“How can a child who is psychologically in a very bad place settle unless they get mental health support?” asks independent reviewing officer Sukhchandan Kaur. She is talking about a 15-year-old boy who was neglected for years and slipped through the social care net until his early teens and has been placed with several foster carers who have been unable to manage his behaviour. Child and adolescent mental health services (Camhs) will not work with him.
“I’ve appealed twice,” she says in despair. “They’ve not even assessed him. For him to be assessed, he would have to be accepted as a referral. And they won’t.”
Kaur’s role is to act as an advocate for children looked after by her local authority, and she is furious she cannot secure the mental health treatment this boy needs. “I am banging my head against a brick wall,” she says.
Camhs’ refusal to assess and treat children who are removed from families into state care before they are in a settled placement was criticised in a recent Education Select Committee report on mental health services for children in care.
‘We’re so used to them saying no that we don’t even refer any more’
The report pointed out that the mental health of looked after children is significantly worse than that of their peers. Almost half of children in care have a diagnosable mental health disorder, and they are four times more likely to have a mental health condition than those not in care.
The MPs’ investigation found that there were “serious and deeply ingrained problems with the commissioning and provision” of Camhs” for children in state care. Neil Carmichael MP, select committee chair, told the Guardian: “We were concerned at the lack of speed regarding diagnosis, and lack of appropriate response thereafter.”
As complex trauma in childhood is likely to affect looked-after children into adulthood, Carmichael is pushing for Camhs to be available for care leavers up to the age of 25.
Camhs is reluctant to assess and treat children who have suffered extremes of neglect and abuse unless they are settled in a permanent placement. This, as the report pointed out, is contrary to statutory guidance “which states that looked-after children should never be refused a service on the grounds of their placement”.
Nevertheless, Camhs’ refusal to accept any referral before a permanent decision about a child’s future has been made has become so absolute that family lawyers acting for young people in care proceedings say they’ve given up asking. “We’re so used to them saying no that we don’t even refer any more,” says Emily Boardman, head of the family department at Turpin Miller solicitors in Oxford.
Once settled, a looked after child may be granted an assessment but will not be accepted for therapeutic treatment unless they meet a high threshold of need. Natasha Finlayson, chief executive of the Who Cares? Trust which works with care leavers, says: “Young people [have to] present with a psychiatric illness. If you can see the blood running down their arms from self harming, or if they’ve [attempted] suicide, then they’ll get access.”
Related: Tackling underfunding in children’s mental health services
Finlayson is scathing about the standardised, off-the-shelf treatments that tend to be offered which, she says, stand little chance of long-term success for this most vulnerable group of children. “We need expertise in and help around sexual abuse, early trauma, domestic violence, attachment, and for children who’ve experienced multiple moves within the care system, compounding their sense of abandonment and loss,” she says.
The medical model Camhs has operated does not work for the sorts of mental health issues these young people have, she adds. There are therapists who specialise in supporting looked-after children with complex trauma, but with cuts now biting deep, some specialist teams have lost staff or been disbanded.
Lack of a permanent placement “cannot be and should not be” a barrier to young people in care being able to access Camhs, says Sally Holland, the children’s commissioner for Wales. The Welsh Assembly, she says, has just created strict new targets for Camhs services in Wales: an urgent referral must now be seen for assessment in 48 hours, and a non-urgent one in 28 days.
Holland insists that more thought must be given to how therapeutic treatment is presented to children so they feel more willing to engage. “There’s not nearly enough alternative or earlier help. There should be primary care teams delivering help at a much earlier stage, and we need to keep putting a lot more resource into those and supporting carers, foster carers and teachers.”
Finlayson believes that Camhs needs to change its approach to young people in care. Of Camhs’ blanket refusal to treat children until they are in a stable placement – a process that still, typically, takes from six months to a year, and even upwards – she says the clinical position is “misguided” and “totally unsuitable”.
Related: What service users want to change in mental health policy
Holland agrees: “Looked after children and children adopted from care may have many issues, none of which hits a threshold, but taken together, cause them significant difficulties,” she says. “We should not be putting up artificial institutional barriers: it should not be ‘do they meet our criteria’ but ‘what do they need?’ They should be getting accelerated help, rather than being banned from help.”
The Education Select Committee recommended that looked after children should have priority access to mental health assessments on entering care. It’s not enough, says Jackie Sanders, director of public affairs at the Fostering Network: “We were very disappointed that the report fell short of recommending that looked after children should also have priority access to subsequent treatment … A prioritisation of looked after children for assessment but not treatment will have little or no impact on their access to mental health services.”
Whatever happens in future to change the delivery of mental health care to children in council care, the damage has been done for Kaur’s young charge. Despite some difficulties, she says, he was bright and doing well at school, but his behaviour after several placement moves has deteriorated to the point no school will take him. The effect of Camhs’ refusal to offer treatment is, Kaur says, “devastating”.
“Those repeated rejections means he’s now losing hope,” she says. “How can I help him to get that mental health support he needs to overcome this sense of despair?”
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Mental health services won"t help children in temporary care settings
