As a kid, Ed Shoemaker liked the outdoors. So when his mother suggested they go camping – putting him in the back of her SUV in the driveway with a blanket, flashlight and a book – he settled in, content. But police rapped on the car’s window later that night, and Shoemaker’s life suddenly changed. They found his mother in the house, “crazy drunk,” Shoemaker, 30, recalled. She claimed that the boy was not allowed to sleep inside.
It was February. In Massachusetts.
That was when Shoemaker entered foster care for the first time, at age 9. In hindsight, he believes his mother, who had multiple substance abuse problems, manufactured a scenario that would force authorities to take her son because she didn’t want the responsibility of caring for him. It wasn’t the first indication of trouble; she had been regularly dropping him at the Nantucket public library in the mornings and leaving him there until it closed. But as a child, Shoemaker didn’t understand why he had been removed from his home.
“That was the first time I tried to commit suicide,” said Shoemaker, who is now a political worker in Boston. He was nearing his 10th birthday at the time. “I said, ‘Screw this. I don’t want to be 10 years old.’ I was frustrated that I couldn’t see my mother, and I didn’t know why I was in foster care.”
The suicide of any child is a tragedy, but studies show children in foster care are four times more likely than other children to attempt to take their own lives. In one study of more than 700 California 17-year-olds in foster care, 41% reported they had thought about death by suicide and nearly one-quarter had attempted it. The situation has become even more dire in the COVID-19 pandemic. Yet the issue is under-examined by researchers and often lacks sufficient attention from policymakers and government agencies, experts said.
Much of what is known about suicide is based on adult samples or samples of children who are not in foster care, said Lily Brown, an assistant professor in the psychiatry department at the University of Pennsylvania who has studied the issue. “So to some extent, we have to extrapolate beyond the data, because it’s a really understudied population,” she said.
Suicide risk is correlated with depression, lack of social support and a history of trauma, maltreatment and abuse – particularly sexual abuse. Since maltreatment and abuse are among the top reasons children are removed from their homes, it is not difficult to understand why foster children are at such a high risk of suicide, experts said.
Despite the clear crisis, many foster care agencies do not have procedures in place to evaluate which children in their care may be at risk – a fundamental first step in preventing suicide. Brown, who published a January article in Perspectives on Psychological Science on suicide risk assessments for foster youth, said public welfare organizations are overwhelmed. “Everyone wants to make sure these kids aren’t dying by suicide, but in a system with not a lot of time and not a lot of resources, it often is not prioritized,” she said.
The COVID-19 pandemic has turned an urgent problem into a cataclysm. Irene Clements, executive director of the National Foster Parent Association, said social distancing requirements borne of the pandemic are causing a mental health emergency for foster youth.
Pleas from foster parents prompted the organization, for the first time in four decades, to present a training on suicide, Clements said. They held a webinar in September.
“The COVID situation has added way more than one layer of issues to these kids and these families,” she said. Not being able to go to school has shattered connections with friends. Even more harmful is that, in many instances, they have been prevented from seeing their birth families.
“This lack of being able to spend the time they need with their parents, grannies, brothers and sisters – which keeps them connected to who they are, their roots, their heritage, their customs – all of that is really harmful,” Clements said.
The organization has been advocating for changes that would permit visits, though exactly what it would take is unclear. “I don’t know what the answer is, but we’ve got to do something,” she said, “because these kids are spiraling.”
It wasn’t a pandemic that kept Kendrea Johnson from her birth family, but she mourned their absence after she was placed in a Minneapolis-area foster home in March 2014. According to a guardian ad litem’s report, Kendrea missed her family and expressed a desire to live with her grandmother. She frequently acted out, threatened to jump out a window to hurt herself and drew a picture of a stick figure with a rope around its neck.
In December of that year, Kendrea was found dead in a presumed suicide. She was 6 years old.
Her grandmother, Mary Broadus, filed a federal wrongful death lawsuit alleging that the foster parents, school officials and county authorities knew that Kendrea suffered from severe mental illness yet failed to look after her safety. Hennepin County settled with Broadus in 2018 for $1.5 million, and the state permanently revoked the foster mother’s license.
Nikki Farago, Minnesota’s assistant commissioner for children and family services, declined to comment on the case. She could not point to specific changes wrought by Kendrea Johnson’s death, but the county ruled she did not die of abuse or neglect.
Suicide among pre-adolescent children is relatively rare. Between 1999 and 2018, 1,751 children younger than 13 took their own lives, according to the Centers for Disease Control. But the numbers are rising precipitously; the rate in 2018 was almost triple that of 1999. And for young children in foster care, suicidality is alarmingly common.
Heather Taussig, a professor at the University of Denver, studied suicidal behavior among 515 9- to 11-year-old children in Denver-area foster care. She and her fellow researchers found over a quarter of the children had a history of suicidality, meaning suicidal thoughts and behaviors.
Typically, foster children in that age group were not being screened for mental health problems unless they exhibited significant behavioral issues, Taussig said. Kids who might internalize their pain instead of acting out could easily fall through the cracks, so such screenings are vital.
But they are not enough.
In a subsequent study, after researchers made recommendations to the children’s caseworkers when mental health services were needed, only half of those children were receiving services nine months later, Taussig said. “So while screening is really important, we also have to have the services available that are developmentally tailored and culturally appropriate … to be able to address significant challenges.”
The lack of services for foster children is indeed a major hurdle, said Hoang Murphy, the founder of Foster Advocates in St. Paul, Minn. “People have to wait six, seven months to get in front of a psychiatrist.” Then there’s not enough time for substantive talk; the focus is on dispensing a prescription.
“That leads fosters to distrust mental health systems and providers because their only experience is about regulation, how to make them docile – it’s not about healing,” he said.
The use of prescription mental health drugs led to one of the most-covered suicide cases in child welfare, the death of Gabriel Myers. The 7-year-old Florida boy hanged himself in his foster home in 2009, an incident that prompted statewide working groups commissioned by the state’s former child welfare director, George Sheldon. Gabriel had been prescribed several mind-altering drugs, including the antipsychotic Symbyax, which carries warnings of suicidal thoughts and is not approved for use in children younger than 10.
The broader use of telehealth during the pandemic could bring lasting change if more youth are able to access therapy appointments online, Murphy said. But what would be truly transformative, he said, is for treatment to include cultural healing.
Native American youth, for example, who are cut off from their cultural roots when they enter foster care, need to receive traditional health and healing methods from tribal events like powwows and sage ceremonies. Kids get the message, through these experiences, that they are welcome: They are part of a larger whole, Murphy said.
Shoemaker, the former Massachusetts foster child, survived several suicide attempts. He graduated from college and has worked on a number of political campaigns; he currently serves as a steering committee member at Foster Youth for Joe Biden. He also volunteers as chapter leader of Foster Care Alumni of America – Massachusetts.
What foster children need in a mental health crisis is compassion, he said. What they too often find is defensiveness and fear. “You’re turned into a hot potato because nobody wants to deal with the liability of having somebody kill themselves,” he said. When he attempted suicide at 9, he was immediately restrained and spent three terrifying weeks in a psychiatric facility.
“I don’t claim to know what the answer is, or what a more appropriate response would have been, he said. “But there’s got to be a better way.”