Paper
Emotional well-being and mental health of looked after children in the UK
- issue: Issue 1 / 2008
- authors: Colette McAuley
- keywords: children in care, emotional well-being, mental health, mental health services, United Kingdom
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- downloaded: 1
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abstract
Aims. This paper will present the prevalence rates of mental disorders among looked after children in the UK. This data will be placed in the context of prevalence rates for children and young people in the general population. Recent developments in child and adolescent services throughout the UK will be considered, particularly in relation to meeting the needs of looked after children. The views of young people on needs and services will be highlighted.
Introduction. At 31 March 2007, approximately 60,000 children (55 per 10,000 children aged under 18 years) were looked after in England. Under the Children Act 1989, the term 'looked after children' refers to children who are provided with substitute care, either on a voluntary basis to assist parents or as the result of a court order. Sixty four per cent were the subject of compulsory care orders. The majority (62%) had entered care as a result of abuse or neglect (62%). Overall, across the UK, there are currently around 78,000 looked after children.
Looked after children may be placed in a range of placements including foster care or a residential setting. The most frequent substitute care option throughout the UK is foster care. In England in 2007, around 71% of all looked after children were placed in foster families. Whilst many children who enter the care system stay only for brief periods, a considerable number of children spend significant portions of their childhood in care (Rose, Gray and McAuley, 2006).
Under Every Child Matters (2004) the aim is for every child, whatever their background and circumstances, to have the support they need to be healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic well-being. A crucial objective is to narrow the gap between outcomes for children in care and those in the wider population. Recent surveys on child and adolescent health in the general population in the UK followed by specific surveys of the mental health of looked after children have provided us with the opportunity to establish for the first time the prevalence of need among looked after children and how that compares relative to other children in the general population. At the same time, it has set significant challenges for the development of services, policy and practice to both meet those needs and promote better outcomes.
Child and Adolescent Mental Health in Great Britain: Results from Recent National Prevalence Studies
Recently a national prevalence survey of the mental health of children and adolescents in the general population in Great Britain was completed, providing the necessary basis for comparison of particularly vulnerable populations such as looked after children. The survey found that 10% of children aged 5-15 years had a mental health disorder (Meltzer et al, 2000). The study included over 10, 000 interviews with parents, children aged 11-15 years and teachers. It used the International Classification of Disease-tenth revision (ICD-10), a standard manual classifying mental illness and behavioural disorders (World Health Organisation, 2001) and its own definition of mental disorder: 'a clinically recognisable set of symptoms or behaviours associated in most cases with considerable distress and substantial interference with personal functions'.
Mental health disorders were found to be present across the age range, with evidence of considerable prevalence in the younger age group. Thirteen per cent of the boys and 10% of the girls in the 11-15 year age group were found to have a mental disorder. In the younger age group (5-10 years), evidence of a mental disorder was found among 10% of the boys and 6% of the girls.
The study set out to produce prevalence rates for three main categories of mental disorder: conduct disorders, emotional disorders and hyperkinetic disorders. Out of 10% of children with mental disorders aged 5-15 years, 5% had clinically significant conduct disorders; 4% were assessed to have emotional disorders-anxiety and depression and 1% were rated as hyperactive.
Higher prevalence rates of mental disorder were found among children in more disadvantaged families. Children were more likely to have mental disorders if they were children of: lone parents, reconstituted families, larger families, families where parents had lower educational qualifications, families where neither parent were employed, families with lower household income, families of lower social class and families in rented accommodation.
Children with mental disorders were also found to be experiencing other problems. Compared with others, they were more likely to have poorer physical health; to have special needs (three times more likely); to have special learning difficulties (three times more likely); to have parents with a mental health problem (twice as likely), to live in families with family discord (twice as likely); to have been more frequently punished by their parents and to have experienced several stressful life events (such as the separation of their parents or the death of a parent or sibling).
A second national prevalence survey using the same methods was conducted by Meltzer and colleagues in 2004 (Meltzer et al, 2005). This was a fresh survey of a further 7,977 children and young people aged 5-16 years living in private households in Great Britain (England, Scotland and Wales). There was no difference in prevalence rate (1 in 10) between 1999 and 2004 in the overall proportions of children with a mental health disorder. The 2004 survey did introduce a number of new topical areas. Children with a mental disorder were more likely to have been excluded from school, to have a poorer ability to empathise with others, fewer family or friends with whom they felt close and to have more difficulty keeping friends. None of these studies included looked after children.
