fect all chil dren. How ever, the
cir cum stances that lead to a child be com -
ing looked after (loss, be reave ment,
trauma, lack of con ti nu ity in car ing re la -
tion ships, or the ac cu mu la tion of
stress ors) com bined with the ex pe ri ence
of being looked after tend to have a con -
sid er able im pact on the men tal health and
wellbeing of a child or young per son. It is
not sur pris ing that young peo ple who are
looked after high light the im por tance of
con trol and choice when seek ing and re -
ceiv ing sup port and of con ti nu ity in
re la tion ships with care-giv ers and with
friends (Stan ley, 2007). Chil dren who are
looked after are more likely to ex pe ri ence
poor men tal health and de velop men tal
health prob lems, com pared with the gen -
eral pop u la tion of chil dren (Meltzer et al.,
2004). Men tal health prob lems are just as
prev a lent among those who are looked
after and liv ing at home with their families
as among those who are in foster care or
residential care.
Poor men tal health in chil dren who are
looked after tends to be man i fested in
com plex ways which can dif fer greatly
from child to child and which may not
con sti tute a readily de fin able set of symp -
toms. For this group of chil dren, the
ap pro pri ate start ing point may not cen tre
on es tab lish ing a di ag no sis using cat e gor i -
cal mod els of dis or der but may emerge
from con cerns elic ited by the child’s be -
hav iour. Ex pe ri enced prac ti tio ners sug gest
that it is more use ful with this pop u la tion
to work with con cepts of change, trauma,
re sil ience, loss and at tach ment and to take
an eco log i cal view of the pre sent ing be -
hav iour that sit u ates that be hav iour within
the child’s cur rent and past ex pe ri ences.
These are sig nif i cant con sid er ations in re -
la tion to the types of ser vice mod els and
in ter ven tions that are likely to be useful in
addressing mental health in the context of
the care system.
Where chil dren re quire treat ment and
care, ex pe ri ence sug gests that ther a peu tic
work with the looked-after pop u la tion is
not ad e quately de liv ered through ‘stan -
dard’ ar range ments for spe cial ist child and
ad o les cent men tal health pro vi sion. This is
a ques tion partly of how ser vices are or -
gan ised and re sources al lo cated, wait ing
times from re fer ral to as sess ment, and
ser vices being pro vided in clin i cal set tings
that are per ceived as stig ma tis ing by chil -
dren and young peo ple (Barbour et al.,
2006). It also stems more fun da men tally
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Family
Community
Secure early
relationships
At least one
good parent-
child relationship
Wider social
network
Positive attitude
Affection
Good housing
Problem-solving
skills
Clear, consistent
discipline
High standard of
living
Communication
skills
Support for
education
Positive school
ethos
“Easy”
temperament
Supportive
long-term
relationship
Positive peer
relationships
Capacity to
reflect and learn
from experience
Range of
opportunities for
pro-social
activities
Healthy living,
eg. diet, activity
levels
Opportunity to
be heard/
participate/
exercise control
Safe
environments
Table 2
Pro tec tive fac tors for men tal health and wellbeing
from the dif fer ent con cep tual frame works
on which care ser vices and treat ment ser -
vices are con structed (McCollam &
Wood house, 2007).
Pol icy con text
The men tal health of chil dren and young
peo ple: A frame work for pro mo tion, pre ven -
tion and care (FPPC) (Scot tish Ex ec u tive,
2004) makes bold state ments about the
im por tance of the men tal health and
wellbeing of all chil dren and young peo ple
as a shared re spon si bil ity across sec tors.
The FPPC ac knowl edges that some
groups of chil dren and young peo ple are
at height ened risk of poor men tal health
and those who are or have been looked
after are among these. Spe cific ac tion is
re quired to pro mote the men tal health of
this group, to pre vent the de vel op ment of
prob lems and ad dress the needs of those
in dis tress through:
• The pro vi sion of train ing and con sul ta -
tion on emo tional and men tal health
needs for res i den tial care work ers and
fos ter carers;
• Ac ces si ble and con fi den tial sup port for
chil dren and young peo ple who are
feel ing trou bled;
• Ex plicit ar range ments within each NHS
Child and Ad o les cent Men tal Health
Ser vice (CAMHS) team in clud ing re fer -
ral pro to cols for looked-after chil dren
and ar range ments for care plan ning and
re view;
• Li ai son be tween spe cial ist CAMHS and
looked-after ser vices, in clud ing
multi-agency plan ning and com mis sion -
ing to en sure the de vel op ment and
de liv ery of ac ces si ble and ap pro pri ate
men tal health re sponses for chil dren
and young peo ple in local au thor ity care.
The Scot tish Needs As sess ment
Programme (SNAP) work ing group sur -
veyed the ex pe ri ences of a wide range of
pro fes sion als work ing with chil dren,
young peo ple and fam i lies and iden ti fied
some key con cerns among the res i den tial
care workforce. These in cluded the high
per ceived need for train ing on men tal
health, better ac cess to ad vice and sup -
port to en able them to care ap pro pri ately
for chil dren and young peo ple in dis tress
and the need for spe cial ist ser vices to be
more flex i ble to pro vide ‘out reach’ sup -
port to fit the con text in which the child is
being sup ported (Barbour et al., 2006).
The Ex traor di nary Lives re view of care
for chil dren who are looked after drew at -
ten tion to the health in equal i ties
ex pe ri enced by this group of chil dren and
young peo ple and re cog nised that achiev -
ing and main tain ing good health is a
pri or ity for them and their carers. To this
end, the re view rec om mends that de tails
about a child’s health are fully re corded
and the in for ma tion passed on quickly to
new carers if the child moves place ment.
Care pro vid ers should be aware of the in -
creased like li hood that some chil dren and
young peo ple who are looked after away
from home may de velop men tal health
prob lems, and know how to gain ac cess to
ap pro pri ate help at an early stage. The re -
view high lights the im por tance of
co or di nat ing local ser vices to help
looked-after chil dren and young peo ple
get the best pos si ble health care (So cial
Work In spec tion Agency, 2006).
The na tional re view of ed u ca tional and
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