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Press release: Inconsistent mental health provision is disadvantaging young people in care

Young people in care are not receiving consistent access to child and adolescent mental health services (CAMHS), with provision varying from good to none at all, according to an Ofsted report published today.

An evaluation of the provision of mental health services for looked after young people over the age of 16 accommodated in residential settings looks at mental health provision in 27 children’s homes in eight local authorities across England. The report highlights the barriers for young people in accessing mental health provision as well as highlighting good practice.

In nine children’s homes there were no delays in accessing CAMHS. However, nearly half (13) of children’s homes visited reported delays; 10 of these homes were privately run. Eleven children’s homes experienced delays of between three and 12 months before receiving a service. For some no service was provided.

Homes in areas where a service level agreement existed between the local authority and CAMHS experienced less delays in accessing mental health services for their young people. Reasons for delays in providing mental health services include: high demand, failure of social worker to make a prompt referral and insufficient resources. In these situations, staff were left to manage young people’s needs and difficulties without direct support or guidance. One home reported that young people went to the bottom of the waiting list after they were moved from one placement to another, even when they had been on a waiting list at their previous placement.

Commenting on the report, Her Majesty’s Chief Inspector, Christine Gilbert, said:

'It is essential that all young people have consistently good access to mental health services that meet their needs, wherever they are cared for and whoever provides the care. Inconsistencies between areas need to be addressed.

'While this is a small survey, it points to important issues in caring and supporting young people experiencing mental health problems.'

A key strength in children’s homes is the care, support and commitment young people receive from staff. Over time, staff in non-specialist children’s homes have developed skills and good awareness and understanding of mental health, leading to improvements for young people. By building good relationships with young people, staff have been able to help them manage their own mental health.

In all the children’s homes visited young people had received an assessment of their needs before admission to the home. In 15 of the 27 children’s home visited, the quality of the assessment information was good and in one was outstanding. However, in four it was inadequate. Limited information from assessment can lead to inappropriate placements and delays in providing correct treatment and support – resulting in poorer outcomes for young people and making it harder to call on specialist support when needed.

Four specialist children’s homes worked exclusively with young people with eating disorders, young people who self-harmed, or young people on the autistic spectrum. In these homes, the majority of referrals came from health professionals, usually through a hospital. In these cases, comprehensive assessments including psychiatric reports were always provided.

The transfer from children’s mental health services to adult services can be a problem. Staff felt the threshold to access adult mental health services was higher than that for young people and that adult services only took referrals for young people with ‘very severe’ mental health problems. This meant that young people may not meet the criteria to receive a service and that the service is discontinued. Resources would then need to be found from the local or voluntary sector for support to continue.

Though the number of young people moving into adult mental health services was small, experiences varied. In four of the children’s homes, good planning and consultation for the transition were successful when the young person reached 18. However, in three children’s homes, transition was poor with no continuity of care. Placements could be terminated and funding withdrawn without any consultation.

For specialist children’s homes, the secure children’s home and emergency placements for unaccompanied asylum seekers, good assessments and specialist mental health services were appropriately provided. In the specialist homes visited, there was a commitment to staff receiving relevant training and updating their practice. As a result staff had a good understanding of young people’s specific needs.

However, the findings suggest training and development across non-specialist children’s homes was varied. In seven of the homes, staff had received no additional training in mental health.

Related Links

1. An evaluation of the provision of mental health services for looked after young people over the age of 16 accommodated in residential settings is available on the Ofsted website
• www.ofsted.gov.uk/publications/080260

.2. Between October 2008 and February 2009, Ofsted carried out a survey of 27 children’s homes, including one secure children’s home and a residential special school registered as a children’s home. These were located in eight local authorities. The settings were selected because they had current or very recent experience of providing for young people aged over 16 in care who had mental health needs. The settings had a range of inspection outcomes. 3. The target group for the survey was young people who were receiving support from child and adolescent mental health services (CAMHS) or specialist services to meet a specific mental health need. The target group did not include young people receiving a service which focused on behaviour management.4. A residential special school is any school providing accommodation for any child which is either: a) a special school in accordance with sections 337 and 347(1) of the Education Act 1996; or b) an independent school not falling with (a) which has as its sole or main purpose the provision of places, with the consent of the Secretary of State, for pupils with special educational needs or who are in public care.5. Secure children’s homes are children’s homes which provide accommodation for the purposes of restricting the liberty of children. The DCSF is responsible for issuing approval to operate as an establishment that restricts liberty. Accommodation in secure children’s homes can only be provided for children and young people who are subject to a court order (sentence or remand) or on a welfare basis under Section 25 of the Children Act 1989.6. The Office for Standards in Education, Children's Services and Skills (Ofsted) regulates and inspects to achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children's social care, and inspects the Children and Family Court Advisory Support Service (Cafcass), schools, colleges, initial teacher training, work-based learning and skills training, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for looked after children, safeguarding and child protection.7. Media can contact the Ofsted Press Office through 020 7421 6617 or via Ofsted's enquiry line 0300 123 1231 between 8.30am - 6.30pm Monday - Friday. Out of these hours, during evenings and weekends, the duty press officer can be reached on 07919 057359.

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