What young people want

High levels of mental health needs have been identified among
looked-after children, and child and adolescent mental health
services (CAMHS) have been urged to respond more
effectively.¹ But few studies have found out the views
of looked-after children and considered what services they would
like.

The study described here used focus groups with looked-after
young people to explore their views and ideas as part of a larger
project, which included a study of the files of looked-after
children and a survey of front-line carers.²

The findings identified consistency and continuity of care as
key factors in securing good mental health for looked-after
children. The young people valued staff who were “always there”.
One young person, Nathan, outlined how the shift changes in
residential homes contributed to a lack of consistency that could
be difficult to handle: “Because staff are on for a day, half a day
and half a night for a bit, you get used to how they’re
treating you and then, when the new shift comes on, they have a
different way of handling us and it feels weird. You have to change
your attitude all the time each and every day.”

Young people found it helpful to “know where they were” with
staff, and emphasised the importance of having clear boundaries.
Jamie described how the need for residential staff to manage a
large group of children could limit their availability: “It makes
things uneasy for you because a member of staff is saying that they
got to spend time with that kid who’s causing trouble, but
then they could have been spending time with you.”

Staff ratios in children’s homes need to be sufficiently
high to ensure that children feel that workers have enough time to
give them individual attention.

The participants had talked to a range of mental health
professionals, including psychologists and specialist counsellors
from voluntary agencies. The more informal approach of the
voluntary sector was particularly welcomed by them. Regardless of
which professional they were talking to, they felt it important
that they had a choice about whether they participated in
counselling or therapy and some control of the agenda. They
favoured unpressurised approaches that allowed them to tackle
difficult subjects at their own pace. They also emphasised that
being offered a choice about whether they received help was
empowering. As Darren said: “Having a choice means you can do what
you want to do, it’s just the thing about having the
power.”

In order for young people to be offered a meaningful choice, a
range of provision needs to be available. One of the research
recommendations is that, as well as ensuring that their own
services are responsive and flexible, councils and health
authorities need to continue to commission relevant services for
looked-after young people from the voluntary sector.

Confidentiality is important for looked-after children as
intimate details of their lives are shared with strangers with whom
they have no personal relationship. This may happen in public
arenas such as case conferences or court settings. The commitment
to confidentiality was seen as a positive aspect of the voluntary
sector service that the young people had used. Lisa compared this
service with her experience of talking to her social worker: “I
said something to my social worker once. Then a couple of months
later you get a review, and it had all of it in, didn’t it?
And I was like, ‘Mum, it’s bullshit, it’s
bullshit, I never said nothing like that, she’s got it all
wrong.’ Know what I mean – trying to lie? And then I called
my social worker and said ‘what do you think you’re
playing at, it was like confidential, talking to you confidentially
and you go away, you fucking put it on paper?’.”

Looked-after children and young people need to have the limits
of confidentiality made explicit. They need to know at the outset
of a relationship what will be passed on to whom and what can be
kept private.

A theme throughout the groups was the value of talking to
someone who had personal experiences of similar problems or of the
looked-after system. Jamie said: “People who live in care have more
of an insight into what it’s been like in care. I reckon that
counts for a lot.”

It was clear that carers who had relevant personal experience
and were able to offer a model of survival for these young people
earned their respect. Rachel described her foster carer in this
way: “My last placement knew how to handle me because they have
been through it as well as I have, so they put a foot down and
that’s why I love them so much.”

Those with relevant personal experiences were seen as more
understanding and easy to relate to. The significance attached to
carers and counsellors having personal experience could be
translated into service planning by providing formal opportunities
for care leavers to offer support to young people in the
looked-after system and receive training in counselling and care
work.

The participants could not discuss their problems in school.
Opinions varied about whether they had experienced hostility from
other children as a result of their looked-after status, though
some stigmatising attitudes had been encountered. Those who had
come across this found that it could affect their willingness to
discuss problems with friends or others outside the care
setting.

Rachel said: “It’s like you see these people in school,
never had a problem with their parents, never done anything wrong,
been perfect, so perfect families, and they turn round at you and
they rip at you, literally, go on at you, ‘oh, you’re
this, you’re scum, you’re shit’ – but they
don’t understand how hurting it is.”

Schools need to be alert to such behaviour and take positive
steps to combat it. Success in academic, sporting or other spheres
can do much to boost low levels of self-esteem and can contribute
to the development of resilience. Social services departments and
schools should work more closely to identify the needs of
looked-after children in school settings and develop joint
strategies for responding appropriately.

The thinking of the young people provided a valuable balance to
the views of professionals recorded on the case files studied and
those of the front-line carers surveyed. Key points included an
emphasis on exercising choice, the importance of confidentiality
and the value of carers having personal experience of the care
system. Their views have been conveyed into the arenas of strategy
development and service planning for looked-after children.

Nicky Stanley is a senior lecturer in social work at the
University of Hull.

References

¹ J Richardson, C Joughin, The Mental
Health Needs of Looked After Children, Royal College of
Psychiatrists, 2000

² The full project report is available from
Nicky Stanley at
N.E.Stanley@hull.ac.uk 
 A version of the report Feeling Mad or Sad – What
Helps? has been produced for looked after young people. It is
also available from the above e-mail address.

Research

Four focus groups were arranged in two local authorities for
looked-after young people aged 12 to 19. Separate groups were held
for boys and girls. The young people were contacted through social
services departments, and both their consent and that of the
parental authority were obtained. Group members were asked to read
and comment on the report produced from the research before
publication.