In 2023, India formally emerged as the most populous country, achieving an expected 1.428 billion people, which denotes 17.8% of the global population [1]. Among this massive demographic panorama, children constitute a notable 18.6%, underscoring India's massive young generation [2]. Sadly, many children in India lack stable family care due to orphanhood, abandonment, and trafficking. In such situations, childcare establishments are the last resort to provide safety and basic needs. Additionally, if a caregiver is unable or incapacitated to care for and lift the children, such children also need childcare establishments.

Institutional care, as defined as a group of living arrangement for more than ten children without parents or surrogate parents, in which a limited number of paid caregivers provide essential care [3,4]. These establishments are considered key support systems, ensuring the well-being of vulnerable children.

According to the United Nations Convention on the Rights of the Child, a child should be raised in a loving, safe, and understanding family environment [5]. The profound lack of sensory, linguistic, cognitive, emotional, and psycho-social stimulation in childcare institutions can negatively affect children's development [6]. Numerous observational studies have spotlighted the developmental obstacles faced by institutionalised children compared to children raised in family settings [7]. Earlier studies on the well-being of institutionalised children strongly report developmental delays in all domains [8,9]. This can be justified by factors such as limited workforce, time, and mone-tary limitations, which allow childcare institutions to offer only minimal needs [10].

Globally, determining the number of institutionalised children is extremely challenging [4,11]. Some countries neglect to record or file the number of children in institutions [12], and others may exclude children from institutions staffed by non-governmental organisations (NGOs). Moreover, some countries count the children only if their parents have legally relinquished them, and children who come in and out of establishments might be counted repeatedly. Thus, due to inconsistent data reporting, the precise number of institutionalized children remains unclear. Despite these challenges, the global number of institutionalised children grows progressively. The significant factors contributing to the institutionalization include poverty, substance abuse, violence, and struggle [13].

Children placed in institutional care have been a central subject of research in many Western contexts, where numerous studies have examined their physical, psychological, and cognitive well-being. Findings consistently reveal that these children face a range of difficulties, including increased hyperactivity, heightened stress levels, emotional instability, and challenges with concentration, attention, and forming interpersonal relationships [14-18]. Research also indicates that developmental delays are common in institutionalized settings, particularly in emotional and social domains [19]. Furthermore, many children in care experience significant barriers to forming secure attachments, which can contribute to long-term emotional and behavioral difficulties [20]. These issues are often rooted in early life adversity, such as disrupted caregiver bonds and the lack of stable, nurturing environments-factors that significantly undermine emotional regulation, cognitive development, and mental health [10].

How individuals perceive and think about their future significantly determines their mental health and wellbeing. Understanding the thinking orientation or cognitive framework of institutionalised children becomes essential when examining their mental health outcomes. Thinking orientation comes from the solution-focused approach, which contrasts with traditional problem-focused strategies. Solution-focused thinking emphasises identifying future-oriented solutions and concentrating on what can be done to improve the present and future rather than focusing on past issues or failures [21]. This was examined through three core subcomponents: problem disengagement (the ability to step back from unchangeable or distressing issues), goal orientation (the drive to set and pursue realistic personal goals), and resource activation (the ability to identify and utilize available support systems). Children with a more solution-focused thinking orientation tended to show better mental health, whereas those with difficulties in disengaging from problems or mobilizing resources exhibited more signs of distress. These findings suggest that fostering a solution-focused mindset could be a meaningful direction for psychological intervention within child care institutions.

Although international research has extensively documented the psychological and developmental challenges faced by institutionalized children, such as emotional dysregulation, cognitive delays, and attachment difficulties [5-11], India lacks sufficient psychological studies on this population. This gap is especially significant within government-run childcare institutions, where most vulnerable children are placed. While national data captures demographic trends, little is known about the mental health, thinking orientation, and familial contexts of children living in these institutions, particularly in states like Kerala.

This study addresses this critical gap by exploring the antecedents to institutionalization, thinking orientation, and family dynamics of children living in government-run childcare institutions in Kerala. It may represent the primary attempt to determine the thinking orientations of this populace.

