Children and adolescents in residential care represent a high risk population for mental disorders. We examined in an epidemiologic survey the level of professional psychopharmacological and psychotherapeutic treatment in relation to the prevalence of mental disorders among this group. The study includes 689 children and adolescents living in 20 residential care institutions in a two-step design. Participants with elevated scores in a screening questionnaire were then assessed by a standardized clinical examination. Data on psychopharmacological and psychotherapeutic treatment were obtained and correlated with the prevalence of mental disorders. Wishes for cooperation with psychiatry on the part of the child welfare providers were recorded by a self-constructed questionnaire. 57.1% of the children and adolescents of our sample fulfilled the criteria for one or more ICD-10 F diagnosis. As most frequent disorders we found conduct disorders (CD), ADHD and depressive disorders. Highest levels of psychopharmalogical treatment were found in ADHD (25 to 33.3%), half of the children and adolescents with ICD-10 F diagnosis got psychiatric or psychotherapeutic treatment. Compared to the high prevalence of severe mental disorders in children and adolescents living in residential care the levels of psychopharmacological and psychiatric/psychotherapeutic treatment seem to be low, especially in those with conduct disorders (CD) and ADHD. Cooperation between the child welfare providers and child and adolescent psychiatry services should get intensified. Adequate psychiatric diagnostic and multimodal therapeutic procedures are necessary.