An agenda for future research regarding the mental health of young people with care experience

A qualitative investigation into care-leavers' experiences of accessing mental health support

INTRODUCTION

People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services.

METHODS

We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up.

RESULTS

Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met.

CONCLUSIONS

We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement.

Care-experienced young people's views on what they want from mental health services

This study explores what care-experienced young people want from mental health services. Six care-experienced young people were interviewed, and an interpretative phenomenological analysis applied. Three key themes emerged demonstrating that the way support is delivered, the people who deliver it, and the environment of mental health services are all important to care-experienced young people. Along with these findings, this study demonstrates that engaging vulnerable young people in research and service design is beneficial.

Constructing the 'zero family': Breaking the intergenerational transmission of maltreatment from the perspective of care-experienced parents

BACKGROUND

Several studies have explored the mechanisms of intergenerational transmission of child maltreatment (ITCM), which also involves care-experienced parents; however, what is less explored is their direct experience, especially regarding resilience processes.

OBJECTIVE

Developing the theoretical framework of ITCM through an exploration of the perspectives of those who appear to have interrupted it.

PARTICIPANTS AND SETTING

A sample of 27 Italian parents - with experience in foster and/or residential care - who have broken the ITCM, completed an in-depth interview between May 2021 and February 2023.

METHODS

A Constructivist Grounded Theory (Charmaz, 2014) approach was adopted in carrying out the interviews, which focused on daily experiences of parenting (Morgan, 2011) and on factors perceived as supporting ITCM interruption. Data were analyzed using open, focused and theoretical coding; the analysis itself was discussed with a consultive board of care-experienced parents.

RESULTS

The study highlighted important aspects that, from parents' perspectives, play a role in breaking ITCM: for instance, how their parenting experience is a challenging process of constructing what they term 'zero family'. Furthermore, starting a family from scratch requires coming to terms with the past, re-imagining oneself as a parent, and managing the complexity of everyday life despite such tensions.

CONCLUSIONS

The results throw light on how the transition to parenthood itself is perceived as a significant developmental opportunity for the interruption of ITCM. However, many problems persist, foregrounding the relevance of discussing possible supports to strengthen parenting agency and skills. Such a discussion should therefore be increasingly informed by ecological approaches and parents' perspectives (also on everyday practices and life contexts), thus avoiding the risk of pathologizing responses.