‘They shouldn’t have to ask’: Exploring the need for specialist mental health services for care-experienced and adopted children

It is well established in international literature that children in care and children adopted (care-experienced children) are a vulnerable population who are at greater risk of poor mental health (McNicholas et al., 2011; Fisher, 2014). The multiple attachment and trauma-related difficulties of care-experienced children are thought to be inadequately represented by psychiatric diagnoses, as children present with a combination of multiple ‘lower level’ difficulties that are below clinical thresholds, yet reflect greater impairment (Hillier, 2014; Tarren-Sweeney, 2008, 2013). In Ireland, Health Service Executive figures (2012) estimate that approximately one in three children attending Child and Adolescent Mental Health Services (CAMHS) have a history of contact with Social Services. This may be an underestimation of need, with national enquiries following the deaths of young people in care in Ireland (National Review Panel, 2011, 2012) noting the paradox that CAMHS were involved with children with less severe difficulties, whereas community child protection services were working with young people with more severe difficulties in spite of having no formal mental health training (McNicholas & Bandyopadhyay, 2013).
This oral paper will present the results of an evaluation of mental health services for children in care and children adopted in counties Louth and Meath. This evaluation was commissioned by the Children and Young Peoples Committee and funded through the Healthy Ireland initiative. Ethical approval was obtained from Tusla Ethics Committee.
Focus group methodology (Andrew & Jonathan, 2006) facilitated an in-depth and interactive exploration of the views of relevant stakeholders. Uniquely, this study listened to the voices of the range of disciplines working to meet the mental health needs of care-experienced children. Focus groups were conducted with each of the following stakeholders: Young Adults with care experience who had mental health needs as children; Adoptive Parents; Foster Carers; Professionals who routinely refer to mental health services (including Social workers, Nurses, Education Welfare Officers and Family Support Workers); Providers of mental health services (including CAMHS, Social Work, Nursing, and Primary Care Psychology); and Senior Service managers of stakeholder agencies (Tusla, CAMHS, Adoption Services, Primary Care Psychology). A purposeful sample of participants was recruited with a total of 34 people participating in the six focus groups. Discussions explored four thematic areas: the mental health needs of care-experienced children and young people; accessing mental health support services; experiences of mental health provision; and suggested service improvements. Thematic analysis was undertaken to highlight the key messages from each group and subsequently across focus groups.

The paper will give an overview of key themes identified with a focus on:
• The pervasiveness and nature of the mental health difficulties
• How to support the carers as the primary promoters of good mental health
• The need to improve access to and communication between services
• The benefits of specialist trauma-informed and attachment-based mental health interventions
• The role of CAMHS
This paper will conclude by proposing the creation of a dedicated integrated specialist service to assist foster carers and adoptive parents to better meet the mental health needs of care-experienced children and young people.