When James McIntyre left the foster care system at age 21, he said good riddance to therapy. It had never helped him much, and it felt like a chore.
“Therapy was thrown at me. If you’re not in therapy, you are not in compliance and you get points taken away from you,” said the 28-year-old Chicagoan, who says he lived in every type of foster care placement, from group homes to adoptive family homes. “It was never an option, and I never got to choose the type of therapist I wanted.”
McIntyre needed services for his post-traumatic stress disorder but practically drowned in one-size-fits-all programs.
“The basic run of the mill sit-down for an hour with a therapist, then leave, that is stressful to me. I had a therapist tell me ‘I don’t care if you talk, I still get paid.’ Even though I didn’t say a word after that, he still got paid.”
That’s why he dropped his meds and his therapists, and hasn’t gone back since — partly out of fear, despite his continuing need. That’s also why he wasn’t surprised to hear the dismal results of a new study that surveyed hundreds of 17-year-olds in foster care about their experiences with mental health services.
The paper, published this week by the peer-reviewed Journal of Adolescent Health, found a high percentage of foster teens do not feel fully prepared to manage their own mental health upon entering adulthood, despite high rates of medication and mental health service use.
“As far as we know, this is the first study to ask 17-year-olds in foster care how prepared they feel to manage their mental health,” said New York University social work professor Michelle Munson, the study’s lead author, in a statement.
One-fifth of the 727 teens surveyed felt less than prepared to manage their mental health after leaving care, even though half of them were using therapy or counseling services and almost a third were using medication. The study also echoes McIntyre’s story about blanket services: “Child welfare providers … may refer all child welfare involved youth to mental health services, even when there may not be an overt need or an interest on the part of the youth.”
“The fact a lot of them identify this preparedness issue, despite how many services they receive, suggests we’ve got work to do,” said Mark Courtney, Samuel Deutsch professor at the University of Chicago, and one of the paper’s co-authors.
After leaving care, foster youth face obstacles to navigating the mental health system, often without a network of adults who can help them figure things out. A 2018 report from New York City’s child welfare agency found only 53 percent of foster youth leaving care were able to secure Medicaid immediately, even though Medicaid is guaranteed through age 26 for any youth who has aged out of foster care.
Munson and Courtney’s study suggests young Americans in foster care — who may have the highest need for care due to traumatic upbringings — may not feel ready to navigate those hurdles.
There were significant differences depending on demographics. The authors highlight that the youth who described having a mental disorder actually felt less prepared to manage their own mental health. And youth who identified as “less than 100% heterosexual” were also associated with feeling less prepared, despite receiving more services.
The paper’s five co-authors analyzed responses to a five-year survey project on the experiences of California’s transition-age foster youth. All of the respondents were paid $60 for a 75-90-minute confidential interview, had been in care for at least six months, and would soon have to prepare to leave care for adulthood.
A third of the respondents came from Los Angeles County, and rest were from a mix of other populous or rural counties statewide. At least half of the youth were using mental health services, “even though only 38% met criteria for a mental disorder,” read the study.
While short on recommendations, the paper points to one possible adjustment child welfare systems could make: embedding greater support within established independent living programs.
Michael Fitzgerald can be reached at firstname.lastname@example.org.