Review of Mental Health Services for Care-Experienced Young People

Review of Mental Health Services for Care-Experienced Young People

Highlights

The evidence was insufficient for the systematic review to draw conclusions on the effectiveness of interventions or how this may differ across different groups, and found 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.

The rapid review 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, and there are recommendations for addressing these barriers.

Report

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Evaluation Protocol (Review 1)

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Evaluation Protocol (Review 2)

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Summary

In 2022, we 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. This often results from 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 – all of which can contribute to poor mental health.

Aims

This evidence review aimed to improve understanding of mental health provision and interventions for care leavers. There were two elements to this. The systematic review sought to understand the impact of policies, programmes and interventions on the mental health of care-experienced young people in high income countries. However, the rapid review aimed to improve understanding of care-experienced young people’s experiences of interventions and the implementation of mental health services, including the barriers and facilitators to accessing and engaging with services.

Method

Two reviews were carried out: a systematic review and a rapid evidence review of studies. The systematic review looked at the impact of interventions and included five studies: four RCTs and one QED. The rapid evidence review looked at care leavers’ experiences of interventions, and included 43 qualitative studies published between 2005 and 2022, 24 studies from academic databases and 19 from grey literature.

Key Findings

Systematic review:

  • 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.

 

Rapid review:

  • This review 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.

Implications for Policy

Most of the barriers for accessing and continuing with mental health services for children and young people were rooted in structural changes for policy and practice, which could take place at a national or regional/local level. Recommendations included:

  • Recognising that equality in mental health services did not lead to equity in mental health services for CEYP and creating “referral pathways” and/or specialised services where implementable to help facilitate access to services for CEYP
  • Greater funding for adolescent mental health services, particularly to facilitate access, create choice and decrease feelings of powerlessness.

 

Other recommendations could be integrated at multiple levels of policy and practice, including at a local level. These recommendations included:

  • Assessing the particular needs of CEYP in order to meet those needs
  • Helping young people understand mental health literacy, including education in educational settings such as secondary schools and colleges, to identify mental health concerns and seek support where appropriate
  • Incorporating psychosocial support aspects in mental health support, acknowledging the importance of relationships for CEYP
  • Additional training and support for children’s social care professionals supporting CEYP to maintain positive mental health and wellbeing, identify mental health concerns and seek support where appropriate.

Implications for future research

These reviews highlight the need for more research on the mental health of CEYP. The reviews showed the need for researchers to specify the population of the study, what services means, the outcomes of interest, and research methods used. Additionally, the reviews particularly highlight the need:

  • To understand CEYP’s mental health needs in order to tailor services to those needs
  • To understand the effectiveness of services, particularly for CEYP in countries other than the USA
  • To identify and evaluate the “core components” of mental health support and services for CEYP and understand how those elements and activities change outcomes for young people
  • To understand the effectiveness and implementation of tailored mental health services versus mainstream mental health services and support
  • To understand the effectiveness and implementation of mental health support focused on relationships and ordinary life
  • To understand equity and how experiences and effectiveness of services differ by different characteristics.
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