Perceived Stigma in the Utilization of Mental Health Services Among Foster Care Alumni

Background:  Research has consistently documented a dramatic drop in mental health service use among foster care alumni.  This is an important issue as studies have found that mental health disorders are chronic conditions that persist into adulthood.  The lack of continued mental health services among foster care alumni can only exacerbate the already poor mental health outcomes experienced.   Reasons for mental health service disruption are unclear.  However, studies of youth in the general population, have shown that stigma is associated with the avoidance of seeking treatment as youth fear being labeled and are afraid of negative responses from peers.  This qualitative study sought to examine the stigma associated with the use of mental health services by foster care alumni while in foster care and upon exit from the foster care system to better explain the underutilization of mental health services by this population. 

Methods: Using the Consumer Experience Survey (Wahl, 1999) as a guiding framework, the current study examined the stigma associated with the use of mental health services while in foster care and upon exit from the foster care system of 13 foster care alumni.  Data were collected through a one hour in-depth qualitative interview.  Interviews were audio-taped and transcribed, and coded for themes across different domains.

Results:  While in foster care, youth avoided telling others they were receiving therapy for fear of being labeled “crazy”, viewed differently, and lied about the reasons for being away at therapy appointments.  Youth also reported having a negative label for being a foster youth, and receiving mental health services only exacerbated that negative perception.  After foster care exit, youth avoided disclosing being in therapy to avoid being judged, labeled, and viewed as not being able to deal with issues.  Youth also reported society’s perception of individuals with a mental illness as more accepting, but indicated that some diagnosis are more acceptable than others.  Overall, after foster care exit, youth reported less stigma in the receipt of mental health services, but few were receiving services. 

Conclusions and Implications:  Research studies have consistently found that mental health stigma is a contributing factor in the underutilization of mental health services.  An interesting finding from this study was that youth in the foster care system reported having a negative label, and the utilization of mental health services only increased that negative perception.  Since youth in the foster care system are required/mandated to attend mental health services, especially those placed in group homes, educating the youth about the benefits of mental health service receipt may increase the acceptance of these services.  Educating the public about the experiences of foster youth, and the reasons for foster care placement, may decrease the negative perception and increase the understanding for the need for mental health services for this population.