Improving Mental Health Support for Children in the Care of the UK State
There are complex policy and practice issues as well as tensions in where responsibility lies in relation to mental health needs of children in the care of the state in the UK. Collaboration across many organisations and leadership from key individuals in the system are essential for the needs of these most vulnerable children to be better met. There is a moral imperative and a financial incentive to getting this right. Alison O’Sullivan explores the role of corporate parenting at a time of increased focus on meeting the mental health needs of children in the UK, making the case for improved mental health support for children in the care of the state as an important part of the solution.
Article 20 of the ‘United Nations Convention on the Rights of the Child’ (1990) says that children and young people have the right to special protection and help if they cannot live with their parents.
Currently, 196 countries have signed the Convention but as Dixon (2016) found many are not meeting their obligations - often due to conflicting community expectations on the appropriate role of the state and a scarcity of public resources. For the state to meet its UNCRC obligations both organisational and governance capacity is required as well as the capacity for the state to act in the best interests of children.
The Puras UN report ‘United Nations Human Rights Council’ (2017) also reflects intensifying international concern about mental health provision, and points towards the importance of an integrated response, which provides support at every level:
“For care to comply with the right to health, it must embrace a broad package of integrated and coordinated services for promotion, prevention, treatment, rehabilitation, care and recovery”
In the United Kingdom (UK) there is a recognition that current mental health support is not good enough. Mental health has become a focus in our society as never before. Celebrities, such as Steven Fry and Ruby Wax and the Royal Family, through the ‘Heads Together’ campaign, have talked publicly about their personal struggles in an overt effort to reduce stigma and to bring mental health issues into the open.
There has been a particular focus on children’s mental health and with the publication of ‘Future in Mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing’ (2015) there is now a government commitment that by 2020 there will be system-wide transformation of the local mental health offer to children and young people.
Members of the UK Parliament and reports from third sector organisations have especially highlighted the mental health needs of children in care in particular. In 2016 the government commissioned the Social Care Institute for Excellence (SCIE) to form an Expert Working Group to propose how the emotional and mental health needs of children in care would be better met. The report ‘Improving the mental health of our children and young people’ was published in 2017. It analysed the problems and made clear proposals about what should be done.
We know that the child mental health system is under pressure and that almost half of all children in care have a diagnosable mental health disorder. We know that the complexity of mental health problems is greater amongst children in care and that their needs are often not fully understood. And even when the right help is agreed there are often delays and inconsistency in support.
External influences are affecting the mental health and wellbeing of all young people, including growing up in a digital age and increased societal inequality. At the same time political conflict and instability in the world is causes mass population movements. In the UK often traumatised children are coming into public care having arrived unaccompanied on our shores.
The recent period of austerity has also seen increased numbers of children taken into care (DfE 2017) and a 140% increase in children and young people on child protection plans in England. The whole system is under significant pressure at the same time as everyone is trying to make it better. Given that we know that the best predictor of psychiatric disorders in adulthood is psychological disturbance or a psychiatric disorder in childhood or adolescence, intervening early can divert people from a lifetime of challenges, potentially generating significant savings.
In the UK the ‘Children Act 2004’ created Corporate Parenting responsibility which gives local Directors of Children’s Services and Lead Local Authority Elected Members the statutory duty to work in partnership with national and local organisations. And the ‘Children and Social Work Act 2017’ strengthens those responsibilities. Large numbers of carers and professionals play a role in fostering the development and wellbeing of those under state care in what is a highly complex system: local delivery of support is through a wide range of public and voluntary agencies and has evolved differently in each place over time.
The report ‘Improving the mental health of our children and young people’ makes specific recommendations to achieve stronger ownership and collaboration between government bodies; better coordination at a national and a local level and different ways of working to create more coherent arrangements for help. It stresses the importance of improved backing for those with day-to-day care roles and a model of care which has the young person at its centre and recognises that without consistently enhancing the child and young person’s decision making power and sense of agency, the whole system will fall short as a Corporate Parent.
There is a long running debate about whether special treatment for children in care is justified. Children in care have higher needs and therefore should attract a commensurate higher level of support. Yes, specialist roles and specialist teams have a part to play and have been seen to be successful where these have been implemented, yet simply doing the basic things right would represent a huge step forward. And until children in care get their share of help, we need to advocate for those children, to highlight the need for good services and to check whether the particular needs of these children – our children – are being properly met. Call that special treatment if you like.
So we need real leadership. By being passionate about children in care, by being determined to make sure we compensate for all the damage and disadvantage these children have experienced and by becoming champions – real corporate parents – for these children, lives will be transformed and potential can be realised.
1. United Nations Convention on the Rights of the Child (1990)
2. Dixon, International Perspectives on the State-as-Parent: Naïve Idealism or Reluctant Pragmatism Poverty & Public Policy - Wiley Online Library
3. Dr Dainius Puras ‘Report of the Special Rapporteur on the rights of everyone to the highest attainable standard of physical and mental health’ United Nations Human Rights Council (2017)
4. Future in Mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing(2015) Department of Health, NHS England
5. Improving the mental health of our children and young people (2017) Social Care Institute for Excellence (SCIE), London
6. Heads Together, Royal Foundation, London
7. Department for Education. Children looked after in England including adoption: 2015 to 2016. London, UK: Department for Education, 2017.
8. Children Act 2004
9. Children and Social Work Act 2017
Alison qualified as a social worker in 1978 and was a Director for Children, Adults and Social Services. She was President of the Association of Directors of Children’s Services in 2015-16. She Co-chaired the Expert Working Group for improving mental health support for children in care together with Professor Peter Fonagy and Dame Christine Lenehan, which reported to Government in November 2017. Alison sits on the Advisory Board for the Children’s’ Commissioner for England.