28.Children in long-term, secure placements are more likely to feel that their mental and emotional health needs are supported. Matching children and young people to suitable foster and residential settings is crucial to ensuring longevity in a placement and happiness for a child or young person.
29.Kevin Williams, Chief Executive of the Fostering Network, told us that “placement stability will be one of the key factors that helps to improve emotional well-being for looked-after young people”. Mr Williams also voiced his support for the ‘Staying Put’ policy which allows young people to stay in foster placements until they are 21. He added that although ‘Staying Put’ could “reduce involvement in mental health services in the future”, implementation is currently “poor” and “sporadic”. The Government has recently announced a 50% increase in funding for ‘Staying Put’ in 2016/17.
30.In our private meeting several young people spoke of the disruption that frequent change had on their emotional well-being and mental health. One care leaver told us “continuity and stability is so important and children in care don’t have any”. Continuity in care also featured heavily in our discussion with young people and in evidence from Sarah Brennan:
We know the linkage—the continuity of care—is absolutely critical for all parts, but certainly around mental health and well-being it is often the relationship and the consistency of care that is the most therapeutic thing. How those local arrangements can enable continuity of care is certainly challenging, but it is also essential.
31.The National Adoption and Fostering Service commented that placement stability can have a positive impact on looked-after children’s “attachment relationships” and subsequently their mental and emotional health and well-being:
Placement stability in its own right can be a valuable asset for improving children’s well-being, and based on research, their attachment security.
32.Continuity of care in an environment where children and young people are able to form strong, enduring relationships should be at the heart of the care system. We are pleased to see an increase in funding for ‘Staying Put’ and expect to see evidence that this additional investment leads to more young people remaining in secure placements for longer.
33.CAMHS are expected to work with young people up until the age of 18. However we were told that CAMHS will see a young person between 16 and 18 only if they are in full time education. The Children’s Services Development Group explained:
There is also a specific problem with a lack of access to CAMHS for looked after children between the ages of 16 and 18 who do not attend school or college. Funding for CAMHS is generally organised through school and colleges. As a result, looked after children who are over 16 and not in education rarely receive CAMHS, even if they require it.
34.Once a young person is over the age of 18 they can be referred to adult mental health services. Several pieces of written evidence described the differences between CAMHS and adult services, which they said were in many cases unsuitable for vulnerable young people such as those in care. The Children’s Society and the Church of England expressed particular concern for the mental health of care leavers:
The period of transition for many children can be characterised by confusion, a lack of coordination and participation. It is known that mental health needs become more acute as children progress through adolescent years and when they leave care. Yet it is then that the access to services becomes more difficult.
35.The NSPCC described the withdrawal of CAMHS at 18 as a “cliff edge” in care. Its 2015 report into the emotional well-being of looked-after children recommended that local authorities and health services should work together to provide mental health support for care leavers up to the age of 25. Extending mental health support for care leavers until the age of 25 was also included in the Alliance for Children in Care and Care Leavers seven key recommendations to this inquiry.
36.NICE guidance recommends that mental health treatment for young people should continue “until a handover with an assessment and completed care plan has been developed with the relevant adult service”. It continues to say that if a young person does not meet the threshold for adult mental health services then other types of support should be identified in a pathway plan.
37.Although the majority of evidence agreed that looked-after young people need better mental health support as they leave the care system, there was some debate over whether providing such support should be mandatory. Claire Bethel told us that:
What I don’t think we want to do is put that on the statute books and make it a mandatory increase in the age from 18 to 25. We want to leave it for local determination but we are very interested and pleased that there a couple of areas in the country […] that are now commissioning services from 0-25.
38.Professor Peter Fonagy, National Clinical Adviser on Children and Young People’s Mental Health at NHS England, agreed with Ms Bethel that a 0-25 mental health service for looked-after children should be made possible but not enforced. This argument is very much in line with the recommendations from The Children and Young People’s Mental Health Taskforce report Future in Mind.
The Taskforce does not wish to be prescriptive about the age of transition, but does recognise that transition at 18 will often not be appropriate. We recommend flexibility around age boundaries, in which transition is based on individual circumstances rather than absolute age.
39.Leaving the care system can be a time of significant upheaval and disruption. This is likely to be more acute for care leavers with mental health concerns. Current support for these vulnerable young people is inadequate and based too heavily on inflexible age restrictions.
40.CAMHS should be made available for all looked-after young people up to the age of 25 in recognition of the distinct issues which this vulnerable group of young people face as they leave the care system. Access to services beyond the age of 18 should be offered where appropriate but not made mandatory where an individual would be better suited to moving onto adult mental health services.
41.In 2014 the Health Committee’s report on CAMHS expressed serious concerns over the lack of reliable data and information on children and young people’s mental health. The Committee described it as “deeply” concerning that the Office of National Statistics (ONS) data on children’s and young people’s mental health was ten years out of date. It received assurances from the Minister that the study would be repeated:
The Minister agreed that prevalence data was “horribly out of date”. During the course of our inquiry, the Government announced that it had identified funding to repeat this survey, and the Minister repeated this commitment in oral evidence to us. Work will begin in the autumn, although the project is not likely to be completed until 2016. While the Minister could not commit future governments to funding the survey on a continuing basis, he told us that in his view a long gap between surveys should in future be avoided, in order to “maintain a current understanding of the scale of the problem”.
42.In evidence to us Alistair Burt admitted there had been a “data shortage” and stated that the Government had commissioned a new ONS prevalence survey which will report in 2018; 14 years after the last study. The studies were previously conducted on a five-yearly basis.
43.The paucity of data was acknowledged by Edward Timpson who also admitted that there was a huge variability in the extent to which local authorities support and monitor their care leavers. Mr Timpson referred to the National Audit Office’s (NAO) report entitled Care leavers’ transitions to adulthood. This report recommended that the Government “monitor the lives of care leavers” to get a “better understanding of the social problems care leavers face, such as […] mental illness”.
44.Concerns over the long-term monitoring of care leavers were reflected in evidence from Professor Fonagy:
I would want to state that specifically in the case of looked-after children, long-term outcomes are poorly monitored and if you wanted to consider recommendations for this Committee, better monitoring of long-term outcomes for this population is of great importance.
45.There is an urgent need for comprehensive and up to date data on the mental health and well-being of looked-after children and care leavers. We are disappointed that a new ONS prevalence survey will not report until 2018.
46.We strongly urge the Government to return to funding ONS prevalence surveys on children and young people’s mental health on a five-yearly basis. We also recommend that they invest in outcomes monitoring to better understand the challenges that young people face whilst in and when leaving the care system.
42 The Adolescent and Children’s Trust () para 7
46 Department for Education, Staying Put Implemention Grant (2016/17)[No.31/2380], March 2016
47 See for further details.
48 See for further details.
50 The National Adoption and Fostering Service () para 20
51 Children’s Services Development Group () para 28
52 The Children’s Society and the Church of England () para 5
55 Alliance for Children in Care and Care Leavers ()
63 National Audit Office, Care leavers’ transition to adulthood, , July 2015
64 Care leavers’ transition to adulthood, , p 11
Prepared 27 April 2016