The mental health and wellbeing of youth in care and care-leavers: Development of a national collaborative research agenda

At present it is estimated that over 75,000 children and young people are currently in state care in the UK (McGhee et al. 2017), with a larger proportion of the child population experiencing some form of state care at some point in their lives. Children come into the care of the state for a variety of reasons and through a number of different legal routes, but there is a common thread of children having experienced a range of adversities, including maltreatment, loss, and poverty, which shape both their pre- and in-care experiences and impact on their mental health and well-being (Baldwin et al, 2019). In the UK, most young people enter care from school age or older, meaning in many cases these adverse experiences have been particularly prolonged. Adolescence is the fastest growing age-group currently entering the care system in the UK.

While there are increasing concerns about the mental health and well-being of children and young people in general (Frith 2016), there are particular concerns about looked after children in particular (Bazalgette et al. 2015). Young people who are looked after have consistently been found to have much higher rates of mental health difficulties than the general youth population, with almost half of looked after children (and three quarters of those living in residential group care) meeting the criteria for a psychiatric disorder (Ford et al 2007; Meltzer et al 2003). Young people in care in the UK are five times more likely to meet the criteria for a psychiatric disorder compared to their peers. There are many reasons for this, including the adversities experienced by children before coming into state care, such as abuse, neglect and exploitation, along with the experiences which some children in care experience during their time in care, which can both add to and exacerbate the difficulties they experience.

This project seeks to address the deficit in our knowledge about how we understand the mental health needs and trajectories of young people who are looked after, and how we can respond in ways which are likely to be helpful. We are seeking to bring together through this project researchers, individuals who work with this group of young people in schools and care settings, policy makers and individuals with lived experience of being looked after by the state.

The project will involve a number of workpackages aiming to: work with care experienced young people to explore how mental health is defined, and the key issues we should be exploring; explore how we conceptualise the mental health needs of young people who are looked after, and how we could and should respond in ways which are likely to be effective and acceptable to young people; discuss the range of research approaches which are likely to be useful and realistic in undertaking high quality research; agreeing amongst experts from research, practice and with lived experience, the ways that research studies can measure and assess the mental health of young people and the impact of new ways of working; and to develop an approach to training and supporting non-mental health practitioners to better identify and support young people and their mental health.

There is strong evidence of the pervasive and life long impact for care experienced young people of their experiences of adversity and trauma. While we have relatively good evidence of the mental health and broader wellbeing outcomes of these young people, there remains limited high quality empirical evidence on key areas required to promote positive mental health, prevent mental health difficulties from reoccuring or escalating, and in addressing both acute and chronic mental health symptomatology. Recent reviews of the extant research have highlighted a number of challenges:

1.The need to understand the mechanisms that link the early experiences of youth before entering care and while in care (such as placement stability), to their mental health and wellbeing outcomes. Such evidence is essential for informing approaches to care and treatment, either from existing evidence-based models and treatments or the development of new approaches.

2.Understanding the interplay between neurodevelopmental disorders (e.g., ADHD), mental health, and physical health. A large proportion of young people in care present with such disorders, but this is often overlooked in mental health research on this group, despite potential implications for how such young people should be cared for, and helped.

3.Understanding cross-cutting barriers and facilitators to young people accessing existing services to address their mental health, including as when they move school or transition to adult services.

4.Understanding what treatments and interventions are most effective and cost effective for addressing the mental health needs of this group, and what type of training would carers benefit from.

5.How we can ensure services that have contact with these young people, such as schools and colleges of further education, and residential units, are trauma-informed in their approach, and from a research perspective, how we can effectively assess what "trauma-informed" means.

The research team has extensive experience of tailoring dissemination to diverse audiences including policy makers, commissioners, practitioners, researchers and service users. Our approach to preparing this proposal has been to gauge both the need for the specific focus of the project, and the receptivity to the work we plan to undertake with organisations across the UK, and representing different foci and interests, including policy makers in government, commissioners of services, service providers in both the statutory and non-statutory sectors, advocacy organisations in respect of youth, care experienced young people, and mental health organisations. For example, the Director of Social Care and Children, Marie Roulston, at the Northern Ireland Health and Social Care Board, the commissioning body for all health and social care services in Northern Ireland, has stated that the work proposed in this application is timely and necessary, and will complement the first ever prevalence study of children's mental health In Northern Ireland commissioned by her office, which will report in mid-2020. While the Chief Executive Officer of the National Youth Advocacy Service, Rita Waters, has stated that the proposed workplan would provide an important step in ensuring high quality research can feed directly in NYAS' services and campaigning efforts, both in the short and longer-term.

We also have significant experience in working with media organisations to ensure that our work reaches the general public. For example, Davidson is one of the key organisers of the Northern Ireland Mental Health Arts Festival, which has been running since 2013 (https://www.nimhaf.org/). Devaney has worked with media organisations such as The Detail to raise awareness of domestic violence, including the development of an art installation displayed at the inaugural European Conference on Domestic Violence (https://thedetail.tv/articles/detail-data).

During the project we would plan to work with partners to profile the evolving work, and to hold a one day conference in March 2021 to share the work from the project. Drawing upon our previous experience, we will hold this event in Edinburgh, and invite all participants in the various workpackages and senior policy makers from each of the four UK countries to participate in the day which will be chaired by Fiona Duncan, who is currently chairing the Independent Care Review on behalf of the Scottish Government (https://www.carereview.scot/).