Care experience and post-18 mental health

The event was held by the Drive Forward Foundation and National Leaving Care Benchmarking Forum. 54 people attended the event including representatives from children’s social care, health services, the third sector and care experienced young people.

Speakers included:

Care experienced young people,
Mark Riddell, National Implementation Adviser for Care Leavers,
Josh MacAlister, Chair of the Independent Review of Children’s Social Care
Becca Randell – Kent, Surrey and Sussex Implementation Lead – Starting Well
Claire Murdoch, NHS England National Mental Health Director (via video message)

“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

Care Experienced young people from Young Person’s Benchmarking Forum (part of NLCBF) identified mental health as their primary priority for Local Authorities to be address coming out of COVID-19.

Farhia’s story

“Everything was going well until I was 18 and 19… My placement broke down so I ended up moving into my own accommodation.. I had to go back to another area, where I had priority housing. I then couldn’t access the CBT I was accessing because it was from a different area. When I sought support, they said I needed to wait at the bottom of the list again. This was at a time when I was living on my own and there was no support around me. I had to drop out of uni for a year.

“I ended up being admitted into hospital multiple times… that was absolutely hell to go through and after having that emergency therapy I slowly started recovering, I went back to uni and finished my degree and worked as a midwife and I was slowly getting my life together.

“Then lockdown came along, as a care leaver you tend to live on your own – and you’re less likely to have support and lockdown really amplified that. I got my care notes in the middle of lockdown & I wasn’t allowed at the time to visit anyone and my mental health took a massive dip and I went into another crisis. I decided to pay for private therapy because I wasn’t severe enough to access emergency therapy and I didn’t want to have to go through the experience of going in and out of hospital again.

“I did get decent help when I was a child in care, You can have the best experience in care – the best foster carer, the best support network, but trauma does not disappear overnight and it takes time to treat that and even though I did get good support when I was young, but that support didn’t last.

“A lot of times when I accessed mental health services, they didn’t even know what ‘care leavers’ were and they were not sensitive to the idea that we were sensitive to attachment – so I would have a stream of mental health nurses who would come and go, not realising that that was causing me more psychological damage because it was mirroring experiences I had in the care system.

“A lot of times the sessions would be – 10 sessions or 6 sessions of CBT – If you know most care leavers it would take those sessions telling you my history. It needs to be something that is longer term and that people who are providing this have knowledge of how to support care leavers and know the nuances of being in care and the unique psychological difficulties it can bring.”

Recommendations

Dedicated mental health provision for care experienced young people – dedicated trauma informed mental health provision for care experienced young people, where possible co-located with leaving care teams.
Emotional wellbeing and early intervention – invest in early intervention and emotional wellbeing services for care experienced young people.
Integration and communication – closer working between leaving care teams and Integrated Commissioning Services; Integrated Commissioning Service involvement on Corporate Parenting Board.
Duty for multiagencies to support care leavers – introduce new duties within Corporate Parenting Principles for agencies including health to support care leavers.
Care Leavers Lead in NHS England, and Champion in each Integrated Commissioning Service – using model seen in HMPPS; explore if NHS model of support for veterans could be used to shape services for care experienced young people.
Co-production of services – co-produce services with care experienced young people.
Staff training – improved training for leaving care teams and foster carers around mental health, and training for mental health teams on impact of care experience.
Accommodation and wider issues – recognise impact of wider issues including accommodation and staff changes has on the mental health of care experienced young people, and seek to address these.
Support across lifetime for people with care experience – a lifetime offer of trauma-informed support for care experienced adults, which understands the impact of care experience.
Establish a model of Virtual Mental Health Leads within children’s services – similar to Virtual School Heads role.

“We’ve got to think about corporate parenting – Is this good enough for our kids and if we were really honest with ourselves, we’d have to say that the health approach across the country – apart from some examples of innovation – we’d have to say this is not the best offer for our kids – so I’ve got something to do with the policy team and the Ministerial Board to push ministers even further in that context.”

– Mark Riddell, National Implementation Adviser for Care Leavers

Pledges from event attendees

Start the conversation between children’s and health commissioners
to connect with other services mentioned today
secure more funding to expand into new local authority areas
support best practice work and advocate for ways of working that make a difference
listen and work in co-production with care experienced population
attend workshops/training to improve practice
do participation differently
challenge the care leavers mental health lead in the local authority – is it good enough?
look at helping scope out research questions and fund research in mental health of care experienced young people
evidencing the difficulties we know are happening on the ground
use Barnardos Neglected Minds Research to inform service improvements
training for the service in emotional coaching
meet with adult mental health team to agree funding to make mental health practitioner role full time
starting the conversation and recognise common challenges and find collaborative solutions

Next steps

Submit this paper to Independent Review of Children’s Social Care’s ‘Call for Ideas’
Meet with representatives from Children and Young People’s Mental Health Programme, NHS England
Share the findings with NHS England Mental Health Director
Explore ways to continue this conversation with representatives from social care, health and third sector

“We have to think differently and creatively with children in care and care leavers, because it’s not inevitable that their outcomes will be poorer. We can change that, we can change that together. We are working with our local authorities because we know a great deal of what we do needs to be in partnership with them. Young People should not be experiencing fragmentation.”

