In March 2015 the Department for Education and the Department of Health jointly published new statutory guidance on Promoting the health and well-being of looked-after children. The key aim of the guidance was stated to be, "to ensure looked-after children have access to any physical or mental health care they may need." It recognised that almost half of children in care have a diagnosable mental health disorder. It emphasised that looked-after children should never be refused a service, including for mental health, on the grounds of their placement being short-term or unplanned; that CCGs and NHS England have a duty to cooperate with requests from local authorities to undertake health assessments and help them ensure support and services to looked-after children are provided without undue delay; and that local authorities, CCGs, NHS England and Public Health England must cooperate to commission health services for all children in their area.

A year later, in April 2016, the House of Commons Education Committee reported that there was widespread non-compliance with these requirements. Provision for looked-after children with mental health concerns is poor in many areas across England, the Committee reported.  Whilst some local authorities were providing integrated services with a strong focus on multi-agency working and support for key workers (e.g. foster carers, school staff), the Committee found that a "significant number are failing to identify mental health issues when children enter care and services are turning away vulnerable young people for not meeting diagnostic thresholds or being without a stable placement." This was, sadly, an unsurprising finding for those of us who work in the field. Children who need access to CAMHS often struggle to get it in a timely manner, or at all, and for care leavers there are both additional risks - meaning they are more likely to need CAMHS support - and additional barriers - meaning they are more likely to face difficulties accessing it when needed.

The Committee stated:

"It is important that all children who need access to CAMHS get it in a timely manner. We believe that looked after children should be viewed as a priority for access to mental health assessments and never refused care based on their placement or severity of their condition. Co-ordination between health, education and social services at a local level is at the heart of effective support for looked-after children with mental health difficulties... Coordination must be driven by strong leadership and we recommend that each local area employ a senior, designated mental health professional to oversee provision. Children and young people need to be better supported as they enter and leave the care system. We recommend that care leavers should be able to access CAMHS up until the age of 25 if necessary and that initial assessments of those entering care should be more thoroughly and consistently carried out.

... Addressing the lack of reliable data about the state of children’s and young people’smental health must be a priority for the Government. We are disappointed that it has been 12 years since the last prevalence survey on children’s mental health was conducted. Finally, the voices of the children and young people in the care system must be heardat every stage. Their input into care planning and the services they receive is crucial to ensuring successful placements and the formation of lasting relationships with the many professionals in their life."

Another year has passed, and today Barnardo's has published research indicating that the Committee's call to action has not been heeded. Today's report, Neglected Minds: A report on mental health support for young people leaving care (by Nicola Smith for Barnardo's) makes for deeply concerning reading.  Nearly half of England’s care leavers may be suffering with a mental health problem, the report finds, with one in four facing a mental health crisis since leaving care. The research conducted for the report shows that there is "significant unmet need amongst care leavers who require mental health support" and that allowing this need to continue to go unmet will continue to result in care leavers being more prone to many problems in later life including a greater risk of suicide and a greater chance of entering custody. The report also finds that those working with care leavers often don’t have sufficient understanding of mental health, with many services are too inflexible to meet the continuing needs of young people - precisely the issues raised by the House of Commons Education Committee in April 2016.  

The report is constructive, suggesting practical ways to address these problems. Barnardo’s is now calling on those working in this area, including the Expert Group and CCGs, to consider how money invested in children’s mental health could be used to develop a service response specifically aimed at supporting young people at the point at which they leave care. The report emphasises that "such support can be provided at a comparatively low cost – if each local authority in England were to introduce a mental health worker into their leaving care teams, for example, this could be achieved at a cost of around £40,000 per year per local authority."  However, the report also recognises that mental health services for children and young people should be developed with local needs in mind, and so a range of options for commissioners are set out in the report.  These are sensible suggestions, including, for example, embedding a mental health worker within leaving care teams to work specifically with care leavers during the process of transition both to provide mental health support directly and to help access to statutory services; and developing training and mentoring opportunities where workers trained in mental health can work to upskill those in leaving care services so that they understand how to support young people better. 

This report is essential reading for practitioners working with children in care and care leavers who have mental health needs. But most importantly, it is essential reading for commissioners who are the decision-makers and purse-string-holders and who can make a real difference to this vulnerable group.