Teens leaving foster system may lack needed mental health care

Many teens and young adults who leave the foster care system don't get needed mental health services, a U.S. study suggests.

In many states, children who live in foster homes age out of this system by the time they turn 18 or 21, a transition that can leave some of them at least temporarily without access to health insurance or unable to continue care with doctors who were treating them before.

When researchers surveyed foster kids before they left the system, more than half of those with symptoms of behavioral health problems were receiving needed services, the study found.

But by the end of the follow-up, when all of them were out of foster care, only about one third of the young adults who needed mental health care were getting it.

"To a large extent, kids who age out of foster care and don't get behavioral healthcare services they need are harmed the same as anyone else who needs services and doesn't get them," lead author Adam Brown, a social services researcher at the University of Chicago, said by email.

"However, for many former foster care youths, the outcomes can be much worse without the family, community, and social supports present in the lives of most people who were not in foster care," Brown added.

Brown and colleagues analyzed four waves of survey data from 732 youths in foster care in Illinois, Iowa and Wisconsin.

The initial surveys were conducted from 2002 to 2003 when the teens were 17 or 18 years old. Three more waves were done when the participants were around 19, 21 and 24.

At the beginning of the study, 68 percent of the youth in foster care had at least one mental health problem, with depression and addiction the most common issues, the study found.

By the end of the surveys, 39 percent of them had at least one mental health issue. Depression was the biggest challenge, but symptoms of post-traumatic stress disorder were the second-most prevalent problem.

While about 61 percent of the youth with depressive symptoms received services at the start of the study, only 39 percent of them did by the end.

One shortcoming of the study is that the wording of survey questions used to measure whether the youth received services was changed over time, which may have led to some shifts in responses, the authors acknowledge in Children and Youth Services Review.

Even so, the findings add to a growing body of evidence on the challenges foster kids face accessing care after they leave the system, said Sonya Leathers, a researcher in social work at the University of Illinois at Chicago who wasn't involved in the study.

"Many youth exiting from foster care are unprepared to navigate service systems as they struggle with basic needs like stable housing and keeping a job," Leathers said by email. "With this instability, mental health needs are likely to go untreated."

The trouble with untreated mental health disorders is they can put these youth at greater risk for substance abuse, educational failure, imprisonment and homelessness, said Dr. Paula Kienberger Jaudes, medical director at the Illinois Department of Children and Family Services.

"Children and adolescents involved in the child welfare system are at greater risk for mental health issues than children in the general population because of histories of child abuse and neglect, separation from biological parents, or placement instability," Jaudes, who wasn't involved in the study, added by email.