Caring for care-leavers

Some research puts prevalence of mental health issues amongst care-experienced children at 50%, while the Anna Freud Centre suggests that 70–80% have recognisable mental health concerns. Such issues are deeply interlinked with other, material disadvantages, such as barriers to accessing healthcare and education. Some also come into contact with the criminal justice system, and many face homelessness beyond care.

These care-experienced children grow into young adults, often with mental health struggles remaining unaddressed. Evidence suggests that many care-experienced young people who need mental health support don't receive it, or, when they do, face further barriers; many have transient living situations, for example, or fall through a 'treatment gap' when moving from children's mental health services to adult services. This can lead to longer-term mental health problems that remain both undetected and unsupported.

To better understand these barriers, the University of Bath's Alice Phillips and colleagues from around the UK worked directly with care-experienced adults to co-produce research exploring their experiences of accessing mental health support. They find a number of key themes that connect care-experienced young people, providing insight into how mental health services could better support them after leaving care.

Nine participants aged between 18 and 25 were recruited via social media for online, semi-structured interviews. All had 'aged out' of children's social care and had experience of trying to access mental health services since leaving, whether through the NHS, private practice, or the third sector.

Four key themes emerged from the interviews. The first, 'taking reluctant steps towards recovery', saw a focus on participants' willingness to engage with support across time. Some reported avoiding mental health support services, worried it would interfere with their lives, or concerned that long waitlists would have further negative effects on their mental health. Negative experiences within services, such as rejection or discrimination, also made participants more likely to avoid them, with the prospect of having to repeatedly retell negative experiences in care only adding to the burden.

'Challenges with being understood and the importance of gaining an understanding of yourself' was the second theme that made repeated appearances during these interviews. In responses falling under this umbrella, participants generally discussed instances in which they didn't feel understood by mental health professionals, and the frustration this caused. Many reflected on their frustrations in finding the right words to describe the qualities and extent of their mental health symptoms, and experienced a subsequent sense of 'hopelessness' when professionals were unable to provide fitting solutions or insight. A few also expressed feeling judged when being asked about their support preferences, feeling that this question somewhat placed the responsibility of knowing what they need to feel better on them.

Under the banner of 'navigating trust', participants described both experiences in which professionals had created safe, trusting environments, and those in which trust had been broken. Here, they emphasised the impact of therapists and support workers being 'relatable and persistent'. Relationships that were given time to develop allowed for more trust to build, and for more openness between parties; however, the situations in which such relationships flourish were not always present. One participant noted, for example, that staff suddenly moving on from roles had made them less prone to establish deep relationships with mental health professionals.

A few participants also shared that 'relatable' professionals helped them to feel more safe throughout the process. Some mentioned feeling more at ease with those who shared characteristics such as ethnicity, gender, or age, while others appreciated staff using 'normal' language, as opposed to medical jargon.

Finally, the team drew out the theme of 'the legacy of not having mental health needs met'. Past experiences of trying to access mental health support were a key driver of seeking help in the future, with failures to receive adequate support leading many to feel they would be better off without making contact with mental health services. Instead, the participants shared, many develop their own coping mechanisms to deal with their distress.

From these themes, the advisory group of care-experienced people brought to light many actionable points for practice. Firstly, they felt that it was important for professionals to develop an "understanding of how to manage care-leavers' apprehensions with engaging with support," and stressed the need for fast-track access to this support. Allowing young people to re-engage flexibly after not attending sessions was also highlighted as one way of improving their experiences; an adjustment that would acknowledge the many practical and personal difficulties care-experienced young people face that may prevent them from consistently accessing support.

The team notes that the self-selecting sample may have excluded those who do not want to talk about their experiences, which may leave the wider picture somewhat incomplete. This study does, however, give us a more intimate insight into the experiences of care-experienced children and young people, and the ways in which they interact with services. Varied insights such as these can ultimately shape how care is delivered, and allow us to model services into the most effective shape they can be. By understanding the triumphs and struggles of care-leavers who access mental health care, we better place ourselves into a position of being able to assist.

Read the paper in full.