Mental health needs, children, adolescents, child care institutions, Sri Lanka) Background The number of children placed in institutional settings around the world is rapidly increasing due to factors like poverty, war, violence and substance use 1. Bringing up children in childcare institutions can deleteriously affect their development due to profound deprivation of sensory, linguistic, cognitive, emotional and psycho-social stimulation 1. According to the United Nations Children's Fund (UNICEF) report in 2009, up to eight million children are in institutions worldwide 2. However true figures may be higher due to gaps in global statistics and unregistered children's homes 3. Reasons for institutionalization Poverty is one main reason for institutionalizing children in most countries 4. Children with learning and physical disabilities are at higher risk of institutionalization due to limited support services 5. This risk is further increased by social stigma and negative attitudes towards disabled children 6. In some countries disabled children are considered unlucky or cursed 6 and people are encouraged to keep them away from home 7. In an Indian study, 90% of 11 million abandoned children were girls, showing how gender discrimination can affect institutionalization 3. Child abuse and neglect are also major risk factors worldwide 2. Multiple reasons lead to enrolling children in residential care settings in Sri Lanka. Some of these are economic hardship, physical or mental illness, disabilities, inability to provide education, domestic violence, labour migration and second marriages 8 .