SC's mental health care crisis lands foster kids on air mattresses in offices

A report filed by independent monitors pointed to South Carolina's lack of mental health care as the root cause of the current foster care crisis, with more than 100 children spending hundreds of nights sleeping in state offices. File

COLUMBIA — After years of fostering mostly infants and younger children, Greenville nurse Jennifer Tice and her husband, Benjamin, knew that some foster kids, especially teenagers, were forced to sleep overnight in Department of Social Services offices.

About two years ago, when they agreed to take one of those teenagers as an emergency placement, they learned just how tough it can be.

The 15-year-old girl the Tices took into their home one weekend told them of sitting in a cubicle for hours as her case manager desperately tried to find a home for her, Jennifer Tice recounted. Finally, the girl fell asleep in the chair, only to awake to her traumatic story being retold over the phone time and time again and hearing families say they couldn't take her in.

Jennifer Tice soon learned more.

Many offices don’t have beds, so they use air mattresses. One office told her they would have “upwards of six” children sleeping on mattresses in a conference room. Other department employees said they just wished they had a table kids could eat on during the long waits.

What Tice was hearing about was the beginnings of a surge in children forced by an acute shortage of foster homes to sleep in state offices or be shuttled around South Carolina to a succession of temporary homes.

As The Post and Courier reported this week, the problem of children staying overnight at state offices began to emerge in earnest around the time Tice learned more about it — in late 2021 and early 2022. After initially tamping down the problem, it’s soared since the beginning of this year.

In March, 16 children spent 49 nights in offices. By May, just over 50 children spent 144 nights in offices. In June, 62 children spent 251 nights in offices, according to the independent monitors’ report. Foster kids spent 132 nights in offices in July, a sharp drop from the month before, said Emily Medere, deputy state director for child welfare services. The state said earlier this year it needs 2,000 more foster homes to meet demand.

“As a mama, I could not stand the idea of a child that’s already been through a traumatic experience separated from their biological family … and only having an air mattress to sleep on,” Tice said. “I can only imagine it makes them feel like, ‘Who’s thinking about me?’ ”

The foster home shortage and the kids sleeping on office floors that result are problems all over the country, not just South Carolina, and have been building for years.

About half of U.S. states have only half the foster families they need, said Serita Cox, co-founder and CEO of iFoster, a national group that provides support to foster families.

North Carolina has seen the number of licensed foster homes fall from about 7,000 to 5,500 since the COVID-19 pandemic, leading counties and community organizations to buy property to keep kids in while they wait for a home, Gaile Osborne, the executive director of the Foster Family Alliance of North Carolina, told The Post and Courier.

Experts and state officials agree it was the pandemic that pushed the system beyond the brink.

“When schools closed down, all of a sudden foster parents are homeschooling their foster children, which they didn’t sign up to do,” Cox said. “You can’t just call up a babysitter. To take care of a foster child, you need another licensed foster parent to come in and take care of the kids just for you to go on a date night.”

The burnout thinned the ranks of foster parents significantly, and because the pandemic also impeded recruitment efforts, their places often went unfilled.

“We’re just constantly chasing our tails trying to get these foster care homes up and running,” said Cindy Bogan-Baber, president of the Berkeley County Foster Parents Association. She is currently fostering three children.

Cindy Bogan-Baber (center) laughs while sitting on the couch and talking to her two adopted sons, Josiah Baber, 7, and Jeremiah Baber, 10, at their home on Aug. 1, 2023, in Summerville. File/Gavin McIntyre/Staff

At the same time, the children coming into the department’s care are increasingly teenagers with mental and behavior health challenges who require intensive support that many foster families are unable to provide. Those are also the children most likely to end up on an air mattress in a conference room.

Of the 109 children that slept overnight in an office from April to June this year, 79 percent had a mental health diagnosis, 31 percent had a history of suicidal thoughts and 15 percent had active substance abuse problems, the monitors’ report found.

The key cause of the latest instability in the foster care system, the report concluded, is South Carolina’s dearth of mental health care for children.

“Finding a child psychiatrist is like finding a leprechaun,” one department case manager told the monitors. South Carolina is the lowest-ranked state in the country for youth diagnosed with major depression who do not receive treatment, the report found.

The pandemic accelerated trends of declining mental health among youth, which plunged headlong into the Palmetto State’s treatment void.

