Foster Care and Suicide

“Elliott Hinkle experienced depression and suicidal thoughts even before entering the foster care system in Casper, Wyoming, at age 15.

At the time, Hinkle, who is transgender, struggled with their sexual identity and gender issues, and their difficulties continued in foster care. They felt like they had no one to confide in — not their foster parents, not church leaders, not their caseworker.

“To my knowledge, I don’t remember ever taking a suicide screening,” Hinkle said. “No one ever said: ‘Are you having thoughts of taking your life? Do you feel hopeless?’”

“With their psychological and behavioral health needs left unaddressed, Hinkle’s depression and suicidal thoughts worsened.

“Do I stay in the closet and feel terrible and want to end my life?” Hinkle said. “Or do I come out and lose all my supports, which also feels dangerous?”

Children in foster care are significantly more likely to have mental health issues, researchers say. They attempt or complete suicide at rates three to four times that of youths in the general population, according to several studies.

LGBTQ+ people in foster care, like Hinkle, are at an even higher risk of having suicidal thoughts.

Yet despite the concentration of young people at risk of serious mental illness and suicide, proactive efforts to screen foster children and get them the treatment they need have been widely absent from the system. And now, efforts underway to provide widespread screening, diagnosis, and treatment are threatened by sweeping funding cuts the Trump administration is using to reshape health care programs nationwide.

In June, federal officials announced they would shut down a suicide hotline serving LGBTQ+ youths as part of those cuts.

Children in foster care use a disproportionate amount of Medicaid-funded mental health services. Meanwhile, President Donald Trump’s massive budget package working its way through Congress contains substantial shifts in Medicaid funding and policies that are projected to drastically reduce services in many states.

“I think anybody who cares about kids’ well-being and mental health is concerned about the possibility of reduced Medicaid funding,” said Cynthia Ewell Foster, a child psychologist and clinical associate professor in the University of Michigan psychiatry department. “The most vulnerable children, including those in foster care, are already having trouble getting the services they need.”

A lack of federal standards and other system-level issues create barriers to psychological and behavioral care in the child welfare system, said Colleen Katz, a professor at Hunter College’s Silberman School of Social Work in New York.

“When you’re talking about anyone getting screened for suicide ideation upon entrance into the system, it’s inconsistent at best,” she said.

Katz said all children entering foster care should have a brief, standardized suicide screening embedded into their initial medical assessment. And more screenings need to be conducted throughout a foster care stay, she said, because youths getting ready to transition out of the system are also vulnerable.

Hinkle, now 31, said the summer before they aged out of the system was “one of the darkest periods, because I was coming to terms with the church not wanting me to be gay and I was about to lose stable housing and whatever foster care support there was.”

Katz studied transition-age youths in foster care in California, which has the highest numbers of placements in foster care nationwide. According to her analysis, 42% of study participants had thoughts of taking their life and 24% had attempted suicide, and she expects findings would be similar in other states.

Katz also examined suicide screening tools and found many that already exist could work and be easily administered by trained child welfare workers or alternative frontline service providers, or embedded in existing mental health services.”

The foster care system has a suicide problem. Federal cuts threaten to slow fixes.
[Minnesota Reformer 7/3/25 by CHERYL PLATZMAN WEINSTOCK]

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