Orphanages threaten children’s mental health—for life. Here’s why

Before we found her the right foster family, Tatiana had been confined to the same cot in an orphanage. At the point when children in the UK would be getting ready to start school, Tatiana couldn’t walk or even stand, she couldn’t eat solid food and she was tiny for her age.

Decades of sound research shows that orphanages damage children’s physical, social and brain development in ways that can last a lifetime. But denying children the love and protection of a family also puts their mental health at serious risk.

Andy Bilson is Emeritus Professor of Social Work at the University of Central Lancashire and an expert in developing systems that support families and stop children entering institutions.

Why are orphanages are so bad for children’s mental health?
I’ve had the sad experience of visiting large orphanages in many countries and seeing big groups of very young children, left without the kind of individual care and attention they need, rocking backwards and forwards just to give themselves some comfort and stimulation. When you see 30 or so two year-olds sitting like that in total silence, you know that this is not a situation that’s good for their mental health or their overall development.

What are the main mental health problems experienced by children who live in orphanages and similar kinds of large residential institutions?
Much depends on the age of the child but for very young children, there are a whole range of issues. Many children who grow up in orphanages develop Attachment Disorders. The low ratio of staff to children, frequent changeovers of staff—even routines deliberately designed to stop children forming settled relationships with individual care givers—all contribute to this problem. When young children are denied the chance to form healthy attachments, through one-to-one care with a parent or other committed adult, this can make it hard for them to establish stable relationships throughout their lives.

“The low ratio of staff to children, frequent changeovers of staff—even routines deliberately designed to stop children forming settled relationships with individual care givers—all contribute to this problem.”

Children in orphanages may also show Indiscriminately Friendly Behaviour, approaching every adult they meet in the same way, hoping for attention and affection. As we know, young children in families are naturally shy of strangers. They look to their parents or other trusted care-givers for reassurance and take time to interact with new people. That’s often not the case with children in orphanages, who haven’t had the chance to form those kinds of relationships, and it’s obvious how vulnerable this makes them.

Anxiety is another major problem for children who have grown up without the reassurance that families can provide. And they may also have Difficulty Regulating Emotions so can become suddenly very upset and angry and not be able to anticipate or control these kinds of feelings.

Quasi-Autistim is also something we see in children who are confined to institutions. When children are denied the nurturing, one-to-one relationships that they experience in families, their brains physically don’t develop as well as they should. This has a negative impact on their ability to read other people’s emotions or to respond appropriately. In this way, these symptoms mimic autism but this isn’t necessarily a fixed condition, with a genetic component, like autism.

“Children in orphanages may also show Indiscriminately Friendly Behaviour, approaching every adult they meet in the same way, hoping for attention and affection… it’s obvious how vulnerable this makes them.”

What is the lasting impact on children’s mental health of growing up in orphanages, without a family?
In general, the outcomes are very worrying. This is true not just for children in orphanages but for children in care systems more generally. They have higher levels of poor mental health and problems forming stable relationships. Although some children who grow up without a family draw on that experience to become exceptional parents themselves, in many cases, as adults they find it hard to form stable relationships and struggle to cope as parents.

Care leavers are less likely to be employed than people who have grown up in a family and they are more likely to have problems with alcohol and other drugs.

By any measure, institutional care, compared with family care, denies children the chance to learn about relationships, everyday life, caring for other people, caring for yourself and this means that care leavers are incredibly unprepared for life in the outside world.

What happens when children are able to leave orphanages and join families?
There is very good research around young children being taken from institutions into foster care which shows that this leads to a clear degree of recovery. Their development and wellbeing dramatically improve.

In one lovely experiment, researchers got children to wear equipment on their heads that measured their brain activity but looked like a space helmet. The scientists encouraged the children to play at being astronauts and recorded significantly more brain activity in the children who were living in families, compared to the children who were living in institutions.

“The scientists encouraged the children to play… and recorded significantly more brain activity in the children who were living in families, compared to the children who were living in institutions.”

Sadly though, not all problems can be solved by moving a child from an orphanage to a family. There’s less evidence to support the restorative power of family in older children. Long-term follow ups show that a large proportion of children will do better but some still require mental health services at the age of 14.

Family is not a total remedy for time spent in an orphanage, which is why it’s so vital to stop children entering institutional care in the first place.

The theme of this year’s Mental Health Week UK is ‘Find Your Brave’ to encourage teachers, parents and carers to help children find positive ways to deal with life’s challenges. Why is this especially challenging for children who are growing up or have grown up in institutions?
It’s very hard for children who have never had the experience of a loving, caring adult in their life to see themselves in a positive light. Even in a family where the situation is challenging, children will receive positive attention and reassurance. For children who grow up without a family, they often struggle to see themselves as “good” in anyway. It’s not 100% in every case but there are clear trends that show these children may find it harder to cope in adult life.

“For children who grow up without a family, they often struggle to see themselves as “good” in anyway… these children may find it harder to cope in adult life. That said, many children who grow up in institutions show extraordinary resilience.”

That said, many children who grow up in institutions show extraordinary resilience. They do find coping mechanisms although these may not always be helpful in the long-term. If you’ve had a history of not being helped by the people who are supposed to help you, you may not want to ask for help when you need it. To help children ‘Find Your Brave’, we need to be ready to deal with some resistance, to be patient, and not to give up.