There are not enough mental health care specialists in the state, especially in rural areas. South Carolina has only one 24-hour crisis stabilization unit, but it is only open to adults, and the state has had a moratorium on developing new rehabilitative behavioral health services since 2015, according to the report.

The state's leaders have said improving mental health services is a key priority, and the state's new 988 crisis hotline is showing promise.

Yet parents’ desperation has become so great, they are increasingly refusing to take their children back into custody after they are hospitalized for a mental health crisis because they cannot care for them, leaving them in the care of the department, the report found.

“Some of these parents are willing to submit to allegations of child neglect because they are desperate for help for their child,” the report said.

Those children, with acute mental health needs, are very difficult to place with foster families and are more likely to bounce from home to home when they are placed, leading to the current crisis.

Troublingly, the monitors found the crisis feeds on itself: The longer children don’t have a stable home, the worse their mental health and behaviors become, making them ever harder to place.

“Though DSS leadership has been rallying staff in a collective effort to stem the crisis for months, a severe insufficiency of services and supports for families is fundamentally preventing progress,” the report states.

S.C. Department of Social Services Director Michael Leach. File/Provided

Michael Leach, director of the Department of Social Services, told The Post and Courier this month he is well aware of the problems, and the department is doing its best to address them.

The department is providing families with the most-challenging children 24/7 crisis support, extra training and a behavioral specialist; began providing day services in the Midlands; resumed directly recruiting foster parents and contracted with a third-party organization to work on keeping children in a consistent home, officials said.

The department has begun building out its own youth mental health support system to tackle the problem at its root, he said.

“I think it’ll take time for us to be able to expand all of those before we see a marked impact,” said Medere, the deputy director.

Monitors urged the department to go further. It should pay full-time professional foster parents, redouble their already successful efforts to place foster children with relatives and work with law enforcement to reduce unnecessary child removals. It calls on the rest of state government to act swiftly to improve the state’s mental health care system.

In May, Gov. Henry McMaster signed a bill that allows the department to provide relatives who care for foster children with the same reimbursements foster families receive. That could play a crucial role in alleviating the crisis by making it easier for relatives to take in children, said Cox of iFoster.

But Jennifer Tice wasn’t willing to wait. In March 2022, she and her husband resolved to do something.

Working with the support of the Upstate business community and the department, they began renovating department offices, adding couches, rocking chairs, tables, TVs, Nintendo Switches, books and beds — real ones.

In March 2022, Jennifer and Benjamin Tice, foster parents from Greenville, founded a nonprofit called Lily Pad when they learned that foster kids were sleeping on air mattresses in conference rooms when they couldn't find a stable home. Since then they've been renovating county Department of Social Services offices to make them more comfortable. At left is a "before" picture of the Anderson County office, and at right is an "after" photo. Lily Pad/Provided

“They go from just having an air mattress in a cubicle to having an entire room that doesn’t even look like they’re in an office,” she said.

They’ve renovated eight county offices, all in the Upstate, but have an aggressive plan to reach the rest of the state. But it’s a problem Tice said she's sad it even needs to be solved in the first place.

“If we ever get to a point where these rooms aren’t used for overnights, then praise the Lord,” she said.

Email -->

Sign Up!

Ketamine, an anesthetic used since the 1960s and abused as a street drug, is often now given for its potent mood-altering effects. Many clinics in Charleston and across South Carolina offer it, but it is not specifically regulated. Read moreKetamine therapy helps patients get 'unstuck' from disorders but is mostly unregulated

A new report finds that one in five woman felt they were mistreated during their maternity care, with higher rates for Black and Hispanic mothers. A program in Charleston seeks to address issues through group sessions for pregnant women. Read moreCDC: 1 in 5 mothers felt mistreated by health system; worse for Blacks, Hispanics

The S.C. Department of Health and Environmental Control (DHEC) and the Department of Education are providing naloxone, an opioid overdose reversal medication, to all K-12 schools in the state that want it for the 2023-24 school year. Read moreSC schools to get overdose-reversal drug as part of CDC plan

Shelby Joffrion, Charleston Police Department's overdose prevention program coordinator, is hosting Narcan training sessions at library locations across Charleston County through September. The next one Aug. 24. Read moreCharleston police holding overdose prevention training at county libraries