– Claire Murdoch, NHS England National Mental Health Director via video message

The resulting recommendations came from from people attending the event, collected via Mentimeter and from speaker comments. These have been described below:

Main gaps and needs

Transition at 18

Poor transition to adult services
Different thresholds with adult mental health services
Cliff edge at 18
Services based on age not stage – should be the other way round
Commissioning silos – leaving care teams under children’s social care, and health under adult services

Relationships

Supporting better, stronger relationships that are sustained long-term
Need strong relationships and consistent support
Difficulties around placement changes and changes in social workers

Accessing mental health services and capacity of services

Lack of post-18 provision, inconsistency across Local Authorities, lack of coordination
Not enough mental health support
Mental health support not at the place where young people need it – barriers accessing it
Difficulty getting referrals to the right services
Limited early intervention support
Lack of proper signposting – not very young person friendly
Need better communication between social care and NHS mental health services to support more efficient pathways to support

Types of support available

Not every child is the same but their mental health needs are treated similarly
Lack of funding for bespoke psychological support for care experienced young people
Need long-term joined up services that have barriers removed and stability in the service so that young person can get the service they need over a period of time
Need long-term trauma/life work therapy in adult mental health services

Children in care

Lack of initial assessment when young people come into care
More support from early years to prevent further difficulties at care leavers age
Lack of family therapy for children and foster carers
Each child in care to have a trauma assessment for accessing adult mental health

Trauma informed support

Lack of trauma informed therapy services
Need trauma informed early interventions
CAMHS too easily disengaging with young people due to their behaviours
Offering long-term trauma/life work therapy in adult mental health services
Support around maintaining engagement with mental health services once a young person has accessed them e.g. safety nets once they are in CAMHS

Staff training and awareness

Inconsistent mental health training for leaving care teams
Gap in understanding what it is like to grow up in care in health teams
Need evidence-based mental health training for social care staff and Personal Advisers
Leaving care workers to have a basic knowledge of mental health training
Lack of understanding of Personal Adviser role with health colleagues

Accountability

A clearer method of accountability for carrying out responsibilities

Emotional wellbeing

Need empowerment of the young person in relation to their mental health
Gaps around identity
Consider wider emotional wellbeing rather than more specific mental health
Need more investment in early intervention e.g. peer support, mentoring

Solutions, good practice and ideas

Staff training

Evidence based mental health training for social care teams
Training for health team on the impact of care experience
Mental health training mandatory for foster carers

Proposed models

Clinical psychologists being placed with Local Authority teams with good links to mental health teams
Specialist mental health teams for looked after young people in each area
Mental health practitioner in leaving care team, but close links with adult mental health services
Outreach offer, trauma informed, long-term relationship based, long-term mentoring
Co-located services with leaving care teams
Virtual mental health leads using Virtual Schools Heads model

Support across lifetime for people with care experience

Healing takes place across the lifetime – please don’t forget older young people too
Offering long-term trauma/life work therapy in adult mental health services

Out-of-area support

When a young person moves area, they keep their priority and don’t start at the end of the waiting list again

Co-production of services

Care experienced young people designing the services they need
Lived experience at the heart of delivery

Duty for multiagencies to support care leavers

Increase the strength of corporate parenting principles to include a set of duties for agencies including health – in the model of Youth Offending services

Identify care leavers as a specific group in mental health services

Care leavers lead in NHS England, and Care Leaver Champion in each Integrated Commissioning Service; use HMPPS model which has been effective
Make sure mental health of care leavers is monitored by CQC
Ringfenced funding for care leavers’ mental health

Accommodation

Extension of supported accommodation post-18 and roll out of “Staying Close”

Veterans model

Explore Veterans Model of support within NHS – could care experienced young people also have a dedicated plan?

Integration and communication

Sharing of information about available services and preventing referral rejection
Leaving Care teams to know who the 18-25 year old Pathways Lead is in their local Integrated Commissioning Service
Corporate parenting panel – invite Integrated Commissioning Service leads, mental health trust CEOs to meet care leavers and to co-create services
Work with Integrated Commissioning Service leads around joint training and clinical supervision
Helping trusts identify care leavers and personal advisers

Emotional wellbeing and early intervention

A more rounded approach – thinking about what we all need to support good mental health, relationships, connection as well as acute services
Wrap-around offer for care leavers; create places and people to belong to
Meet young people where they are and don’t make them wait; repeat their issues to different professionals or go into crisis before acting
More focus on supporting interdependencies – community, connection and relationships supporting good emotional/mental wellbeing
Relationships before processes
Working creatively with charities to provide care leaver services
Psychology input into youth work provision – those who may connect with young people first
Resourcing peer support groups
Empowerment of care leavers in relation to their own mental health so that growth can be self-determined, nurturing self-awareness, self-regulation, knowledge of mental health, and understanding of triggers

Examples of good practice showcased

Care Leavers and Mental Health, Northamptonshire Children’s Trust, funded by Public Health
Psychological Wellbeing Service, Pure Insight
Lifelong links project / the House Project supporting young people in Coventry
Prescribing GP located with leaving care team – Salford
Support for young people who have gang related issues – young people are more likely to use that support – Wandsworth