The Adoptee
Mental Health Crisis
Mental health is a key adoptee health issue. Within the broader mental health crisis in the United States, we highlight the additional challenges adoptees may face in their development and mental health related to adoption, including abuse or neglect in pre-adoption experiences, disenfranchised grief and ambiguous loss, identity formation, attachment, and the search for biological roots. For visibly adopted adoptees, there may be additional challenges around loss of privacy, adoption stigma, and handling microaggressions related to interracial families.
For some adoptees, these challenges can manifest in various ways, including feelings of abandonment, isolation, or confusion about one's sense of belonging. Other adoptees may not struggle with their mental health. Like all people, an adopted person's perspectives often change over time.
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This page focuses on the adoptee mental health crisis. We argue that a basic understanding of adoption is crucial to providing support and resources for adopted individuals to navigate these complex experiences. We hope this page provides both context and resources for both adoptees and the clinicians who care for them.
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Page overview:
Adopted people are between 3-4x more likely to attempt suicide
as compared to non-adopted siblings raised in the same household. After controlling for other risk factors independently linked to suicidality, adopted people—including those adopted as infants—were still 3.7x more likely to report attempted suicide.
Adoption & Mental Health
Although adoptees and their experiences vary widely, adoption is associated with increased rates of:
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Mood disorders
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Anxiety, depression, bipolar disorder type I (Westermayer et al. 2014)
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Substance use disorders (Baden et al 2022, Yoon et al 2012, )
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Personality disorders (Westermayer 2015)
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Attempted suicide (Keyes et al 2008)
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In-patient hospitalization and contact with mental health (Behle and Pinquart 2016)
Adoptees also report adverse childhood events, experience difficulty with relationships, and struggles with identity.
Many in the adoptee community are aware of the mental health crisis.
One example of this Adoptee Remembrance Day. Held on October 30, just before National Adoption Awareness Month in November, Adoptee Remembrance Day is meant to remember the adoptees who didn’t make it— those lost to suicide, murdered or abused by their adoptive parents, deported from their country of adoption, or re-homed or trafficked after disrupted adoptions.
Adoption always involves loss as well as gain.
Adoption & Loss
​Although adoption is often framed as a “win-win," adoption fundamentally involves multiple losses as well. Any child must have the legal parent-child relationship legally dissolved to be “available for adoption." Separation from a primary caregiver is recognized as an adverse childhood experience (ACE), with implications for childhood development and long-term well-being. Even in cases of parental abuse or neglect, it may not have been the adopted child's wish to be separated from their parent.
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Losses in adoption can include:
- Parent(s)
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Sibling(s)
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+/- Foster parents or caregivers
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+/- Foster siblings
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Extended family
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Family traditions
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Cultural knowledge
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Sense of belonging
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​Familiar environments/foods
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Integration of pre- and post-adoption selves
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Birth history
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Family medical history
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For adoptees who spent time in foster care with a foster family or in an orphanage, they have experienced multiple separations from their primary caregiver.
For transracial adoptees, they may deal with difficulties surrounding rac​International adoptees often lose a sense of connection to their country of origin, culture, and first language.
For transracial and transethnic adoptees, they often lose a sense of connection to their racial and ethnic communities as well as privacy around their adoption (as their racial differences from their parent(s) may be visually apparent and result in unsolicited public comments).
Although adoption is a one-time legal process, adoption is also a life-long event for many adoptees especially as adoptees may feel the impact of these multiple losses throughout their lifespan. It is common for these losses to be triggered annually especially around birthdays or at other life milestones (parenting, caregiving, death of parent).
Recall that no adoption experience or adopted person is the same—affected by their age at the time of adoption, maturity, and personality.
Society often fails to recognize the loss and complexity inherent to adoption.
Helpful Terms Around Grief
What is disenfranchised grief?
What is ambiguous loss?
What is adoption competency?
There has been growing recognition that members of the “adoption triad" —adopted people, families formed through adoption, and biological parents who made an adoption plan—face distinct challenges and require professional support after adoption.
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The landmark report published by the Donaldson Adoption Institute in 2013 highlighted that:
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Adoptive families are 2-5x more likely to seek care
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A quarter of adoptees and adoptive families in a national survey considered the therapist they were working with to be incompetent in adoption issues.
