange, but foster kids, unlike kids living with their biological families, sometimes don’t have adults who are willing to put up with difficult behavior in order to keep them on fewer medications.
The kind of mental health treatment they receive is also important. Unfortunately, because there are people who like to use the child welfare system to advance a political agenda, many foster kids who have challenges like anxiety and depression or even bipolar disorder are being treated instead for gender dysphoria. It is not uncommon to hear child welfare experts say that transgender youth are overrepresented in foster care — the implication being that their parents have rejected them in part because of their gender identity. But these are often kids with other significant mental illnesses and rather than treat those first, states are authorizing doctors to treat them with drugs or even surgeries. In some states, potential foster parents who don’t support this kind of treatment are prevented from caring for these kids at all.
The crisis in youth mental health — particularly since the pandemic — is now widely acknowledged. But there is a danger in throwing all of kids’ problems into one bucket. Some children, because of their home environment and family structure, have it much worse.