Making the case for better mental health support for children in care
This week has been a significant week for making the case for better mental health support for children in care. The Children’s Commissioner published her annual briefing on children’s mental health services 2023-24 on 18 May. This set out the continued concerns that children are still experiencing long waits to access mental health services, with the number of children still waiting for treatment increasing by 50,000 to 320,000 in the past year. Almost half of those referred for being ‘in crisis’ have their referral closed or were waiting for their second contact at the end of the year. There has also been an increase in children being referred for neurodevelopmental conditions. Whilst the report is not about children in care specifically it sets out the troubling context for the provision of mental health support for children. What is even more concerning is that research shows that children in care are at least four times more likely than their peers to have a diagnosable mental health condition, such as anxiety, depression, post-traumatic stress, or conduct problems. The need for action is clear.
That is why Rachel Hiller and various academics and partner organisations have worked together with us to produce ‘Increasing access to evidence-informed mental health service provision for children in care in England – National recommendations for change’. This sets out actionable changes that could make a positive difference to the provision of mental health support for children in care.
Key recommendations in the report include:
- All local areas to develop a joint service delivery plan and new KPIs, between CAMHS and children’s social care, to increase knowledge and accountability.
- Introduction of an initial mental health and wellbeing assessment, 4-6 months after entry to care.
- All local areas to have a co-located mental health service between children’s social care and CAMHS, which is commissioned to provide direct and indirect evidence-based support.
- The development of a new children’s social care mental health practitioner (CSCMP) training programme, to upskill the children’s socialcare-based mental health workforce on evidence-based therapies.
- Update to the NICE guidelines for Looked After Children.
A key message within the report is “help me get what I deserve”. Children in care have often experienced abuse or neglect during their childhood as well as loss and trauma related to this. Against this background it is not that surprising that there is a need for high quality and evidence-based interventions to support them. However, this does not always happen. We know that there is a postcode lottery of support available across the country as well as varying levels of intervention and types of support, some with limited evidence of their efficacy. We hear too often of children being denied support and intervention because this is seen as a “social care” issue or because there is a lack of “stability”. Sometimes interventions are refused or not sought as there is already therapeutic work underway. This report sets out that children can have therapy and a mental health intervention if that is what they need.
Greater strategic collaboration and partnerships between mental health services and children’s social care at local level is needed. We know that this can work as practice models have existed across the country where there is effective joint commissioning between children’s services and CAMHS. Unfortunately, arrangements like this are sporadic and vary from region to region. Too often agencies only speak their own professional language and discourse and have a lack of knowledge of other agencies’ resources, support and processes. Breaking down professional silos is a solution and must happen. The children are the same regardless of which service they are under and better joint working can only improve services that are available to them.
We also know that the mental health needs of children in care can be missed. There are lots of assessments of children when they enter care; an initial health assessment followed by a review health assessment one year later (for those over five years) and then annually. This is a holistic health assessment and whilst it covers a child’s wellbeing it also covers many other areas. That is why we recommend an initial mental health and wellbeing assessment four-six months after entry to care when the child’s needs are better known and understood by carers and agencies, and is not completed at a time of transition and likely loss for them when they have just become looked after. This, alongside better interagency working, would provide better pathways to support and understand each child’s unique needs.
CoramBAAF and the authors of this report are ambitious for children in care. One of the most important roles the state has is the responsibility for children in care. They deserve and are entitled to have any mental health needs identified as early as possible as well as access to the best evidence-based interventions to support them.
James Bury, Head of Policy, Research, and Development, CoramBAAF.