International research has reported that children in care are disproportionately represented in clinical populations receiving psychiatric services and those who have mental disorders are less likely to be reunited with parents than are other foster children. Therefore the rate of mental disorders among children who are permanent wards without access (i.e., children in provincial child welfare care who do not have rights of access to their biological parents) is especially important to understand since these children can only leave care via adoption. Otherwise, they spend the remainder of their childhoods in fostering arrangements before transitioning to adulthood. This study looked at the situation in Ontario, where the permanent ward population doubled during the decade ending in 2005 while the rate of wards leaving care by adoption decreased.