A new lawsuit accuses North Carolina’s Department of Health and Human Services of failing to protect children with disabilities in the state foster care system, while spending millions a year to segregate them in psychiatric facilities.
Staff from Disability Rights North Carolina have observed the abuses outlined in the lawsuit through years of visits to state facilities, says Assistant Legal Director Holly Stiles. The monitoring is part of the organization’s federal mandate to advocate for disability rights.
“We realized that there was a fundamental, systemic problem where children in the foster care system in particular are being warehoused in these facilities for long periods of time and are not being returned to their communities with the services that they need,” Stiles said.
Black and Latino children are disproportionately represented in the foster care system, the lawsuit says. Once in the system, Stiles adds that children of color are also more likely to be confined to psychiatric residential treatment facilities, known as PRTFs.
“[When] a child who needs any sort of mental health or behavioral health treatment or other support can't get it in their community, the answer is to send them to a PRTFs because there may be a bed available,” she said. “So that's just a failure of our system of services for people with disabilities in North Carolina that we don't have the services or a place for these children to live in our communities.”
The lawsuit says DHHS increased its reliance on these facilities by 119% from 2010 to 2018. More than 500 children in North Carolina’s foster system were placed in these psychiatric facilities in 2021. Some of the facilities are located as far away as Utah, Stiles says.
“They are not near their family, friends, anyone who would be able to come and visit with them,” she said. “The social worker that is tied to their case also can't visit with them and confirm how they're doing.”
Children in state care have certain protected rights, like access to their own clothing, healthy food and phone calls, and Stiles says these rights are frequently denied.
“It's pretty jarring when you walk in and see a 9-year-old at a locked facility,” she said. “They have locked doors and a lot of them have razor wire and tall fencing. And they do look like what I think looks like a prison. Absolutely.”
The Department of Health and Human Services spends about $100 million a year to institutionalize foster children in these psychiatric facilities, the lawsuit states.
That money could be used to benefit children instead, points out Deborah Dicks Maxwell, president of the North Carolina State Conference of the NAACP, a co-complainant on the lawsuit.
“That is a lot of money that could go back into the community to provide integrative services, which is not as costly [and] which is more beneficial to the well-being of these children being productive citizens and healthy children,” Dicks Maxwell said.
Youth would be better served, the lawsuit states, by community- and family-based housing that includes access to mental and behavioral health services.
“There are evidence-based, effective community services that have been researched and studied and have been shown will help these kids stay in our community,” Stiles said. “That will ensure that they have a chance to go to school, and they have a chance to do things like get a job.”
DHHS confirmed it received the lawsuit and said in a written statement, “North Carolina can and must do better for children with complex behavioral health needs.”
The statement suggested establishing a new Division of Child and Family Well-Being, among other measures, and called for significant financial investment from the North Carolina General Assembly to address needs.
