NUMBER 814 • 25 AUGUST • MENTAL HEALTH
I am always concerned when I hear that to improve the health of young people in public care, we need to teach them how to be more resilient. When I was a child and I complained that things were 'unfair' my mother would respond that life was unfair and that you just had to learn how to LUMP it. Now, in my situation that was acceptable because if I was suffering a major injustice, I was pretty sure that my mother or my father or one of my three brothers would rout for me with the school, with my community, with the world or with whoever was causing the wrong. Teaching young people in public care how to be more resilient who may not have this support and who may have little control on what happens to them, may appear like learning to LUMP it. Surely, if we want to improve their mental health, we first have to tackle some of the structural problems, which are beyond their control and which impact on their mental health.
This paper first considers the extent of mental heath problems amongst children and young people in public care in England and Wales and remind us of the outcomes for these children. Second, it explores the structural problems that are impacting on these children's mental health and considers what we as a society need to do to ameliorate the situation. Finally it considers strategies to promote resilience amongst looked after children. We cannot expect children who are looked after to do it all themselves. We all have a responsibility to promote their well being.
What is the extent of mental health problems amongst children in care?Meltzer et al., 2003).
A recent survey has suggested that 45% of children in care in England and Wales aged 5 to 17 have mental disorders. This figure is four times higher than for all children (
Earlier studies by the author, using data from children born in 1958 in the National Child Development Study (Cheung & Buchanan, 1997; Buchanan & Ten Brinke, 1997) demonstrated that children and young people who had been in care were 4/5 times more likely to have mental health problems than those brought up in a range of disadvantaged settings. The two figures taken some 40 years apart suggest that, despite all the initiatives, rates of mental health problems amongst the care population have not improved. The NCDS findings were quite stark with mental health risks, particular for young men who had been in care, extending into adult life. Tragically in the long term many young men who had previously had anti-social disorders became depressed and suicidal as adults. Further research (Harnden & Stewart-Brown, in press) indicates that such young people may be more prone to major diseases such as cardiac problems and cancer. Quite apart from the humanitarian tragedy, the long term economic and health cost implications are great.
What are the outcomes for children in public care in England and Wales?We know that in England and Wales, children who enter public care are gravely disadvantaged before they ever enter care (Bebbington & Miles, 1989). Society has intervened in the lives of these young people with the aim of safeguarding and promoting their welfare but the reported outcomes give little credence that this has happened. As reported by the recent Social Exclusion Unit report on the Education of Children in Care in (2003): 'between a quarter and a third of rough sleepers were (previously) in care; young people who have been in care are two and a half times more likely to be teenage parents and around a quarter of adults in prison spent some time in care as children' (SEU, 2003). In 2001/2002 only 8 per cent of children in care achieved five or more A *-C grades at GCSE (the entry qualification to further education) compared to 50% of children in the general population and just 1 per cent of care children went on to university. In 2001-2002 only 46% of care leavers were known to be in employment, education or training at age 19 compared to 86% of all 19 year olds (SEU, 2003).
What, we may ask, comes first, the poor outcomes or mental health difficulties? Undoubtedly some children are at risk from their pre-admission experiences, but there is growing evidence that experiences in the public care may have exacerbated or even caused their later difficulties (Cheung & Buchanan, 1997; Buchanan & Ten Brinke, 1997). These cannot be resolved by teaching young people to become more resilient. We need to tackle the structural problems that threaten their mental health.
Buchanan, A. (2004) 'Learning to LUMP it?' How to improve the mental health of children in public care. Is it just a matter of building resilience? International Journal of Child & Family Welfare, 2004/4, pp 197-198