A 13-year-old boy in the custody of the Baltimore City Department of Social Services was admitted to an inpatient psychiatric hospital in September 2018. About two weeks later, an administrative law judge ruled that there was no medical reason for him to stay there. But Social Services didn’t pick him up for nearly four more months.
A similar thing happened to a 14-year-old boy in the custody of the Prince George’s County Department of Social Services in October 2018 and to a 14-year-old girl in the custody of the Baltimore County Department of Social Services in January 2019, according to data provided by the Maryland Office of the Public Defender, which represents children in this situation,
And there are dozens more children in Maryland’s foster care system with similar stories. They spend weeks, sometimes months, in psychiatric hospitals after doctors and even judges say they no longer need to be there because local Department of Social Services, or DSS, workers say they have nowhere else for them to go.
“Local DSS departments, they’re not removing children from hospitals even when judges are ordering it,” said Del. Brooke Lierman, who represents South Baltimore in the House of Delegates.
She said the DSS agencies sometimes ask a circuit court to overrule the administrative law judge, “simply because DSS doesn’t know where to take the child.”
Lierman is sponsoring state legislation that would prevent DSS from sidestepping the administrative law judges’ orders. The bill has a hearing Thursday before the House Appropriations Committee.
But the bill does not address the root cause of the problem — not having a place to put the kids.
“The degree of specialized service required to meet the particular needs of that youth exceed what is in most cases offered in state, and in many cases it's a struggle to find the appropriate services nationally,” said Greg James, the deputy secretary for operations at Maryland’s Department of Human Services, which oversees the state’s child welfare system.
In an interview last month, James said the kids who end up in psychiatric hospitals generally have needs that can’t be met in a foster home. He said the most appropriate placement for these kids is in a residential treatment center, a secure facility with around-the-clock care.
But there are only about 350 spots at these facilities in Maryland. Children vying for them end up on waitlists at facilities both in- and out-of-state.
“We've had situations where we have gone to multiple providers around the country and they have declined to take a youth before we could find the right placement,” James said.
In some of those cases, the children wait at psychiatric hospitals.
Lierman said she plans to amend her bill to increase the capacity at residential treatment centers to try to eliminate the backlog.
But residential treatment center beds are just one part of a complex situation, said Heather Iliff, executive director of the Maryland Association of Resources for Families and Youth, a coalition of child welfare service providers.
“Over the past decade, Maryland has been working hard to reduce the number of children in care,” Iliff said.
That’s something states around the country have been striving for and a new federal law encourages. The idea is that the money states save by reducing the number of children in their foster care systems should be spent instead on programs that support struggling families to prevent children from needing to be removed from their families’ care to begin with.
“But there have been some unintended consequences, which means that the children who remain in care are the children with the most severe needs, and the savings that would have been achieved by reducing the children in care was not reinvested into the system,” Iliff said.
Without proper mental health treatment, children’s needs grow more complex as they get older, Iliff said. But if Maryland were to invest more in mental health services for children who are still living with their families — or even when they first enter the foster care system — they might not end up in psychiatric hospitals to begin with.