The data was gathered as part of the District Psychiatric Rehabilitation Project (DPRP), a pioneering initiative funded by the state government and carried out by the Institute of Mental Health and Neurosciences in Kozhikode, with collaboration from the Department of Social Justice, Government of Kerala. The project aimed to provide mental health care and rehabilitation services to residents of government welfare institutions in northern Kerala. The project lasted one year and involved a multidisciplinary team comprising a psychiatrist, clinical psychologist, psychiatric social worker, and occupational therapist.

Findings from this study aim to inform the development of tailored mental health interventions and highlight the value of solution-focused therapeutic approaches in institutional settings. The study also offers insight into how family dynamics and early experiences influence children’s mental health trajectories in care.

The study included 187 children residing in government childcare institutions across Kozhikode and Malappuram districts. A majority of the children (77.0%) were from Kerala, while 23.0% were from other states. The sample comprised 56.7% girls and 43.3% boys. The primary reason for institutionalization was referral by the Child Welfare Committee or the police (71.7%), followed by safety concerns at home (23.0%) and economic hardship (5.3%). A mental illness diagnosis was reported in 39% of the children, and 11.2% had significant physical health conditions. In terms of parental status, 49.7% had both parents alive, yet 66.3% reported receiving no family support. Academically, 48.1% of the children performed at an average level, and 66.8% demonstrated average intellectual functioning. These background characteristics are summarized in Table 1.

Gender-based comparisons revealed meaningful differences in the reasons for institutionalization and health status. Among girls, 30.6% were institutionalized due to safety concerns, compared with 13.6% of boys. Economic hardship was cited exclusively among boys (10.5%), with no such cases reported among girls. Physical illness was reported by 19.6% of girls and none of the boys. Mental ill-ness was more prevalent among girls (51.4%) than boys (23.5%). These gender-based differences were statistically significant. Detailed comparisons are provided in Table 2.

Children diagnosed with mental illness showed distinct patterns in familial and institutional background. Among these children, 47.2% were orphans, and 72.2% reported receiving no family support. In contrast, among children without mental illness, 20.2% were orphans, and 60.4% lacked family support. Additionally, 37.5% of children with mental illness had been institutionalized due to safety concerns, compared with 16.8% of children without such a diagnosis. All observed associations were statistically significant. These findings are presented in Table 3.

In the domain of thinking orientation, girls demonstrated significantly higher scores in goal orientation (M=3.51, SD=0.64) compared with boys (M=3.18, SD=0.72). However, there were no statistically significant gender differences in problem disengagement (girls: M=3.11, SD=0.66; boys: M=3.09, SD=0.61), resource activation (girls: M=3.22, SD=0.68; boys: M=3.16, SD=0.69), or overall thinking orientation (girls: M=3.27, SD=0.54; boys: M=3.24, SD=0.57). These results suggest that girls may be more inclined toward goal-directed thinking, while other cognitive domains appear similar across genders. A detailed summary is provided in Table 4.

Children with mental illness had consistently lower scores in several components of thinking orientation. The mean score for problem disengagement was 2.91 (SD=0.65) among the clinical group, compared with 3.24 (SD=0.59) in the non-clinical group. For resource activation, the clinical group scored 2.97 (SD=0.68), while the non-clinical group scored 3.41 (SD=0.71). Overall thinking orientation was also lower in children with mental illness (M=3.06, SD=0.55) than in those without (M=3.38, SD=0.56). Although children with mental illness had slightly lower scores in goal orientation (M=3.30, SD=0.66) than those without (M=3.41, SD=0.67), this difference was not statistically significant. These results indicate that lower think-ing orientation is associated with poor mental health outcomes among institutionalized children. Findings are detailed in Table 5.

This study examined 187 children residing in government-run homes in Kozhikode and Malappuram districts to understand their antecedents, thinking orientation, family support, and parental backgrounds. The participants were aged between 6 and 17 years, with a mean age of 12.4 years. Notably, 23.0% of the sample were non-native to Kerala, possibly reflecting the state’s role as a major destination for migrant laborers and their families. The sample was also predominantly female, which may be attributed to cultural and gender-based vulnerabilities, as supported by prior literature [20].

