Contents

Introduction

This guidance document sets out considerations for local authorities and Integrated Care Boards (ICBs) in commissioning and providing support for young people who are care leavers. For the purpose of this document the young people under consideration are those for whom local authorities have responsibilities under the Children (Leaving Care) Act 2000 as amended by the Children and Social Work Act 2017.

This guidance document has been developed to support professionals working with care leavers to better meet their mental health needs. We highlight some of the great support offers available in London. These often showcase where health, care and local authorities are working together to ensure that care leavers have their mental health needs met.

Context

Early adulthood is a challenging time for many young adults and can impact their mental health and wellbeing. For care leavers who lack wraparound familial support afforded to many of their peers, this is often an even more challenging time as they move out of care. Care leavers often have unique needs as a result of growing up in care and most will have had some adverse childhood experiences prior to being in care.

There is limited detailed research on the prevalence of mental health conditions for care leavers. However, the most recent research (ONS, 2003) indicated prevalence in children in care at 44%. If this is projected forwards, we should expect similar levels of prevalence in the care leaver population.

Response

The Pan London Care Leavers Compact

Supported by the Association of London Directors of Children’s Services and informed by young people, the Pan London Care Leavers Compact has been developed to explore themes including transport, housing, employment, training and education (ETE) offer, mentoring, standardised financial offer, data and health. The health theme of the Compact includes supporting care leavers’ physical health, and ongoing work to improve mental health services for care leavers.

Survey of dedicated mental health services for care leavers currently provided

A survey conducted by the London Innovation and Improvement Alliance (LIIA) in January 2023 highlighted some of the key challenges, including:

• variation in support across London,
• variation in support for care leavers living outside of their home borough,
• high thresholds, and,
• long waits for accessing Adult Mental Health Services.

Aims and key considerations

Outlined below are some of the key considerations that should be reviewed when developing support and services for care leavers with their mental health.

Care leavers are able to access services aimed at young adults

When developing support and services for young adults aged 18-25, it is
important to consider what additional support care leavers and care experienced young people might need to access services.

Services and support for 18-25 year olds should consider the following groups:

• Young adults transitioning from Child and Adolescent Mental Health Services(CAMHS) to Adult Mental Health Services (AMHS).
• Young adults who do not meet the AMHS thresholds.
• Young adults accessing support and services for the first time.

Partnership working between leaving care team and ICB

It is important for ICBs and leaving care teams to work together to effectively meet the needs of care leavers. They should have a strong understanding of the current gaps in support and put in place resource to address these. This might include support to accessing primary care, providing clinical input when making referrals to AMHS, joint working to provide early intervention and wellbeing support.

Equity of offer for care leavers regardless of where they live

There are many considerations that ICBs and leaving care teams need to address when looking at equitable offers of support for care leavers. The recent survey completed by London Innovation and Improvement Alliance (LIIA) has identified issues including variation in provision across London, as well as ongoing high thresholds. In addition, it has been noted that care leavers who do not live within their home boroughs do not receive or have access to the same level of support as those that live in, or nearby, their home boroughs.

The TRHIVE Framework

This guide has been written to align to the THRIVE Framework to support an integrated, person-centred, and needs led approach to providing advice, support and services for care leavers. The THRIVE Framework conceptualises need in five categories: Thriving, Getting Advice and Signposting, Getting Help, Getting More Help and Getting Risk Support.

The framework aims to improve outcomes for children and young people’s mental health and wellbeing. Note that areas do not need to have implemented the i-THRIVE model to use this guide.

Outlined below are considerations of the key needs of care leavers within the THRIVE Framework. We hope that overview provides ICBs and leaving care teams with ideas and clarity on how they might best meet the needs of care leavers.

• Thriving: For care leavers it’s important to consider Thriving in a wider context given the additional support and needs that this cohort may have.
• Getting advice: A key pillar of the THRIVE Framework focuses on providing advice and signposting for those that need it. This is particularly important for care leavers as they often have less support than their peers
• Getting support: The second pillar of the THRIVE Framework is around providing support for those that need focused goals-based input. It is important for those working with care leavers to have an understanding of what support is available to them and what is appropriate support for their needs.
• Getting more help: Care leavers often face considerable challenges which may impact their mental health. Whilst there is limited data, we know that a significant number of care leavers will likely need to access AMHS. It is important for leaving care teams and NHS/ICBs to take a joint approach when assessing and accessing support for care leavers.
• Getting risk support: Leaving care team has a good understanding and are able to access crisis provision and risk support for care leavers if needed.

Further information and resources

Refer to the full Meeting the Mental Health Needs of Care Leavers guidance for further recommendations and to access case studies and additional mental health resources to support care leavers.