10 October marks World Mental Health Day. According to World Health Organisation (WHO), half of all mental illness begins by the age of 14 – though most cases go undetected and untreated.

Here we've interviewed the authors of our new good practice guide, Supporting the Mental Health of Looked After and Adopted Children, to give an insight into this new book, and discuss why it is a vital resource for carers.

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Hello! Thank you for agreeing to this interview. Can you tell us a bit about yourselves, and your backgrounds to date?

We’re both Consultant Clinical Psychologists who have worked with children within a variety of mental health services in NHS, social care and community settings. Our work has involved assessing and providing interventions for children with a wide range of mental health difficulties. Between us, we have set up and delivered a number of targeted Child and Adolescent Mental Health Services for looked after and adopted children around the country. In addition to providing direct therapy, much of our work has focused upon informing and educating those working at the coal-face with these children, including social workers and teachers. Over the years, we hope that we have contributed to an increased understanding by professionals, carers and parents alike, about the emotional needs of looked after and adopted children, and how to support them. 

Can you give an introduction to your co-authored book, Supporting the Mental Health of Looked After and Adopted Children, and what's inside it. Who is it written for, and why is this book so important right now?

We’re hoping that this guide does what it says on the cover! We want to continue to share our knowledge, about how looked after and adopted children can be supported to have and develop good mental health, in a straightforward and accessible way that will hopefully appeal to the busy social worker.

While writing, we were mindful of many issues that we have observed in our daily work. Firstly, that some professionals and services can become focused on labels and diagnoses. For example, social workers have frequently asked us what intervention or therapy a child may need for a specific issue such as ‘anxiety’. However, as clinicians, we know that the answer to this is not simple because ‘anxiety’ can have many causes and effects and the child is likely to need a tailored intervention.

Secondly, we know from experience, and from that of our colleagues, that good interventions begin with children being in a place of safety and stability with a good carer. Children also benefit when the adults supporting them work together - i.e. the child has a good ‘team’ around them. We have taken the approach of using a holistic framework that begins with knowing about a child’s history and current life alongside care planning. 

We felt that it was important to breakdown some of the confusing language that can be used by services. We wanted to write using plain English and provide accessible information about concepts. We were also aware that social care professionals are busy people who value guidance regarding what they can do. So, we provide practical advice which we hope is realistic given the current economic climate. 

We have split the book into two parts:

Part 1 sets the scene and explores what mental health really means for children who are in (or have been) in care. We introduce a framework of how to understand children in their context and lay out a comprehensive model for intervention. In this section we also highlight relevant legislation and explore available support services and their limitations. We also look at the National Institute of Clinical Excellence (NICE) Guidelines for mental health provision. 

Part 2 focuses on common worrying behaviours and symptoms experienced by looked after and adopted children and young people. Although we were mindful that categorizing children’s problems could oversimplify the issues, we were also aware that busy social workers may need a way to access relevant information quickly. So, we decided to arrange this section so that social workers can quickly find information about a particular mental health issue. We really hope, however, that readers will also consider some of the more general information from Part 1, which will give a foundation for making sense of the chapters in Part 2.

We wrote this book for primarily for UK social care professionals but also for the many other professionals, carers and parents who are involved with supporting looked after and adopted children. 

This book is important right now because sadly we’re hearing more and more about children who are in emotional distress. The numbers of children experiencing difficulties, particularly those related to parental substance misuse and parental mental illness, are increasing. In an era of austerity and decreased funding for support services across the board, it is so important that we use resources wisely and target interventions, both from a social care and health perspective, so that they can make the greatest difference. 

What's changing in the field – are children's mental health issues worsening, or have we become more aware of them, and better at recognising issues?

Children’s mental health issues are certainly becoming more complex. Children are coming into care for many different reasons, often connected with parental substance abuse, poverty and neglect. Mental health awareness is increasing and although in some ways the stigma that used to be attached to such difficulties is decreasing, society still often tends to label children with challenging behaviour, as being ‘bad’, rather than understanding that these children may not have had their fundamental emotional needs met very well. Some professionals who work with children may not be well versed enough on the effects of early trauma and poor attachment experiences on children, and how to help children recover from these.

What challenges and issues do you feel that social workers, foster carers and adopters currently face with regards to the mental health of looked after children? What is the impact of these challenges, and how can this book help its readers?

The challenges for social workers, foster carers and adoptive parents are many. These days, children have frequently suffered multiple traumas and broken attachment relationships before they entered care. This can make any resultant mental health difficulties hard to unpick. We are painfully aware that child mental health services are stretched to the limit and are not always set up to be able to be flexible enough to meet the needs of these children. And, within the wider community, there is often not enough understanding of mental health difficulties generally and those related to attachment and trauma issues in particular. 

The book describes a range of health issues and symptoms – some are apparent but some may be less well recognised. Can you tell us a little bit about this, are there any vital issues that carers might not perhaps know about?

It is really difficult for any carer or social worker to get to grips with the complex concepts of what constitutes mental health. Thankfully both carers/parents and social workers are now becoming familiar with concepts such as attachment difficulties and trauma, and how problems can be rooted in the child's experiences. Mental health diagnoses can however sometimes seem to be more confusing and separate from the child and his or her experiences. We hope that this guide helps readers to understand the overlap between early experiences, attachment relationships, adverse life events, trauma and mental health diagnoses.

The book follows an 'attachment focused' understanding of mental health issues that aims to be more holistic and looks at the ‘whole child’ – can you tell us about the importance of looking at mental health in this way, and why this is important to consider in this context?

When we trained in clinical psychology back in the 90s, the word ‘attachment’ was rarely used. Over the last decade or so, ‘attachment-focused’ has become more popular and known about. This is for good reasons! The evidence is that mental health is intricately connected to our relationships and life experiences. Mentally healthy people tend to have had better emotionally connecting relationships throughout their lives and to have experienced less trauma in their relationships, particularly during childhood. We also know that mental health difficulties have many causes and influences. For example, if someone lives in an economically deprived place then their mental health can suffer. Basic physical things, such as a nutritious diet and good sleep also impact on mental health. In fact, there really is a spider web of factors that influence mental health. 

You've included an 'aide-memoire' which covers information needed to understand why a child has mental health difficulties – the 'Child Attributes and Past and Present Experiences matrix (CAPPE)'. Can you tell us more about this?

We know from our social work colleagues that they are frequently faced with the task of gathering a lot of information to share with other people. We have recalled the many consultations we have had over the years with our social care colleagues about children. Much of the consultation time was focused on trying to understand, identify and piece-together what was known about the child’s past and present experiences so that we could then give guidance which ‘fit’ that child’s needs. We wanted to provide something that would assist our colleagues with remembering all of the different things that can influence a child’s mental health, and provide a way in which they could easily document it.

What other resources would you recommend to carers – both for the children, but also in helping the carers look after themselves, too?

Our guide contains a lot of books and references which could be useful to children and carers. We spent a lot of time on this and many of the books listed have been recommended to us by foster carers and adoptive parents. It is so important that carers look after themselves and that they are well supported by their local fostering and adoption service. Organisations such as The Fostering Network, Adoption UKPAC UK and the National Association of Therapeutic Parents are also good resources for carers.