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Adoptive families reported seeking out multiple therapists — some reported seeing up to 10 clinicians.
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Many adoptive families reported encountering clinicians whose advice was not only ineffective, but actively harmful.​
According to the report, adoption-competent mental healthcare is the most requested post-adoption support as well as the most effective for improving adjustment, yet is the most difficult resource to access.
Few clinicians, including physicians, clinical psychologists, social workers, and other mental health clinicians receive any adoption-specific training.
​The scarcity of adoption-competent clinicians can be attributed to the lack of formal education on adoption issues in professional training programs. This, in turn, contributes to a lack of awareness among clinicians, making recognition of this professional knowledge gap around adoption difficult. Even mental health clinicians, whom other professionals may assume have received training on adoption, receive minimal instruction. In 2013, a national survey of graduate-level clinical psychology programs, “the average time spent teaching about adoption at the graduate level was eight minutes per semester, as compared to about three to 10 times that amount on subjects that impact far fewer people, such as autism." The 2013 Donaldson report found that:
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Approximately 30% of psychologists received any adoption-specific training
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Less than 17% of marriage and family therapists, social workers or counsellors receive adoption-specific training
Additionally, a 2022 study of primary care physicians found that almost none had received training on adopted patients. Among the study participants, training was entirely in the context of children—not adults.
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​In the absence of formal training, clinicians may provide well-intentioned but ineffective and even harmful advice to their patients. Those with personal connections to adoption may add insight and perspectives that enrich their care, but also risk transference that could be a detriment. It is important to recognize that personal experience does not equate to professional competence, particularly for an experience as emotionally-laden and varied as adoption.
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Although the need for post-adoption supports has been well-documented for decades, a standardized definition and accreditation system for adoption competency was only recently established.
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​In October 2023, the National Center for Adoption Competent Mental Health Services (led by the Center for Adoption Support and Education (CASE) and funded by the U.S. Department of Health & Human Services, Administration for Children & Families, Children's Bureau) launched an evidence-based training for mental health professionals, which had been piloted in 8 states since 2018. This web-based competency training is free and grants continuing education credits (National Association of Social Workers (NASW) and National Board of Certified Counselors (NBCC)) to those who complete the 25-hour course.
The training builds a foundational understanding of:
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the nature of adoption as a form of family formation and the different types of adoption
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the clinical issues that are associated with grief, separation and loss, attachment, and adoptive identity formation
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the common individual and family developmental challenges in the experience of adoption
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and the characteristics and skills that make adoptive families successful.
One study found that clinicians who have undergone adoption-competency training reported “significantly higher levels of satisfaction and significantly stronger therapeutic alliances with their clinicians." The same study also found that adoptive families engaging in treatment with these clinicians also reported significantly higher satisfaction scores compared to clinicians who had not undergone the training.
Although adoption competency training and accreditation is now freely available, many patients and clinicians remain unaware.
With adoption competency in its infancy, we highlight the importance for clinicians to:
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enroll in free, online adoption-competency training
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preferentially refer to mental health clinicians who have completed adoption competency training
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or to other clinicians experienced in navigating adoption issues
Additional Recommendations for Clinicians
In addition to the standard of care and practices to ensure excellent care of any patient experiencing a mental health challenge (screening, pharmacotherapy, and referring to counselling as appropriate), we recommend the following additional tips for adopted patients.
Additional Tips Around Adoptee Mental Health for Clinicians
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Listen to your patient.
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No adoptee or adoption experience is the same.
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Normalize complex feelings.
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Recognize that some adoptees see adoption as a traumatic experience​​
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Share resources around adoption
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​A 2025 qualitative study by Geller suggests that adoptees found books, documentaries, and other sources of community support to be helpful in conjunction with therapy.
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​Adoptee communities (in-person and virtual)
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Media: books, blogs, documentaries​​
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Refer to a mental health provider.
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Clinicians who have completed adoption competency training should be preferred if available, then clinicians with experience working with adoption issues.
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Personal experience ≠ professional competence.
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Carefully consider self-disclosure.
Common Questions
Why is adoption associated with increased risk of mental illness and poor outcomes?
Is adoption a trauma?
What if the adopted person isn't dealing with issues related to adoption? Is an adoption-competent therapist still necessary?