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Foster children at high risk for a multitude of mental health problems

By Yesenia Barrios

Lisa Cohen, author, boxer and former foster child

Lisa Cohen had to start over 13 times. As a foster kid she needed to find new friends at each new school at each home where she was placed. 

One time, after being forced to leave a foster home she loved, she woke up in her new home with cuts in her arms. She had been fighting the blinds in her sleep, having a bad dream that involved missing the last foster parents.

That night, she got a “whipping” from her new foster mother for damaging the blinds, she said.

“I would have taken the beatings, the physical because you can get past that, but the mental abuse is the worse because that follows you. That is the kind of stuff that makes you want to unalive yourself,” she said.

Cohen told her story during a recent episode of Therapy Thursday, an Instagram Live event hosted by Urban Health Media Project, which last month focused on foster care and its impact on mental health.

Broken bonds

“I was very depressed as a child,” said Cohen, who spent most of her childhood and teenage years in the foster care system.

Out of half a million children in the U.S. foster care system, up to 80% have significant mental health issues

A healthy bond between a child and their primary caregiver is pivotal to a healthy psychological development, and every time that bond is broken it is detrimental to their mental health. 

“When we think about all the things children learn in the context of home and family, not having that stable home, they are not able to learn how to approach a relationship, how to approach people, view structure, and process their emotions,” said panelist and therapist Marsheena Murray, director of behavioral health, Medical Home for Children in Foster Care, MetroHealth Medical Center, Cleveland.

Separating children from their main caregiver, even if done for the safety and welfare of the child, can be significantly more traumatic than the abuse and/or neglect they were receiving, according to the National Child Traumatic Stress Network.

“Trauma doesn’t just mean physical abuse or neglect. It can be grief, the loss,” Murray said. “A lot of kids report coming into the system just alone as a trauma for them.”

Marsheena Murray, therapist at MetroHealth Cleveland

Children in the welfare system have higher rates of suicide attempts than children who are not. Suicidal attempts were also more prevelant after physical and sexual abuse. For every adverse childhood experience of  a foster child, there is a 60% increased risk in suicide attempt,  according to a study out of the University of Colorado. 

The abuse children in the system experience presents as chronic anxiety. 

“When my son first arrived, his condition was very poor in a lot of different ways,” said Yvette Martinez, a panelist and former foster parent who worked in child welfare for eight years. “He had a very heightened sense of fear where (sic)  the door closing, or anybody’s voice being elevated really agitated him, and (it) really activated in him a response.”

The long-term uncertainty and trauma impacts the children mentally, physically and emotionally. 

“If you think about kids who are experiencing trauma, they’re hyped up, on edge– waiting for the other shoe to drop,” said Murray. “Your body is meant to be elevated for some time, but it is not meant to be elevated for months, for years even.” 

Repeatedly adapting

Foster children repeatedly adjust their personality and adapt to different traditions and customs to fit in with each new family situation, with the hope to be accepted and loved in their new home. 

“I recall kiddos that were coming from a certain home that practiced certain religious practices, and they were placed in new homes where there were very different religious practices or expectations around that,” said Martinez. 

Psychological evaluation and therapy are required of children in the system, but it can sometimes be a challenge for children to trust their therapists and social workers. However, it is important not to force them. 

“One important part in trauma-informed care is giving people power and choice,” said Murray. 

World of constant change

Cohen says she became rebellious when she started seeing her therapist, but after learning to trust her, therapy became a vital part of healing.  She is now “so thankful” to her therapist who kept her grounded and offered some stability in a world of constant change, she added. 

Aging out of the system can be a specially difficult time. Many youths lack a stable home or tools to navigate the world. Lacking basic skills, low education levels, and poor mental health results in thousands of former children becoming homeless. Up to 46% of youth in the system become homeless at least once by 26, according to research led by the University of Chicago.

As she aged out, Cohen chose to join the U.S. Navy at 20 years old, and at 28, she started her professional boxing career. A few years later she  won the IFBA Junior Featherweight World Title and also founded and directed Too Fierce Boxing and Fitness, a non-profit organization for at-risk children that integrated boxing and fitness, and coaching for success. She also wrote a memoir where she recalls her journey in the foster care system. 

Foster parenting journey

Murray encourages everyone to become a foster parent. 

“It is an investment in time but it can really make a huge difference,” she said. “Keep your eyes on your purpose because it is going to be a journey, and there are going to be times where it is difficult but you have to think about your purpose.”

For Martinez, her purpose was clear from the beginning.

“It wasn’t temporal or selective in our hearts or minds– it was commitment, and it was love, and it was unconditional,” she said. 

Cohen encouraged potential foster parents. 

“To anybody who wants to be a foster parent, do it because you want to do it. Don’t do it with the expectation that you can create a person in your image,” said Cohen. “Don’t create an expectation, don’t do it for the money.”


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