The reasons for institutionalization in the current study predominantly included safety concerns at home, economic hardship, and referrals by the Child Welfare Committee (CWC) or police authorities. Among these, CWC/police referrals were the most common. Children admitted through this route often face high levels of neglect, exploitation, or abandonment, echoing broader systemic issues of child vulnerability in India.

Consistent with prior findings is that a significant proportion of institutionalized children in our study reported health challenges. Specifically, 11.2% of the sample experienced significant physical illnesses, and 39.0 % displayed symptoms of mental illness-a key finding [24]. These outcomes support earlier assertions that institutional care environments may adversely affect children’s intellectual, physical, behavioral, and socio-emotional development [17]. Contributing factors such as parental substance abuse, behavioral issues, and school dropout are closely intertwined with the mental health challenges observed [22,23].

Our study found that nearly half of the children in institutional care have both parents, but 66.3% lack any form of family support. The current findings highlight the fact that institutionalized children often suffer from emotional and developmental delays due to the absence of stable familial care [23]. While prior studies have suggested that children with living parents might still face externalizing behavior problems due to dysfunctional relationships, our findings contrast with this. Children who reported support from either or both parents were more likely to demonstrate better mental health outcomes. This supports the view that not merely the presence but the quality of family relationships significantly influences child well-being [24].

It is encouraging to observe that the academic performance of the inmates did not show a significant negative impact, which may be attributed to the finding that most participants demonstrated average intellectual functioning. This result stands in partial contrast to earlier literature suggesting that institutionalized children often experience cognitive delays and lower academic achievement due to disrupted attachments, trauma, and limited educational stimulation [24,25]. However, in our sample, the presence of structured schooling, stable routines, and possibly supportive caregiving within the institutions might have helped maintain academic engagement and preserved cognitive development. Previous research indicates that intellectual functioning can act as a protective factor, buffering children from some of the adverse psychological effects of institutionalization [25]. Thus, while institutional care is frequently associated with negative developmental outcomes, our findings highlight that under certain conditions-such as consistent schooling and supportive environments-children may retain average cognitive performance and academic stability despite early adversity.

A noteworthy gender-based finding emerged in relation to the antecedents of institutionalization. All children admitted for safety-related concerns were girls, while none of the girls were institutionalized solely due to economic hardship. This suggests that girls are more likely to be institutionalized for protection, even in the absence of severe financial distress. Prior studies have similarly documented heightened risks of physical and sexual exploitation for girls, reinforcing the view that gendered vulnerabilities play a decisive role in institutional placement decisions [26].

Gender differences were also observed in health outcomes. While some literature suggests boys may have greater access to healthcare services [27], our study reflects previous findings indicating that girls are more prone to mental health issues. These patterns may be reflective of gender-specific stressors and coping strategies, and further underline the need for gender-sensitive mental health interventions.

Another important insight is that children institutionalized due to economic hardship showed comparatively better mental health outcomes. While poverty is generally considered a risk factor for psychological issues, this finding suggests that institutional care can act as a protective factor under certain conditions. Stable, nurturing environments and attachment-based care within institutions have been found to buffer children from the adverse effects of poverty and trauma [26,27]. This complexity underscores the importance of contextualizing mental health outcomes within individual life experiences and the quality of institutional care received.

Another important insight is that children institutionalized due to economic hardship showed comparatively better mental health outcomes. While poverty is generally considered a risk factor for psychological issues, this finding suggests that institutional care can act as a protective factor under certain conditions. Stable, nurturing environments and attachment-based care within institutions have been found to buffer children from the adverse effects of poverty and trauma [26,27]. This complexity underscores the importance of contextualizing mental health outcomes within individual life experiences and the quality of institutional care received.

One of the primary objectives of this study was to assess the thinking orientation of institutionalized children. Globally, there needs to be more research on the thinking orientation of institutionalized children, particularly regarding how they approach problem-solving. Children may adopt a solution-focused or problem-oriented perspective when addressing challenges. Solution-oriented thinking prioritizes accomplishing the favored alternate, specializing in actionable steps instead of digging into the underlying reasons for the problem [28]. Mental health is directly linked to expectations about the future. Moreover, they stated that optimism and depressive symptoms have an inverse correlation [29].

