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As of this year, there are 800,000 children in foster care in the United States.  Most of those children are removed from their birth homes due to severe neglect, abuse or trauma.  When children spend the early years of their lives in traumatic or neglectful situations, they are more likely to develop mental health issues.  Not surprisingly then, foster care alumni (adults who grew up within the foster care system) have disproportionately higher rates of mental health issues.  However, according to a study found in Child Welfare, the actual rate of mental health issues and comorbid physical symptoms floored me.  In comparison to the general population, where 64% experiences depression that is comorbid with other mental health issues or physical symptoms like heart disease, cancer, or diabetes, 98% of foster care alumni experience comorbid depression.  94% experience comorbid Post Traumatic Stress Disorder.

Even when children are removed from traumatic situations early, they continue to deal with significant consequences of that early trauma as adults.  Granted, it should be expected that children who came from abusive or traumatic situations have behavioral or mental health issues.  (I don’t say that as a matter of judgment, simply as a matter of survival.*)  However, I would think that when children are removed from their homes and put into the child welfare system, regular mental health checks and timely follow-up would be mandatory.  Apparently, timely follow-up may be the missing piece of the puzzle.  75% of children who enter the foster care system with serious and obvious clinical impairment will not have received mental health service 12 months following their intake.

In light of these sobering statistics, child welfare systems are expanding their services.  Treatment Foster Homes and additional services are becoming more readily available.  When these children have access to mental health coverage through their insurance, they use it.  In California, although children in foster care represent only 4% of the state-sponsored health insurance, they use 43% of all expenditures.  Expanding the availability of mental health coverage would seem to be a necessary portion of the solution.

Pecora, P.J. Jensen, P.S., & et. Al (2009). Mental health services for children placed in foster care: an overview of current challenges.  Child Welfare. 88(1).  5-25.

July 2020