Most of Amber’s days for the last three months have followed the same schedule. The teenager wakes up, eats breakfast, then sleeps until lunch, sometimes dinner. That’s how she spent Thanksgiving, Christmas, and her birthday. She doesn’t go outside or talk to many people, and the only school she gets is about an hour and a half of tutoring each day.
Amber is in Maryland’s foster care system, but she was admitted to a psychiatric hospital in mid-October, shortly after she tried to kill herself. WYPR is not using her real name to protect her privacy.
A judge ruled in late October that it was not medically necessary for her to stay in the hospital. But the local Department of Social Services responsible for her care had nowhere else for her to go.
As of the beginning of February, she was still there. She didn’t know when she would leave or where she would go.
“I really don’t care as long as I leave this place,” she said.
Amber is among dozens of children in Maryland’s foster care system who have spent weeks or even months in psychiatric hospitals without a medical reason because social services workers say they don’t have anywhere else to place them.
Carroll McCabe, chief of the mental health division of the Maryland Public Defender’s Office, said she began noticing an increase in the number of children social services workers were taking from foster care placements to emergency rooms.
“The Department of Social Services was filing emergency petitions alleging that these children had mental illnesses, and derivative of their mental illnesses, they were dangerous,” explained McCabe, whose office represents Amber and other children in social services’ custody who are involuntarily committed to psychiatric hospitals.
When the children arrived at the psychiatric units, “in some cases, the pediatric psychiatrists found that the children didn't have a mental illness or that the child wasn't dangerous,” McCabe said. “And the Department of Social Services would refuse to pick up the children because they said they didn't have any place else to put the children.”
Anyone who is involuntarily committed in Maryland gets a hearing before an administrative law judge to determine if there is a medical reason for their continued stay in the hospital. But even after judges rule at these hearings that the children should be discharged, some stay for several more weeks or longer.
McCabe recalled an 11-year-old boy whose doctor was trying unsuccessfully to get him discharged. A judge said he should be released, but Social Services wouldn’t pick him up.
“I just remember him crying and crying and asking me why this was happening,” McCabe said. “It's just tragic.”
McCabe says there have been at least 85 of these children in Maryland since the beginning of 2018.
The Maryland Department of Human Services, the state agency that oversees the system, acknowledges dozens of children staying longer in hospitals than they need to. But agency officials point out that the problem affects a small portion of the roughly 4,500 children in the state’s foster care system.
“It's not that that's not significant,” said Greg James, the Department of Human Services’ deputy secretary for operations. “We're dedicated to ensuring that 100% of our youth have appropriate placements that are both safe and beneficial to them, but I think it's also important to focus on the scope of the challenge that we're facing.”
When it comes time for discharge, James said most children won’t go directly to a foster home. They need the higher level of supervision they can get at a residential treatment center.
But there are waitlists for the roughly 350 spots at those facilities in Maryland. Some children — like Amber — end up on waitlists at out-of-state facilities.
“Some of the youth have such specialized needs that it is difficult to have a huge capacity of those beds available anywhere in the country, and so in those cases we do struggle,” James said.
The challenges for Maryland’s foster care system are shared by almost every state in the country.
Marcia Lowry, director of the national advocacy organization A Better Childhood, said states lack good options for children with any mental health needs — which describes most children in social services’ care.
“A lot of these kids are kids who would not have had the serious mental health problems they display by the time they get into a psych institution if they had been in a proper placement to start with,” Lowry said.
She said states are leaving children not just in psychiatric hospitals, but also in homeless shelters and juvenile detention facilities.
Though states can’t force foster homes to take children, Lowry said, they can provide support for those that do.
“If, for example, the child needs individual therapy, if the child needs a special school, if the child needs daycare, there are many wonderful people who will take in a child and work with a child, provide a stable home, a foster home, for the child if they can get sufficient services for the child,” she said.
But those services require time and money that many states’ child welfare systems can’t or are not willing to part with.