Summary
In 2022, WWEICSC commissioned the Centre for Evidence and Implementation (CEI) to undertake an evidence review on mental health provision and interventions for care leavers. Two reviews were carried out: the first looking at the impact of interventions for care leavers, and the second focusing on the experiences of care leavers using mental health services.
Care leavers are much more likely to experience poor mental health than their peers in the general population. This often results from the abuse, neglect or trauma that led them to enter care, and is compounded by instability while in care. Care leavers also move into independence at a much younger age than their peers, without family support networks, which can lead to loneliness, homelessness, poverty and unemployment – which contribute to poor mental health. Currently, there is no national data collected concerning the mental health and wellbeing of care leavers in the UK.
Objectives
There were two key research questions for this evidence review:
1. Impact of interventions – What is the impact of policies, programmes and interventions for care-experienced young people (CEYP) on their mental health in high-income countries?
The review of impact covers two secondary research questions, which are:
a. What is the impact of mental health interventions for CEYP?
b. What is the evidence on the effectiveness of targeted services compared to universal services?
2. Experiences of interventions – What are the experiences with the implementation of mental health services for CEYP in the UK?
The rapid review answers three secondary research questions:
a. What are the barriers to and facilitators of accessing mental health services for CEYP, including equity in access?
b. What are the barriers to and facilitators of successfully engaging and continuing with mental health services for CEYP after access?
c. What do we know about the acceptability and appropriateness of mental health services for CEYP (e.g., viewpoints on targeted versus universal services, preferences on the points of delivery)?
Methods
Two reviews were carried out to answer these questions. The first question was answered using a systematic review and the second question was answered using a rapid evidence review of studies. The systematic review included five studies: four RCTs and one QED. The rapid evidence review included 43 qualitative studies published between 2005 and 2022; 24 studies from academic databases and 19 from grey literature.
Key findings
For review 1 (understanding impact) the evidence was insufficient to draw conclusions on the effectiveness of interventions or approaches for the mental health of care leavers. This review also found that there is a lack of evidence on how effectiveness and experiences of approaches to mental health may differ for care leavers, such as by gender and ethnicity. Review 2 highlighted the importance of relationships with professionals for young people with care experience, and the training that those professionals receive. The findings indicated there are systematic barriers to accessing the mental health system for young people with care experience, including thresholds, limited services and transitions to adult care.
Recommendations
This report makes recommendations for practice and policy, which include specialised services for care lavers, more funding for adolescent mental health services, training for professionals, and incorporating psychosocial support into mental health support. The report also makes recommendations for more research in this area, particularly for a greater understanding of needs of young people with care experience and the effectiveness of services for them.