Root causes of good and poor teenage mental wellbeing and health outcomes when you’ve been in care as a child

This is a report by Healthwatch Staffordshire. The project is a 'deep dive' into the topic of mental health amongst teenagers that have been in care when children.

Mental health issues among young people have increased, with the government adopting measures to support the achievement of improved emotional wellbeing and mental health. Staffordshire County Council (SCC) has developed a joint Strategy to  improve mental health outcomes for young people and the Staffordshire population,through collaboration with key stakeholders. 

This report focuses on the root causes of good and poor mental health, among care leavers in Staffordshire. The report is based on a survey of care leavers in Staffordshire. The focus population is young people with age between 17/18 to 25 years, inclusive of  additional needs or SEN, if applicable. 

There is additional data from previous surveys compiled, such as national and Staffordshire data which was reported to the government over the past five years, as well as a wealth of qualitative data gathered through our Healtwatch Staffordshire lines of enquiry, illustrated in the diagram below. We continue to receive feedback.

The major risk factors for poor mental health include exposure to abuse and neglect before the care period, for example, due to family dysfunction characterised by mistreatment and / or absent parenting. Other factors were vulnerability to socially unacceptable behaviours, such as drug abuse and offending acts or criminality. 

It is vitally important that careful selection of foster families and placement centres is considered by the local authority, to minimise exposure to factors that increase the likelihood of poor mental health conditions.

A positive aspect which was highlighted in the study, is that most of the care leavers which now live independently, have acquired suitable accommodation and are feeling more optimistic about their future.

Securing education, employment, or engaging with training programmes, is also positive for the care experienced young people’s mental health and emotional well-being, thus it contributes to better outcomes, in the longer term.

Key findings include:

1. Care experienced young people have access to a wide range of services within Staffordshire, from the local authority, the NHS, and other organisations, including the voluntary and non-voluntary sectors.

2. The young people we talked to, told us that services are fit for purpose; services are person-centred, and they focus on prevention and early intervention, thus reducing the risk of heightening needs and people potentially reaching crisis point. 

3. The referrals process for mental health and emotional support, has been streamlined into a single point of access, which has been a positive change.

4. Waiting times should be reduced, by increasing capacity across the mental health system (i.e. within NHS provision, community based support and other commissioned provision), and by increasing focus on prevention and early intervention to reduce demand. 

5. The young people we talked to, told us that mental health support services offered by the NHS are adequate; however, certain services andpathways are still in need of further improvements. 

6. NHS services need to continue to work jointly with the Local Authorities, other government bodies, Healthwatch England, to improve mental health outcomes for all, nationally. Locally this would be Staffordshire County Council, Staffordshire and Stoke on Trent ICS, Healthwatch Staffordshire and Healthwatch Stoke. 

There are recommendations in this report.

• Transitioning from CAMHS into adult mental health services needs to be smoother, thus less problematic for care experienced young people (CEYP).

• Reduce the risk for vulnerable people of ‘slipping through the net’, thus potentially having exacerbated problems, or even reaching crisis point.

• Reducing waiting times should be a priority, by increasing capacity across the mental health system (within NHS provision, community-based support and other commissioned provision), to ensure that needs are met by the most appropriate 
service. There should also be an increased focus across the system on prevention and early intervention to reduce demand on specialist services and to achieve more positive outcomes for children and young people. NHS CAMHS provision is available via MPFT or NSCHT, alongside other commissioned services, such as: Action for Children, Your Emotional Support Services (YESS), MIND, Changes, Starfish Health and Wellbeing, STARS – for people suffering from addictions.

• Face-to-face appointments to be kept as the main form of intervention, as this is what patients told us they prefer, while also maintaining the option of benefiting from the flexibility of online sessions, for those who need them, when they need them = CHOICE.

• Increase overall effectiveness of one-to-one appointment, by improving initial assessment methodology, and early intervention, making it more productive, with less focus on medication alone, but more focus on emotional support (counselling sessions, 
talking therapies, CBT, advice on self-help, and support groups in the community etc.)

• If possible, increase the number of interventions, /or offer alternative support network, to sustain progress achieved through counselling and psychotherapy.

There are no follow up actions in this report.