The majority of the children placed in the facilities, which are located in North Carolina and out of state, would be better served in a community setting, and in many instances, should have never been placed in the psychiatric facilities at all, the lawsuit states.

Black children and other children of color are disproportionately represented among children in foster care in North Carolina and among those sent to psychiatric facilities, the complaint says.

In the 12-county Charlotte region, 153 Medicaid-insured children stayed at psychiatric residential treatment facilities in 2022, according to DHHS data. In the 10-county Triangle region, 89 kids stayed at those facilities.

Disability Rights has found that more than half of the children sent to these facilities were in foster care, according to Holly Stiles, an assistant legal director for the group.

The treatment is causing young people in foster care to lose important family connections and to miss out on key developmental activities, the suit argues. It says the children have also been subjected to often prison-like conditions, dangerous physical and chemical restraints and dozens of medications.

At least one of the youth, a 15-year-old from Craven County, was airlifted to a hospital trauma center after another youth slammed his head to the ground while he was institutionalized at a facility in Kinston, starting in April 2022, the lawsuit states. The teen was then taken to the emergency room with a head injury after another assault before he was discharged to a group home in January 2023.

In court papers, DHHS has noted that improving services for children with behavioral health needs in the foster care system is one of the top priorities of secretary Kinsley, who was appointed to lead the agency in January 2022.

But that requires coordinated efforts not just by DHHS but by social service departments in each of North Carolina’s 100 counties, and the General Assembly, which must pay for improvements, the department said.

“It is a long-term, herculean effort, in which DHHS plays an important, but not solitary, role,” the department wrote in a court filing.

Kelly Crosbie, who heads the department’s Division of Mental Health, Developmental Disabilities, and Substance Use Services, on Thursday said that the agency has been working to ensure the vast majority of foster children are cared for in communities.

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