This document summarizes research on the mental health needs of looked after young people and a 3-year training project to address this issue. It finds that about 60% of looked after children have emotional or mental health problems, but historically only around 25% received support. A growing number of looked after children indicates increased need. The training project aims to provide subsidized mental health training to social workers, foster carers, and other professionals working with looked after youth to improve identification of needs and collaboration between services. Feedback is sought from participants on priority training topics for their local areas.
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Layp mental health and stigma
1. Looked after young people:
mental health and stigma
Roger Catchpole
Training & Development Manager
2. What is it about?
• Setting the context
• YoungMinds research on mental health,
Looked After Young People and stigma
• A 3 year training project
3. A growing issue
• There were 65,520 looked after children
at 31 March 2011, an increase of 2 per
cent from 2010 and an increase of 9 per
cent since 2007
• January 2012 saw the highest ever
number of care applications in a single
month
4. Mental health
• About 60% of those looked after in
England have been reported to have
emotional and mental health problems
(NICE: 2010)
• Among young people, aged 5-17 years,
looked after by local authorities 45%
were assessed as having a mental
disorder (ONS: 2003)
5. The gap between needs and
provision
One study in 1997 found that 80% of
Looked After Children needed mental
health support while 27% received it.
How much has that changed?
Phillips, J. Meeting the psychiatric needs of children in foster care: social
workers views. Psychiatric Bulletin, 21: 601-611
6. Not enough
A survey of 106 looked after children concluded:
• The high numbers of ‘need’ appeared unchanged
• The poor needs/met ratio is still evident
• Requests for help are impeded by a perceived lack of
understanding/empathy/experience (of being from Care)
• Few of those that feel able to ask for help would turn to
mental health professionals
• Professional mental health solutions are viewed as
stigmatising
• A clear majority choose the alternative coping strategies of
increased drug/alcohol consumption
A National Voice; Emotional Wellbeing Report (2010)
7. What the research tells us
• Children and young people say their emotional
wellbeing and self esteem is supported when
they are cared for in an environment where
they feel they belong
• Stability and continuity make a difference
• Foster carers want ongoing training to deal with
emotional needs and more access to services,
in particular mental health services
Improving the emotional and behavioural health of Looked After Children and
Young People: C4EO
8. What helps?
• Comprehensive assessment of needs on entry
that identifies mental health needs
• Good communication and collaboration
between mental health professionals and care
staff
• Staff with good understanding and awareness of
mental health needs
• Engagement and consultation with young
people
An evaluation of the provision of mental health services for Looked After Young
People (Ofsted 2010)
9.
10. “Always makes
a good effort” “Very polite”
‘Very aggressive
towards other
young people”
“Improving in
Maths and
English”
“Doesn’t “Always
concentrate well” disrupting
class”
How does the school see you?
11. Outside I
Inside I Feel..........
Behave..........
“Worried” “Mature”
“Lonely” “Confident”
“Given up ” “Just get on with it”
“No Hope”
“I hate it”
“Going to explode ”
“Don’t trust anyone ”
“Let down” “Won’t talk to anyone”
“Quiet ” “I know everything ”
“Happy ”
12. “Better than I thought” “They are not really
listening and twisting
“I don’t talk to other people words”
about my problems”
“How I see mental Health
Services” “They ask too many
“Why would I talk to a
questions”
stranger”
“My voice is not heard”
“It took me a long time to tell people “Judgemental”
that I was in danger in my supported
accommodation but in the end I got
help”
13. In foster care I felt trapped.
Residential care gave me freedom.
18. Mental health training
• 3 years funding
• Delivering subsidised
training
• Developing online
toolkit
• 360 people trained in
2011/12
19. The training agenda so far
• Conceptual models of mental health –
nature, nurture and events
• Risk and Resilience
• Attachment and Neuroscience
• Reflective practice
• Inter professional practice
20. Who needs training?
• Any of the 60 or more practitioners and
managers involved in the life of a typical
Looked After Young Person including;
social workers, residential child care staff, managers,
foster carers, education professionals, learning mentors,
learning support assistants, family court staff, GPs and
other primary health care staff, A&E staff, CAMHS
workers, independent visitors, YOT members,
substance misuse workers, housing workers, early years
professionals etc..
21. What we know
• Priorities are different in different areas
• We need to add value to existing training
not duplicate it
• Raising awareness and skilling up
individual practitioners is important but
will not achieve systemic change on its
own
22. What we want to know
• What are the priorities in your area?
• Is there training that would make a real
difference to the Looked After system in
your area?
• Might you be interested in working with
us?
Education Young people we asked to fill out fake Personal education plans as if they were there teachers so that they could consider how they felt they were seen at school. They were also asked to think about whether school was a place where their emotional well being was supported. Findings - Some young people felt they were seen as disruptive at school and their relationship with teachers was seen as negative. A few young people stated that teachers were pleased with their behaviour. Many of the young people identified that teachers would recognise that they had good relationships with other young people. Most of the young people stated that they did not feel that their emotional needs were understood or that they could talk about their emotional needs at school, especially because staff did not have experience of the care system. A few said that they felt judged and that they would like to be listened to more. Some said that they liked to keep home and school separate and that they did not want to be singled out because they were Looked After. This emerged in other discussions where some young people stated that they wanted to be thought of as “young people” rather than “Looked After Young People”.
Many young people said that despite feeling scared they tried to pretend everything was fine. Young people moving to independence or supported accommodation shared their anxieties about living with less support. They appreciated maintaining contact with their residential homes or participation workers. For young people living in a secure setting, the importance of pretending they were ok seemed significant. Some young people identified that they were scared and homesick but were more likely to lash out and get in trouble rather than share their feelings.
We asked young people to tell us what they thought about the services that are available to support their emotional well being. We wanted to explore whether there is stigma attached to mental health services. Many young people had a fairly negative perception of mental health services. Those who had not accessed services were wary and suggested that they were for people who are particularly unwell. Words such as “mad” and “mental” were used to describe who services may be aimed at. Suggestions for improvement centred on building relationships- there was a reluctance of talking to strangers and a fear of what may be discovered if they did open up. Emphasis was put on trust and young people identified that they were more likely to talk to adults working in participation services or their carers than workers within CAMHS. Young people stressed that they need time to build relationships with professionals before they access emotional support from them. Some young people had been involved with CAMHS and there was a general suggestion that those who had received a diagnosis had found it helpful but wished that they had received assessments earlier rather than waiting lengthy periods to get support
There needs to be more widespread understanding of what it means to be a Looked After Young Person. Participants repeatedly stated that the only representation of children in care that others know is the TV character Tracy Beaker and that they are tired of telling peers that they are ‘not like Tracy Beaker’. Discussions in school around equality and diversity should include conversations about where young people may live. Normalising the idea of Care so that all children understand that young people grow up in a variety different settings, including foster care and residential care, will help to alleviate some of the stigma attached to children growing up away from the family home and will improve their overall wellbeing and mental health.