Critical Values Based Practice Network

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Growing up in care: implications for adult mental health

Written by Miranda Roberts on . Posted in Clinical Psychology Bite-Size

Growing up in care: implications for adult mental health

Issue 25 – November 2010

Author: Miranda Roberts (c/o jenny.poole@nottshc.nhs.uk)

Key points

  • Looked after children have commonly experienced abuse or neglect in their birth families and have lacked safe and responsive relationships with caregivers
  • Even after leaving their birth families and entering care, children do not necessarily receive care which meets their needs and may continue to experience rejection and instability
  • These experiences are likely to have an ongoing impact on people who have grown up in the care system and are likely to contribute to mental health problems in adulthood.  

Implications for practice

  • Mental health professionals need to be aware of and sensitive to the ways in which clients’ experiences as a child may impact on their current mental health.
  • Mental health services should endeavour to meet clients’ attachment needs by providing safe and responsive relationships, even when clients behave in challenging or rejecting ways.
  • Services and staff should also be reflective of their own behaviour and interpersonal styles and how these impact on clients’ attachment responses.
Looked after children typically face multiple disadvantages throughout childhood and rates of mental health problems in this client group are high compared with the general population1. In many cases this disadvantage continues into their adult lives, for example a study in the USA reported poorer socioeconomic, educational, criminal, and physical and mental health outcomes for adults who were in care during childhood2. By definition, looked after children have been removed from birth families that were unable to provide adequate care and in some cases were abusive and/or neglectful. In a research study3 a young boy recounted his experiences of physical abuse: “Like, she [his mother] would be mean in the morning, like all the time, and then she had this man [mother’s boyfriend] and he used to beat us….yeah, you know like a piece of a table, the leg, it had nails in it and he used to beat us with that” (p292). In general, the early lives of looked after children have lacked the presence of secure relationships with adults who are sensitive and responsive to their needs. According to attachment theory, when safe and responsive relationships with caregivers are not available, the child may adapt to their environment by developing ways of relating to others which are characterised by negative views of themselves and/or others, and interact in fearful, dismissive or dependent ways. Without subsequent experiences of positive relationships, these interpersonal styles may persist into adulthood4.

Experiences in the Care System

Aside from the trauma and inadequate parenting leading to removal from birth families, many looked after children experience frequent changes in their foster/adoptive care arrangements, which may contribute to attachment difficulties. As a result of their histories and ongoing instability in their lives, looked after children may be distrustful and rejecting of new caregivers. This may lead some children to behave in ways which carers find challenging and struggle to understand and manage. Foster carers therefore have a very challenging job which requires them to understand and respond to the child’s needs in the face of these difficulties, as well as managing their own emotional responses to feeling challenged or rejected by the child 5. Carers are not always able to provide children with care that meets their often complex needs and enables them to develop a secure attachment relationship. In some situations, carers may choose to end the child’s placement with them. For the child, this is likely to be experienced as further rejection and reinforces the child’s negative view of themselves and/or others. Looked after children may also experience rejection at school due to responses from teachers and peers. It is important to highlight that the difficulties which looked after children often experience are due to the failure of the adults around them to care for them properly. It is the responsibility of the adults who continue to play a role in the lives of these children, including foster/adoptive parents, teachers and social workers, to ensure that adults do not continue to fail them and that they now receive care which meets their needs. This is by no means an easy task. Adults involved in the care of looked after children need access to resources, e.g., training, and emotional, practical, social and financial support, if they are to provide them with the care they need.

Adult Experience and Mental Health

Many looked after children have grown up lacking experience of positive care-giving relationships and experienced rejection in multiple areas of their lives. Given the difficulties and disadvantage that young people in the care system face, it is unsurprising that adults who were looked after children are over-represented in adult mental health services. The poor relationships looked after children commonly experience with caregivers can lead to ongoing difficulties in relationships and this is likely to have a significant impact on adult mental health. Moreover, research has identified links between childhood abuse and the full range of adult mental health diagnoses 6. Finally, there is evidence that young people leaving care are significantly disadvantaged compared to their peers: 75% leave care with no academic qualifications, 50% are unemployed 7 and 20% are homeless within 2 years of leaving care8. This lack of social and material resources is inevitably a further contributor to mental health difficulties.

Implications for Practice

Mental health professionals working with adults who grew up in care need to be sensitive to the range of experiences such people have faced, and how such experiences as a child may impact on their current mental health.   In particular, workers need to be mindful of the clients’ history of attachment relationships and how this impacts on their current lives and relationships, including their relationship with services. Services should endeavour to meet clients’ attachment needs by providing safe and responsive relationships, even at times that clients behave in challenging or rejecting ways. Moreover, it should be remembered that services and staff make an equal contribution to their relationships with service users. Some routine practices in mental health services may be experienced by clients as coercive or invalidating. Staff should also reflect on how their own backgrounds and experiences may impact on their relationships with clients. Service users should have the opportunity to discuss difficult experiences from their past in a safe space; staff can help to create this by asking in a sensitive and respectful way about experiences of abuse. For further information on these issues, refer to the Bite-Size articles on ‘Childhood Trauma and Unusual Experiences’ and ‘Adult Attachment and Mental Health’. 

REFERENCES

  1. Meltzer, H., Gatward, R., Corbin, T., Goodman, R. & Ford, T. (2003) The Mental Health of Young People Looked After by Local Authorities in England. Office for National Statistics
  2. Viner, R. M. & Taylor, B. (2005) Adult health and social outcomes of children who have been in public care: population-based study. Pediatrics, 115, 894 –899
  3. Whiting, J.B. & Lee, R.E. (2003) Voices from the system: A qualitative study of foster children’s voices. Family Relations, 52(3), 288-295
  4. Bowlby, J. (1969) Attachment and Loss Vol I. London: Hogarth
  5. Schofield, G. & Beek, M. (2005) Providing a Secure Base: Parenting Children in Long-Term Foster Family Care. Attachment and Human Development, 7(1), 3-25
  6. Read, J., van Os, J., Morrison, A. & Ross, C.A. (2005). Childhood trauma, psychosis and schizophrenia. A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350
  7. Department of Health (1997). ‘When Leaving Home is also Leaving Care’: An Inspection of Services for Young people Leaving Care. London, Social Services Inspectorate, Department of Health
  8. Biehal, N., Clayden, J., Stein, M & Wade, J, (1995). Moving On: Young People and Leaving Care Schemes. London: HMSO
   

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