Mental health and well-being of looked-after children Contents

Conclusions and recommendations

Access to mental health services

1.Current methods of assessing children and young people’s mental health and well-being as they enter care are inconsistent and too often fail to identify those in need of specialist care and support. Initial assessments are rarely completed by qualified mental health professionals with an appreciation of the varied and complex issues with which looked-after children may present. (Paragraph 13)

2.We recommend that the Government amends the statutory guidance to make clear that an SDQ should be completed for every child entering care as a starting point. In addition all looked-after children should have a full mental health assessment by a qualified mental health professional. Where required this should be followed by regular assessment of mental health and well-being as part of existing looked-after children reviews. (Paragraph 14)

3.Looked-after children who need access to mental health services often have numerous and complex issues that require specialist input across multiple agencies. We have heard evidence that CAMHS is often unable to provide this care due to high thresholds and a refusal to see children or young people without a stable placement. The inflexibility of CAMHS is failing looked-after children in too many areas and leaving vulnerable young people without support. (Paragraph 21)

4.CAMHS should not refuse to see children or young people without a stable placement or delay access to their services until a placement becomes permanent. (Paragraph 22)

5.We recognise that CAMHS is not the only, or in many cases the most suitable, source of support for looked-after children. We recommend that where possible CAMHS should form a part of a multi-agency team in which education, health and social care work in partnership. Looked-after children and young people are best supported when professionals collaborate and services are tailored to the needs of the individual. (Paragraph 23)

6.It is important that all children who need access to CAMHS get it in a timely manner. In recognition of the distinct challenges which looked-after children and young people face, we recommend that they should have priority access to mental health assessments by specialist practitioners but that subsequent treatment should be based on clinical need. (Paragraph 27)

The care system

7.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. (Paragraph 32)

8.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. (Paragraph 39)

9.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. (Paragraph 40)

10.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. (Paragraph 45)

11.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. (Paragraph 46)

Workforce development

12.Training and support for foster and residential carers is highly variable and in many local authorities fails to equip carers with the knowledge and skills needed to support looked-after children with mental health difficulties. Foster and residential carers are professionals who need comprehensive and regular training in how to properly support children and young people in their care. (Paragraph 52)

13.The current Training, Support and Development standards should be supplemented with specific modules which focus on mental health and emotional well-being. The Department for Education and the Department of Health should fund and develop these learning modules, building on best practice and those existing programmes with clear evidence of success. We recommend that the Government creates a curriculum development committee to oversee the formation of these modules. (Paragraph 53)

14.We support the recent recommendation made by the Youth Select Committee on the inclusion of mental health training in the core content of initial teacher training. We see this as a minimum requirement. Training on emotional well-being and mental health should also be included in continuous professional development for current teachers. (Paragraph 57)

School provision

15.School based counsellors should be available to identify early potential problems and signpost children and young people with more acute mental health difficulties to specialist care. Schools have a clear role in teaching about mental health and well-being, and should work with partners in health and local authorities to direct students to further support. (Paragraph 63)

16.The interface between schools and health services needs to be strengthened to ensure that teachers and schools are better equipped to identify, assess and support children and young people with mental health difficulties. However, schools must not be relied on to provide specialist care and treatment. We recommend that, if successful, the current schools link pilot be extended across all clinical commissioning groups with funding for all schools to train a mental health coordinator. (Paragraph 64)

Service integration, leadership and local implementation

17.We recommend that the statutory guidance on promoting the health and well-being of looked-after children be revised and strengthened to incorporate the recommendations made in The Children and Young People’s Mental Health Taskforce report Future in Mind. (Paragraph 69)

18.Since the publication of the Children and Young People’s Mental Health Taskforce report last year, and the more recent independent Mental Health Taskforce report, the Government has committed to both a qualitative analysis of Local Transformation Plans and the creation of an expert working group on the mental health needs of looked-after children. We look forward to seeing both pieces of work. (Paragraph 77)

19.Looked-after children will only benefit from Local Transformation Plans if their needs are addressed and funding allocated for their care. We recommend that all plans state the services they provide specifically for looked-after children and the funding assigned for them. (Paragraph 78)

20.No looked-after child should face a delay in accessing services after moving local authority area. We recommend that the Government amend its joint statutory guidance to clarify the balance of responsibility between local authorities when looked-after children and young people are placed out of area.(Paragraph 84)

21.Integration of education, social care and health services should be driven by strong local leadership. The Health and Well-being Board should have ownership of this agenda and strategic oversight of the commissioning of services for children and young people in their care. We recommend that each local area employ a senior, designated mental health professional with expertise in the diagnosis and treatment of mental illness and awareness of the broader risk factors common in looked-after children. (Paragraph 91)

The participation of looked-after children in decision making

22.All looked-after children should play a meaningful part in the decisions made about their mental health care. They should also be empowered to have a more active role in decisions about their placements to increase the likelihood that they will be stable and successful. (Paragraph 98)

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Prepared 27 April 2016