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Mental Health Harm to Mothers When a Child Is Taken by Child Protective Services: Health Equity Considerations

Most recent available census data indicate 47,885 young people were living in foster care through the child protection system in Canada in 2011. Although placement of a child in foster care is a recognized factor influencing children’s health, behaviour, and social trajectories, very little has been documented about its consequences on the health and social outcomes of mothers. Mothers of these children represent a highly marginalized and growing population of caregivers, who are disproportionately poor, racialized, and likely to have also been in foster care as children. Among mothers, Indigenous women experience the highest rates of forced separation from their children, with census data showing Indigenous children comprising over 50% of all children aged 4 years and younger in foster care, while accounting for only 7% of the child population. One explanation for inattention to these issues is that mothers most affected are cut off from sources of power in society and face significant social judgment for ‘failing’ in their responsibilities as parents. State structures like the child protection system play a crucial role in this devalorization process through stigmatizing policies that place blame on individual parents for ‘family problems’ that are often the result of systemic and historical deprivations. As a result, empirical research has rarely considered the health and social conditions of this population of mothers, and while we know most are already structurally disadvantaged and vulnerable to poor health prior to loss of children, the health and social harms experienced following removal of children have yet to be systematically documented. In this issue of the Canadian Journal of Psychiatry, WallWieler et al.’s study of the mental health effects of losing a child to foster care helps to fill this void and marks a pioneering step in bringing a population health focus to assess some of the adverse impacts of this system on women’s lives. Drawing on a unique data set from Manitoba, where administrative health and census data have been linked to child protection files for the first time, this team has published the first 2 studies using populationlevel analyses of health outcomes in this group of mothers. This study compares longitudinal mental health diagnoses and treatment among mothers who have lost a child to foster care with mothers who experienced the death of a child. According to study results, mothers who lost custody of a child to foster care experienced significantly higher rates of depression, substance use, physician visits for mental illness, and prescriptions of psychotropic medications compared to mothers surviving the death of a child. Interpreting these results, authors suggest the disproportionate share of mental health burden among women with children in foster care is likely a reflection of lower social support and a lack of social acknowledgment of grief following this form of loss. Since the analysis could not evaluate the role of exposure per number of children lost, the authors further identify the higher likelihood of compounded grief among the target population due to losing multiple children to this system. In addition, authors note that mothers who experienced a child’s death were more likely to be of higher socioeconomic status, which could be an important factor in facilitating their access to mental health supports outside the public health care system and in turn explain some of the mental health disparity between populations. The study lists several limitations, including potential unmeasured confounding due to the absence of variables accounting for other stressful events in mothers’ lives, such as divorce and intimate partner