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22 OCTOBER 2008

NO 1363

Residential care and mental health

Although the Scottish Needs Assessment Programme (2003) report has been influential in developing awareness of the needs of looked-after children, many difficulties still exist in ensuring that appropriate resources are available to meet them. The descriptions provided by residential workers in this study give a human dimension to the statistical reports of high levels of mental health problems in looked-after and accommodated children. They also paint a vivid picture of the experience of working with distressed and sometimes violent young people on a daily basis. What is clear from the accounts is that for a substantial proportion of these young people, their experience of being in residential child care has not been able to ameliorate their mental health difficulties in any enduring way. The residential workers who responded to the survey were clearly committed professionals who wanted to be able to provide a high quality service but a number of factors impeded this. Internally it was clear that staff found it difficult to balance the extreme needs of the most disturbed young people with the needs of the other young people. There was a clear recognition that when staff were able to spend substantial time with young people, it was experienced as very helpful. The reports of poor child/staff ratios and insufficient time meant that it was rarely possible for practitioners to offer this. Respondents also stated that in many cases the unit in which they worked was not structured and supported to provide the therapeutic help that a child needed. It was clear that within the sector there was a strong belief that more specialised, smaller units which could allow a more in-depth approach were needed. Gaining access to external help seemed fraught with difficulty, partly as a result of a general lack of capacity within services but also because these children posed a particularly difficult challenge for some external professionals to engage with. The reported inflexibility of services and the stigma associated with them meant that even when a service was offered it was not always possible to encourage the young person to access this.

The impact on staff of working with such intense emotional and behavioural difficulties appears to be high. The data showed that residential workers have greater exposure to the problems than any other professionals surveyed. There was a strongly expressed need from many respondents for support and training for themselves in their day-to-day work. Support and training for staff can have two helpful purposes for this group of staff. First, it can help staff to survive the psychological onslaught that working in this intense environment can provoke. Second, it allows staff to remain in touch with the distress behind behaviour and enables them to plan positively and therapeutically for young people, rather than sliding into angry punitive responses. Conlon and Ingram (2006) describe how staff consultancy can support staff to work in a therapeutic way.

Although many of the respondents identified very troubling situations in which they felt that little positive help had been offered to young people, they were also able to identify situations in which they had experienced considerable satisfaction. Almost invariably residential workers linked these positive outcomes to people working together well. This could be at the level of the residential setting but also included occasions in which outside professionals or agencies had worked closely with residential workers and each other to provide a planned integrated service which had had positive outcomes for young people. Often the positive relationship that residential workers had with young people was the vehicle through which help was provided with advice from external professionals. Alternatively these relationships allowed staff to support young people to access external services themselves.

JUDY FURNIVALL, PHILIP WATSON, ROSALINE S. BARBOUR, GRAHAM CONNELLY, GRAHAM BRYCE AND LOUISE PHIN

Furnivall, J.; Watson, P.; Barbour, R.S.; Connelly, G.; Bryce, G. and Phin, L. (2007). 'Hard to know what to do': How residential child care workers experience the mental health needs of young people. Scottish Journal of Residential Child care, 6, 1. pp.10-12.

REFERENCES

Conlon, M. and Ingram, G. (2006). Connecting with children in care. Mental Health Today, 6, 7. pp. 16-19.

Scottish Needs Assessment Porgramme. (2003). Needs assessment report on child and adolescent mental health: Final report. Retrieved April 2007 from http://www.headsupscotland.co.uk/documents/SNAP1.pdf

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