Blog by Hannah McCowen for the Alliance for Children in Care and Care Leavers  – a coalition of organisations that work with children in care or leaving care, and that share a commitment to improving the care system in England.

This Children and Young People’s Mental Health Week, we’re calling for a mental health strategy for children in care & care experienced young people. We believe these changes would make a difference to care experienced children & young people’s mental health.

Mental Health: Key to all of our ambitions for care experienced young people – A Call for a Dedicated Strategy

Everywhere I go, I hear people talking about their ambitions for care experienced young people. This includes young people themselves; leaving care professionals from local authorities and the charity sector; government officials and more recently business leaders. Their ambitions range from creating strong relationships and communities and accessing meaningful education and employment opportunities to the importance of young people being able to thrive where they live.

At the heart of achieving these ambitions lies positive mental health. Yet care experienced young people and leaving care professionals from across England tell us that accessing timely, appropriate mental health services is one of the biggest challenges they face. With a general election less than a year away, the Alliance wanted to share what we believe would make a difference.

What are care experienced young people telling us?

We know that care experienced young people can face particular challenges, including:

Accessing continued mental health support when they move areas or transition between services. Often care experienced young people have to join the back of the queue in a new area.

Mental health professionals not fully understanding the impact of care experience. Young people tell us that some professionals they work with use models of care that do not always best meet the needs of children and young people with care experience.

“Young people who have ADHD, mental health or trauma don’t feel like they can advocate for themselves, feeling like if they speak on how the feel or what they are going through they will be dismissed” Care experienced young person (YPBMF, 2023)

“Mental health was hugely played out in the care home, I was constantly exposed to suicide and self-harm, and at the time the staff didn’t have the correct training to deal with this. The doctors just told me I needed to exercise.” Mental Health Awareness Week | Just Keep Swimming | Alfie’s Story (nyas.net)

Receiving the right mental health support in a timely manner at the point when the young person is ready to do this. Many young people say that when they finally felt ready to get support and took that huge step, the support was not available.

“Getting diagnosed early would have helped to get the right support.” Care Experienced young person, YPBMF, 2023

Why is mental health a particular issue for children and young people with care experience? 

 ‘In terms of mental health, nearly half of looked after children meet the criteria for a psychiatric disorder. In comparison, one in ten children who are not looked after suffer from a diagnosable mental health disorder.” Page 15, Case for Change, Independent Review of Children’s Social Care

Children going into care have often experienced significant trauma and difficulties before they go into care, and the process of being ‘taken into’ and ‘being in care’ can be traumatic in itself.  Due to pressures around foster care and children’s home placements, many children and young people in care are moved far away from the people and places that they know, with many still experiencing multiple moves during their time in care.

As young people turn 18, CAHMS support finishes and they have to negotiate accessing adult mental health services.  When trauma manifests itself in a person’s actions and behaviours, it is often labelled as a behavioural issue rather than mental health –  preventing that person from being seen as eligible for support.

Young people leaving care are then expected to become financially independent far earlier than their peers.  With current cost of living pressures, this can be even more challenging. According to the National Leaving Care Benchmarking Forum, 76% of care experienced young people surveyed said the cost-of-living crisis was having a negative impact on their mental health.  (Survival is Not Easy, NLCBF, 2022). 

On top of that, let’s remember those care experienced children and young people are also facing other challenges – like the 1 in 4 care leavers who identify they have a disability or long term health condition (What Makes Life Good, Coram Voice).  And what about the 1 in 4 young people leaving care who arrived in England as an unaccompanied asylum seeker, separated from their families (DfE 2023)? What have they seen in their home countries and as they travelled to England and what’s it like to have the uncertainty of an asylum claim in process?

What gives me hope?

The determination of care experienced young people to be make a difference: The voices of care experienced young people have never been stronger, with groups of young people sharing their stories and insights about how they would like to be supported to professionals and key decision-makers.  I am incredibly proud to work with young people from the Young People’s Benchmarking Forum who often bring a perspective and ideas for addressing an issue that I would never have thought of. We must make sure that we keep young people’s voices at the heart of developing our mental health services.

“Mental health awareness week is so important, it is an opportunity to make mental health ok, and to normalise these conversations. We need these difficult conversations to be able to make change.” Mental Health Awareness Week | Just Keep Swimming | Alfie’s Story (nyas.net)

Commitment of leaving care professionals: The National Leaving Care Benchmarking Forum runs events throughout the year for leaving care practitioners and managers. The commitment and determination to improve the services and support on offer, despite limited resources, is inspiring.

Emerging good practice: We are seeing models of support that are making a difference; for example, basing mental health practitioners within leaving care teams, who help both young people and those supporting them to navigate health services.  This relies on health services playing their part and working closely with the children’s social care team to understand the level of need in their area and how to support people with care experience effectively.  A great example of this is the Meeting the Mental Health Needs of Care Leavers guidance for leaving care teams and Integrated Care Systems across London.

What should a dedicated mental health Strategy include?  

Mental health is a priority area for the Alliance for Children in Care and Care Leavers – a coalition of 37 organisations working in this area.  We are calling for a mental health strategy for children in care and care experienced young people that includes ten key points:

1. Extend Corporate Parenting Duties to Health Services. We believe the plans to extend corporate parenting duties to public bodies (Stable Homes Built on Love, DfE 2023) will mean health services have to consider and respond to the needs of these particular children and young people.
2. Appoint an NHS England Lead for children in care and care leavers
3. Identify a lead in each of the NHS’s Integrated Care Systems for children in care and care leavers.
4. Appoint a Virtual Health Lead or Designated Strategic Lead Professional for each Local Authority based on the model of Virtual School Heads which has made a significant difference. This could be an existing member of the health or social care team.
5. Coproduce Services with children in care & care experienced young people – To ensure that services reach and meet the needs of this particular group of children and young people.
6. Ensure Early Intervention and Prevention mental health services are available to provide dedicated and trauma-informed mental health services for children, young people and families on the ‘edge of care.’
7. Offer dedicated mental health services for young people leaving care that are care experience aware, trauma informed and co-produced between the health services and leaving care teams.
8. Training for mental health professionals to understand the needs of children and young people with care experience and how they may need different approaches.
9. Identify care experience in mental health data by introducing care experience fields to the Children & Young People Mental Health Survey and the Adult Psychiatric Morbidity Survey to allow for analysis.
10. Ensure that helping children recover from trauma is a central aim of children’s services. This aim should be set out in primary legislation, regulations and guidance.

A final thought…

One way or another we will end up paying for this – we either invest now or we’ll end up paying for this through our public services in the future.

When I speak to frontline leaving care workers, it’s clear we’re already paying for this – as they try to plug the gaps and provide additional support to young people who really need dedicated and specialised mental health support.

But most of all our young people are already paying for this… not being able to move on with their lives, mental health issues creating a barrier to getting ‘job ready’ or creating trusting relationships.  Let’s start thinking like a good parent would and get this sorted for our children and young people.