SCOTT SIMON, HOST:
Dozens of children in Maryland's foster care system are being left in psychiatric hospitals for weeks or months and not for any medical reason. Rachel Baye of member station WYPR reports that local social service agencies don't have anywhere else for the children to go.
RACHEL BAYE, BYLINE: I find Amber (ph) in a small, windowless conference room. She wears sweat pants, a T-shirt and socks - no shoes.
AMBER: I just don't feel like wearing shoes.
BAYE: Amber is a teenager. We're not using her name to protect her privacy. She's in Maryland's foster care system. And she was brought to this psychiatric hospital after she tried to kill herself. 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 doesn't have another place for her to go. She missed Thanksgiving, Christmas and her birthday. She hasn't been outside. She has no school, except for an hour and a half of tutoring each day. She says most days are the same.
AMBER: You wake up. You eat breakfast. And then you - I go back to sleep. But I don't know what you really do after that.
BAYE: She doesn't know when she will leave or where she will go.
AMBER: I really don't care as long as long as I leave this place.
BAYE: Carroll McCabe leads the mental health division of the Maryland Public Defender's Office. Her office represents Amber and other children in social services' custody who are involuntarily committed to psychiatric hospitals. She says a couple of years ago, she began to notice that social services workers were increasingly taking children from foster care placements to emergency rooms. From there, doctors sent them to inpatient psychiatric hospitals.
CARROLL MCCABE: When the children got onto the inpatient psychiatric units, the pediatric psychiatrists were evaluating the children. And in some cases, the pediatric psychiatrists found that the children didn't have a mental illness or that the child wasn't dangerous. And they contact - they would contact DSS because they wanted to discharge the children. 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.
BAYE: Even after a judge rules that there is no medical reason for a child to stay in the hospital and orders them discharged, some stay for several more weeks or even months. McCabe recalls 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.
MCCABE: And I just remember him crying and crying and asking me why this was happening.
BAYE: McCabe says there have been at least 85 of these children in Maryland since the beginning of 2018. The Department of Human Services, the state agency that oversees the system, acknowledges dozens of children staying longer in hospitals than they need to. But they point out that the problem affects a small portion of the roughly 4,500 children in the state's foster care system.
GREG JAMES: And it's not that that's not significant.
BAYE: Greg James is the Department of Human Services' deputy secretary for operations.
JAMES: We're dedicated to ensuring that 100% of our youth have appropriate placements. But I think it's also important to focus on the scope of the challenge.
BAYE: When it comes time for discharge, James says 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.
JAMES: 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.
BAYE: The challenges for Maryland's foster care system are shared by almost every state in the country. Marcia Lowry is the director of A Better Childhood, a national advocacy organization. She says states lack good options for children with any mental health needs, which, she says, is most children in social services care.
MARCIA LOWRY: A lot of these kids are kids who would not have had the serious mental health problems that they display by the time they get into a psych institution if they had been in a proper placement to start with.
BAYE: Lowry says states are leaving children not just in psychiatric hospitals but also in homeless shelters and juvenile detention facilities. Those states can't force foster homes to take children. Lowry says they can provide support for those that do. But that support requires time and money. For NPR News, I'm Rachel Baye in Baltimore.
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SIMON: And if you or someone you know struggles with thoughts of suicide, you can call the National Suicide Prevention Lifeline at 1-800-273-8255, or text the word HOME to 741-741. Transcript provided by NPR, Copyright NPR.