The Mental Health of Looked After Children: Results from National Prevalence Studies in England, Wales and Scotland
The first national survey of the mental health of young people looked after in England has also been recently completed by the same team (Meltzer et al, 2003). The ICD-10 classification was used again. This time, of necessity, the data was gathered from a wider range of carers (foster carers, parents, residential care workers) as well as young people aged 11-17 years and teachers. The sample comprised of 1,039 looked after children drawn from 134 local authorities across England.
With regard to prevalence, 45% of looked after young people aged 5-17 years were assessed as having a mental disorder. This figure comprised of 37% with clinically significant conduct disorders, 12% with emotional disorders-anxiety or depression and 7% were rated as hyperactive.
Prevalence rates for mental disorders were much higher for looked after children than children in the general population. Regarding children in private households, the rate of mental disorder for looked after children aged 5-10 years was over five times higher (42% compared to 8%) whilst in the 11-17 year age group it was over four times higher (49% compared to 11%).
Conduct disorder was the most frequent disorder for both age groups of looked after children. Although the trend was for a much higher prevalence rate for all disorders amongst looked after children than children in the general population, the greatest disparity was found with conduct disorders. Looked after children were seven times more likely than children in the general population to have conduct disorders.
Children in residential care were much more likely to have a mental disorder than those in foster care or placed with family or friends (72% compared with 40% and 32%). Of those living in residential care, conduct disorders predominated (60%) with 18% having emotional disorders, 13% less common disorders and 8% hyperkinetic disorders. Interestingly, less common disorders, including those in the autistic spectrum, were found more frequently among children in residential care than in any other placements.
Where children were rated as having a disorder, most carers (88%) agreed with the diagnosis. However, mental health problems (as opposed to disorders) are likely to be more widespread as over two fifths (43%) of the children not assessed as having a mental disorder were viewed by their carers as having emotional, behavioural or hyperactive problems.
Looked after children with a mental disorder were also more likely to have other problems. Over three quarters of them had at least one physical complaint compared to 57% of children not assessed to have a mental disorder. They were nearly twice as likely as children with no mental disorder to have marked difficulties with reading, maths and spelling. Overall, 62% of all children were reported to be at least one year behind in their intellectual development. Among children with a mental disorder, 42% had a statement of special educational needs, twice the proportion in the sample with no disorder. They were also four times more likely to report not spending time with friends. Young people with a disorder were also twice as likely to have played truant as other children.
With the completion of similar surveys in Wales and Scotland (Meltzer et al, 2004a; 2004b), the mental health needs of looked after children (at least in terms of prevalence of mental disorders) throughout Great Britain are well portrayed. We are now in the unique position of having a new level of information to inform planning and provision of services to meet those needs.
This paper will consider recent developments in child and adolescent mental health services throughout the UK, particularly in relation to meeting the needs of looked after children. The views of young people on needs and services will be highlighted.
Key references
Department for Education and Skills (DfES) (2004). Every Child Matters: Change for Children. London: The Stationary Office.
Green, H., McGinnity, A., Meltzer, H., Ford, T., & Goodman, R. (2005). Mental Health of Children and Young People in Great Britain, 2004. London: Office for National Statistics, The Stationary Office.
Meltzer, H., Gatward, R., Goodman, R. & Ford, T. (2000). The Mental Health of Children and Adolescents in Great Britain. London: Office for National Statistics, The Stationary Office.
Meltzer, H., Corbin, T., Gatward, R., Goodman, R. & Ford, T. (2003). The Mental Health of Young People Looked After by Local Authorities in England. London: Office for National Statistics, The Stationary Office.
Meltzer, H., Lader, D., Corbin, T., Goodman, R. and Ford, T. (2004a). The Mental Health of Young People Looked After by Local Authorities in Scotland-Summary Report. London: Office for National Statistics, The Stationary Office.
Meltzer, H., Lader, D., Corbin, T., Goodman, R. & Ford, T. (2004b). The Mental Health of Young People Looked After by Local Authorities in Wales, London: The Stationary Office.
Rose, W., Gray, J. & McAuley, C. (2006). 'Child Welfare in the United Kingdom: Legoslation, Policy and Practice'. In C. McAuley, P.Pecora & W. Rose (Eds) Enhancing the Well-Being of Children Through Effective Interventions: UK and US Evidence for Practice. London: Jessica Kingsley.
Contacts: Colette McAuley, Professor Social Work Studies and Director of the Child Well-Being Research Centre, School of Social Sciences, University of Southampton, M.C.McAuley@soton.ac.uk