"I'm not like Tracy Beaker"
Our new report, Improving the mental health of Looked After Young People: An exploration of Mental Health Stigma, examines the particular perceptions and experiences of mental health stigma amongst some of our most vulnerable young people.
Figures from the National Institute for Health and Clinical Excellence show that around 60% of Looked After Young People have some level of mental health problem, and they are often amongst the most marginalised in our society.
Young people’s participation is a key element of design and delivery of the work of YoungMinds. The voices and opinions of the Looked After Young People we spoke to in our report will therefore be used to inform policy makers and the professionals who work with them with the aim of improving Looked After Young People’s mental health and wellbeing.
We met with approximately 50 young people and ran a variety of creative workshops focussing on the areas of placements, education and support services. YoungMinds also ran two groups for professionals; one of residential child care workers and the other of supervising social workers.
Participants provided a diverse range of feedback and clearly demonstrated that every young person is different with varying needs, wishes, likes, dislikes, experiences and ideas. However, despite this diversity, some clear themes emerged from the workshops.
Young people were asked to consider how they were perceived at school. They documented how they thought teachers viewed their behaviour, their relationships with others and their academic achievements.
Some young people felt they were seen as disruptive at school and their relationship with teachers was seen as negative. A few young people stated that teachers were pleased with their behaviour.
Most of the young people stated that they did not feel that their emotional needs were understood or that they could talk about their emotional needs at school, especially because staff did not have experience of the care system. A few said that they felt judged and that they would like to be listened to more.
Some said that they liked to keep home and school separate and that they did not want to be singled out because they were Looked After. This emerged in other discussions where some young people stated that they wanted to be thought of as “young people” rather than “Looked After Young People”.
Looked After Young People usually live away from the home of their birth parents. They often experience leaving the family home and moving somewhere new with unfamiliar adults and other young people. Some young people stay in the first placement that they move to, some return home and others may live in multiple placements. Some of the young people who we spoke to had lived in more than fifteen placements.
We spent time with young people exploring their thoughts and views about expressing their feelings in their placements. We wanted to understand whether they felt that they could talk about their feelings to their carers and whether their placements provided environments where their emotional wellbeing could be supported.
Young people have had different experiences in their placements. Many of the young people in foster care and residential care said that they can talk to their current carers about their feelings. However, they identified previous placements as less positive and stated that they did not think that their carers understood their needs.
Young people told us that they were often anxious when they moved into placements and that their perception of foster care and residential care were very different from reality. They worried about moving in with people who they did not know and the importance of visiting a placement first was highlighted as vital. Many were happier in their placements than they had anticipated which suggests that a more comprehensive and structured admissions process would be beneficial.
Many young people said that despite feeling scared they tried to pretend everything was fine.
Young people moving to independence or supported accommodation shared their anxieties about living with less support. They appreciated maintaining contact with their residential homes or participation workers.
For young people living in a secure setting, the importance of pretending they were OK seemed significant. Some young people identified that they were scared and homesick but were more likely to lash out and get in trouble rather than share their feelings.
Looked After Young People come into contact with many services. The Local Authority has a duty to ensure that needs identified in their care plan are being met and these include young people’s mental health needs. We asked young people about their perception of Local Authority Services and mental health services. We wanted to explore whether there is stigma attached to these services. We also asked young people to think about what they would like the support services to be like and asked them to describe their ideal mental health service.
Many young people had a fairly negative perception of mental health services. Those who had not accessed services were wary and suggested that they were for people who are particularly unwell. Words such as “mad” and “mental” were used to describe who services may be aimed at.
Suggestions for improvement centred on building relationships - there was a reluctance of talking to strangers and a fear of what may be discovered if they did open up. Emphasis was put on trust and young people identified that they were more likely to talk to adults working in participation services or their carers than workers within CAMHS. Young people stressed that they need time to build relationships with professionals before they access emotional support from them.
Some young people had been involved with CAMHS and there was a general suggestion that those who had received a diagnosis had found it helpful but wished that they had received assessments earlier rather than waiting lengthy periods to get support.
To improve looked after young people’s mental health and wellbeing they need more information before moving into placements. This includes understanding what a foster placement or residential child care or a secure unit might be like.
Young people must have an opportunity to visit placements prior to moving in and spend time with potential carers.
All foster carers and residential workers must have training in supporting the mental health needs of young people. This needs to be backed up with regular supervision and reflective support sessions.
Young people leaving care need to know that they can have support when they move out of their placements as this can be a very anxious time for them and most feel vulnerable and insecure.
Young people stated that it was particularly helpful when they continued to have contact with residential workers form the placement where they had previously lived or other adults with whom they already had a positive relationship with.
There needs to be a choice of places to live for young people leaving care.
Mental Health Services
Young people identified carers, family members and participation workers as the adults they were most likely to talk to about their emotional wellbeing.
Qualities identified were: relationships which had been given time to develop and for trust to be earned, support provided in non-clinical settings and support given whilst undertaking other activities which took away some of the stigma of seeking help for mental health issues.
Participants stated that they want workers to be young and down-to-earth and to have an appreciation of what they have been through. Consideration should be given to how these methods can be replicated and used in other settings to support emotional well being. Peer mentoring may be appropriate if support is given and managed well.
The use of art, play, drama and music should also be used as methods for communication and improving emotional well being.
If young people are to engage with mental health services work must be undertaken by service providers to engage with young people and to develop trusting relationships. This process of engagement is vital even though it is time consuming.
This may mean that the onus of engagement is on the practitioner rather than the service user which may not be traditional. However, young people who have had experienced considerable trauma may have learned that it is safer not to trust adults and may be rejecting of the therapist for much longer than other young people and creative ways of developing trust and building relationships may be necessary in order for the therapeutic process to begin.
Overall young people continued to have a negative perception of mental health services and considerable work needs to be undertaken to reduce this stigma.
Involving Looked After Young People in the rebranding of local CAMHS would be helpful so that child-centred services can be developed and services reframed so they are more appealing and accessible to young people.
In order to reduce stigma, young people should have control over who has access to information about them. It is not necessary for all teaching staff to know that a young person is Looked After. However, at times it may be helpful. As part of the admissions “Personal Education Plan” meeting young people should be asked about information sharing. This should be reviewed at the follow-up meeting once the young person has begun to develop relationships with school staff.
In order for Looked After Young People’s mental health to be supported, all staff members must have basic training around the needs and experiences of Looked After Young People. Understanding why a young person is behaving in a certain way may reduce stigma and enable a young person’s emotional needs to be supported so that they can subsequently achieve academically.
In conclusion, there needs to be more widespread understanding of what it means to be a Looked After Young Person.
Participants repeatedly stated that the only representation of children in care that others know is the TV character Tracy Beaker and that they are tired of telling peers that they are ‘not like Tracy Beaker’.
Discussions in school around equality and diversity should include conversations about where young people may live. Normalising the idea of care so that all children understand that young people grow up in a variety different settings, including foster care and residential care, will help to alleviate some of the stigma attached to children growing up away from the family home and will improve their overall wellbeing and mental health.
Thank you to everyone who contributed to this report; The Network for Social Change for funding it; the young people of Woolwich, Nottingham, West Sussex, Ealing, Worcestershire and the adults who supported them. Thank you also to the social workers and residential workers in London who also contributed to their thoughts, and to Celeste Ingrams and Soulla Akritas for helping with the workshops.
Charlotte Levene is the Project Lead of Improving the mental health of Looked After Young People: An exploration of mental health stigma