Report: Reviews on mental health services for care-experienced young people

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Research shows that the mental health support available to young people who have left out-of-home care is inconsistent and insufficient. Meanwhile, these young people face multiple vulnerabilities – including trauma experiences, carer transitions and difficulties accessing support – and are disproportionately affected by mental health problems in comparison with non-care-experienced peers. On leaving care (usually at age 18), mental health deteriorates for many, despite no longer being eligible for relevant support services. 

In light of a call for urgent action on this issue as part of the Independent Review of Children’s Social Care, CEI was asked to review the evidence about effective mental health services for care-experienced young people, for What Works for Children's Social Care (now called Foundations: What Works Centre for Children & Families).

“We investigated evidence for both the impact of policies and interventions for the young people concerned around the world, and also for their experiences of the implementation of mental health services in the UK,” says lead author, CEI’s Dr Ellie Ott.

“We did this work in consultation with two advisory groups – one comprised of young people with lived experience and one of relevant policy, practice and research professionals.”

The two resulting evidence reviews sifted through more than 6,000 research papers. Eight relevant papers (reporting the results of five studies) reported evidence of the impact of policies, programs and interventions, however no firm conclusions could be drawn on service effectiveness. A second review, investigating experiences with the implementation of mental health services, drew on 43 studies (24 academic, 19 grey literature) representing the voices of young people and professionals involved in their care and case management. This review explored barriers and enablers for care-experienced young people to access mental health services.

“We found that the young people had trouble accessing services due to long waiting times, challenges of geography and high and stringent thresholds for acceptance into care,” says Ellie. “Barriers to young people seeking or desiring support included concerns about services labelling or stigmatising them, skepticism around the ability of services to help, and feelings of vulnerability in talking about mental health. Young people also placed importance on having their own mental resilience and not relying on others for support.”

“Enablers to engagement with mental health services included having strong, trusting relationships with professionals, as well as those professionals understanding what it means to be ‘care-experienced’.”

“We learnt that services may be made more acceptable and appropriate by improving client choice and control within services, by having more specialised services and pathways, and by placing greater importance on the supportive relationships and social networks that young people establish for themselves.”

The review also found that some young people experienced disruptions to their support when they moved to a new region, transferred to adult mental health services, and during the pandemic.

“There is, sadly a paucity of research on the effectiveness of different approaches in this vitally important area of mental health service provision,” says Ellie. “We need to pilot and evaluate initiatives for the mental health of care-experienced young people while focusing on improving mental health services for young people in general.”

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The report “Reviews on Mental Health Services for Care-Experienced Young People” was developed by Dr Ellie Ott and Emma Wills at CEI and David Taylor at Monash University, commissioned by What Works for Children’s Social Care (now Foundations What Works Centre for Children and Families).