Secondary data analysis of social care records to examine the provision of mental health support for young people in care

Background: Young people in care are much more likely to experience mental health difficulties than the general population, yet little is known about the provision of mental health support for this group in the United Kingdom. Methods: Using routinely collected social care data, we explored the provision of mental health support for 112 young people in care in the UK. We identified young people experiencing elevated internalising or externalising difficulties in their first year in care (based on strengths and difficulties questionnaire scores) and extracted data on mental health referrals and provision. We generated descriptive statistics relating to provision of mental health support and used regressions to examine predictors of mental health provision, and associations between support and mental health outcomes one and 2 years later. Results: Eighty-one percent of the children (n = 79) were referred to mental health services in their first year of being in care. Referrals were usually for emotional or conduct problems. Those with higher externalising symptoms were more likely to be referred than those with higher internalising symptoms (OR = 1.2, (95% confidence interval (CI): 1.01, 1.38)). Females were more likely to access support than males (OR = 3.82 (95% CI: 1.2, 13.3)). Sixty-eight percent of children (n = 66) accessed mental health services in their first year of being in care. Of those who accessed services, support ended prematurely for 29 (44%) of them, often due to placement instability or disengagement. Accessing support in the first year of care was not associated with changes in mental health 1 year (OR: 2.14 (95% CI: 0.62,7.29)), or 2 years after entering care (OR: 0.72–8.57, (95% CI: 0.72, 8.57)), although methodological limitations are noted. Conclusions: Mental health difficulties for children in care are recognised quickly, but mental health support may be difficult to access, with issues evident in retention and engagement

Older person’s mental health: Considerations for psychological practice

The first chapter of this thesis is a qualitative evidence synthesis via meta-ethnography, exploring the views of psychological professionals working with older people. A search was conducted via relevant databases and a total of 10 qualitative studies met inclusion criteria. Six themes, or third-order constructs, were developed from the aggregated findings. These are presented in the context of the original studies, with professionals’ age, stage of training, and cultural background considered for accordance and divergence between the studies’ findings. Implications are discussed, which suggest an increase in older person psychology is much needed during professional training, supported with adequate supervision. Tighter inclusion criteria, i.e., by way of professional group or country, may have served in providing specificity and relevance for specific psychological organisations. The second chapter reports a qualitative study exploring the views, perspectives, and experiences of older people with depression and their contemplations of meaning and purpose in life. Five older patients of older person community mental health teams contributed to the data via semi-structured interviews. Data was analysed via Interpretative Phenomenological Analysis. Three themes were developed: Living a Full Life; Developing the Self; and, Connecting Past, Present, and Future. Relationships with family, friends, and wider community were established as important for continued meaning and purpose, as was the continuation of learning and self-development. Time, in terms of perspectives of the future and regret from the past was seen differently by those at varying points along the depression trajectory. Again, a tighter inclusion criteria is commented on as a point for future research given the divergence of participants’ current level of depression within the sample. Implications for policy and practice are discussed

The development of young peoples' internalising and externalising difficulties over the first three-years in the public care system

Although we know there are high rates of mental health difficulties amongst young people in out-of-home care (i.e. social welfare-involved children), there is limited evidence on the longitudinal development of these problems, particularly from when they enter the care system. Using the routinely collected carer-reported strengths and difficulties questionnaire, we explored internalising (emotional and peer) and externalising (conduct and hyperactivity) difficulties for 672 young people across their first 3 years in the UK care system (2–16 yrs, 51% boys, 76% Caucasian). In all cases stable profiles (resilient or chronic) were most common, while changing profiles (recovery or delayed) were less common. Findings showed that entry into the care system is not enough of an intervention to expect natural recovery from mental health difficulties. Number of placements and being separated from siblings were associated with greater difficulties. Implications for child welfare and mental health systems are discussed