This study assessed children's thinking orientation through problem disengagement, goal orientation, and resource activation measures. Problem disengagement refers to the cognitive ability to shift attention away from problems that are perceived as unsolvable or beyond one’s control, allowing the individual to conserve psychological resources and avoid chronic stress. The concept is rooted in coping theory, emphasized adaptive self-regulation through disengagement from unattainable goals. In the context of institutionalized children, who often experience prolonged exposure to uncontrollable stressors (e.g., trauma, separation, neglect), the ability-or inability-to disengage from such problems can significantly influence mental health outcomes. Our findings show that children with poor problem disengagement tend to report higher levels of psychological distress, suggesting that difficulty in letting go of unresolvable concerns may exacerbate internalizing symptoms such as anxiety or depression.

Goal orientation was examined as a measure of futuredirected motivation and planning, drawing on frameworks such as Dweck’s goal theory and Bandura’s self-efficacy model. Children with higher goal orientation are more likely to set purposeful objectives and persist through adversity, which may act as a protective factor in the face of institutional stressors. Similarly, resource activation-the ability to recognize and utilize internal and external supports-derives from resilience theory and the broader positive psychology literature. It reflects the child’s capacity to mobilize coping mechanisms and social resources in challenging circumstances.

The findings of the research showed statistically significant differences in thinking orientation between children with and without reported mental illness. Specifically, children with poor mental health scored significantly lower on problem disengagement and resource activation, suggesting that they may find it more difficult to detach from distressing or unchangeable problems mentally and to recognise or utilise supportive resources in their environment. These components are essential aspects of a solution-focused cognitive style, which emphasises coping, forward-thinking, and resilience.

Lower scores in problem disengagement reflect a tendency to remain entangled in problem-saturated narratives, which has been associated with emotional dysregulation, rumination, and heightened stress sensitivity in children [30]. Likewise, reduced resource activation may signal poor self-efficacy and social support perception, both of which are known predictors of depressive and anxious symptoms in vulnerable populations [27]. These findings align with prior literature suggesting that institutionalised children, due to repeated adversity and limited emotional scaffolding, often develop cognitive patterns that emphasise obstacles rather than solutions [28].

Although the difference in goal orientation was not statistically significant, the observed trend-where children without mental illness scored slightly higher-may still hold conceptual importance. Goal orientation is central to motivation and purposeful behaviour, and its relative stability may reflect protective factors, such as structured schooling or positive role models within the institution. However, it is notable that the overall thinking orientation score, which combines all three subcomponents, was significantly higher in children without mental health problems. This reinforces the notion that a solution-focused thinking style, when present, may be associated with better psychological functioning among institutionalized children [28].

Gender-based differences in thinking orientation were also evident. Girls demonstrated significantly higher goal orientation compared to boys, though no major differences were observed in other dimensions. These results may reflect socialization patterns and emotional regulation strategies that vary by gender, and they highlight the need for tailored mental health and life-skills interventions within institutional care settings.

This study offers valuable insights into the multidimensional experiences of institutionalized children in Kerala. The results underscore the significance of cultivating adaptive thinking orientations through structured, supportive care environments. A holistic, individualized approach is essential to improve the long-term well-being and developmental outcomes of children in institutional settings.

This study highlights the psychosocial and cognitive realities of institutionalized children residing in Government children’s homes in Kerala. Significant gender-based differences were observed in antecedents, health status, and goal orientation. Importantly, the study found that mental health outcomes were strongly influenced by family support, the child’s background, parental involvement, and their thinking orientation. The role of thinking orientation, particularly its subcomponents-problem disengagement, goal orientation, and resource activation-emerged as a critical yet underexplored area in the Indian context, making this study a preliminary but valuable contribution.

The findings reinforce existing evidence that institutionalized children remain vulnerable to poor mental health, despite the availability of basic psychological services. There is a pressing need to strengthen institutional mental health systems by ensuring the involvement of trained professionals, including psychiatrists, clinical psychologists, psychiatric social workers, and psychiatric nurses. In line with global trends, we recommend incorporating future-oriented, solution-focused therapeutic approaches to help children build on their strengths and resilience, rather than focusing solely on their problems.

Ultimately, children in institutional care have the right to grow and thrive in emotionally safe environments. Enhancing mental health services within these settings is not just a moral imperative-it is an investment in the nation’s future.