Supporting the mental health and wellbeing of care leavers: Hearing from care leavers and messages from research

[Intro] 

This is a Research in Practice podcast, supporting evidence-informed practice with children and families, young people and adults.

Fidelma: Hello, I'm Fidelma Hanrahan from Research in Practice. This podcast is part of a series exploring support for care leavers' mental health and wellbeing. In our other episodes, we hear about good practice from people working with care experienced young people to support their mental health and wellbeing. We also hear from a researcher looking at the national picture when it comes to mental health support for care leavers. For this episode, we invited three care experienced young people to share their thoughts and reflections on mental health support for care leavers. Victoria hosts the podcast and is a representative from the young people's benchmarking forum. She is joined in discussion by Jasmine and Nicole, who are part of the policy forum at Drive Forward Foundation. Drive Forward Foundation facilitates a policy forum of care experienced people who campaign for effective change and equality of opportunity for care leavers. The young people's benchmarking forum, is part of Catch 22's national leaving care benchmarking forum, which are a form of local authority leaving care teams in England working together to improve outcomes for young people leaving care. Drive Forward and NLCBF have been working together around mental health over the past couple of years because this is an issue young people and leaving care professionals have continued to raise with them as a priority area of concern. Victoria, Jasmine, and Nicole speak powerfully and reflectively about the kinds of things that can impact care leavers' mental health, what good support looks like, and what they would like to see change when it comes to mental health support for care leavers. At the beginning of this podcast, you'll hear Victoria, Jasmine and Nicole introduce themselves. And then, you'll hear Victoria pose the first question for discussion.

Victoria: So, hello. I'm Victoria, I am a care leaver and I work for the National Leaving Care Benchmarking Forum as the young people benchmarking forum representative. And today, I am here with Jasmine and Nicole who will introduce themselves.

Jasmine: Hello. My name is Jasmine and I'm care experienced.

Nicole: Hello. My name is Nicole, I'm a care leaver from South London and I'm part of the policy forum at Drive Forward Foundation as well.

Victoria: Wow. It's great to have you both here. And today, we're here to talk about care leavers' mental health and wellbeing. So, I just have a few questions and a general chit chat about that. So, I will start off with asking what kind of things put a strain on care leavers' mental health and anything that is specific to care leavers?

Jasmine: I would personally say family and friends. So, like, forming relationships with people as well can be quite difficult, especially when the question comes up when they ask about family history because it's, like, me, myself I don't mind. I'm more open with it now, whereas before I'm just, like, 'Oh, it's a bit awkward just explaining.' Because also, when you say to someone, 'Oh, I was fostered,' they're just, like, 'Oh, what's fostered?' And then, you have to go into explaining it all and then, yes.

Victoria: Yes, no, that definitely makes sense. I think, you never know what to say or whether they know, like, what a care leaver is or being care experienced and stuff. I think, one thing is when you have left care, if you've lived out of borough and you come back into your borough where your family are and you're not sure, like, how to be around them because you haven't been around them for so long, is one thing.

[Skills for independent living] 

Jasmine: Yes, and I would say, like, care experienced young people, they move around a lot when they're in care and then when they're put into their own place, they're not always equipped to deal with the tasks that they have to deal with growing up. So, like, paying rent and stuff like that, they might not know how to manage all of that and they're not given the right skills to learn how to cope with that situation.

Victoria: Yes, no, exactly. I think, it's very daunting when you're put into your first flat. Like, if you've lived in residential and you're around loads of staff and other young people and then you go into your flat and it's just you by yourself, it's a lot to get used to. I think finance issues is definitely a big thing as well. Like, obviously, you can have Universal Credit but when you're in care a lot of the things are paid for and allocated to you, like pocket money. And it's done differently when you're in your flat and you have your universal credit and your bank details and stuff. It's hard to do that budgeting with, like, how to top up your gas and electric, your weekly food shop and things like that. It could just all be very daunting to get used to when you haven't done it before. Yes, and I think a lot of other care leavers struggle with that too. Do you think there's anything that PAs can do to help care leavers with, you know, starting off as independent?

Nicole: I think maybe they could run, like, focus group sessions for care leavers. Like, teaching them life skills that they might not have learnt in care or from, you know, relatives that would've taught young people their age.

Jasmine: Definitely agree with Nicole as well, workshops are really helpful and sometimes it's not just about the workshop. I mean, it's all great to just tick boxes with doing the workshops but also, it would also be nice to do, like, a follow up. Even just to say, you know, 'How are you getting on?' Or is there any further support they can provide as well? Which would be really helpful.

Victoria: Yes, no, I agree. I think, obviously, it's their job to come and visit you and check up on you every six to eight weeks but I think having a relationship with the young people is important. Like, giving them a call, giving them a text like you said and with the independent stuff, instead of having, like a standard visit, you could come and do my food shop with me and let me know what to buy and how to budget according to my monies and stuff. Or it could be helping me decorate. Just things like that, it's been a little bit less professional and more one-to-one relationship type of vibe. Do you think that PAs understand care leavers' mental health or, like, how to deal with it? Or do you think that, like, young people feel comfortable talking about their mental health to PAs and stuff like that?

[Support from Personal Advisors] 

Jasmine: I mean, me personally, I don't feel comfortable to speak to my PAs about my mental health. And that's just down to, just the constant rejection that I had throughout my experience. From having that close relationship with one of my PAs and then having them, you know, when you hear a lot that it's very common for PAs to just stay for a short while. And, you know, you get to that stage where you're getting to that stage of getting close to them and bonding and then it's like, 'Oh, I'm leaving,' or you don't get a warning of when they're leaving, you hear it from the person that's going to replace that certain PA. So, like, for me, number one, I'm a sort of person that what supports me is if someone asks and prompts me. I mean, you can ask and I can say, I'm very quite blunt so I will say yes or no or, you know, give pretty much a blunt answer. So, like, for me, the short answer is, I didn't feel comfortable to speak to my PAs about it.

Nicole: I had a more positive experience with a PA. So, like, even though they don't have to do the same training as social workers and stuff like that, I feel like because their caseload is less, they have more time to talk to the young person about their mental health and stuff like that.

Victoria: Yes, no, I definitely agree. I think, it can be difficult because I think, I mean, I know that a lot of young people have anxiety and I feel maybe sometimes PAs generalise this and it's not specific to that young person. I think, in the past, I've talked to my PA and it's difficult because I think she doesn't understand the reasons behind it or, like, why I have a certain diagnosis and things like that. But, again, like I said before about the relationship, as we got to know each other, and had more conversations, we understood each other and she didn't try to, like, fix anything. She was more supporting me through it. One of the things that she did was, like, give me a book on trauma and just coping mechanisms and how to express myself, which helped. And it was just nice, like, it showed that she cared. If you're a care leaver and, you know, you're at home, do you think you know where to go for support? Like, if you were feeling upset, or just you needed support with something, do you know where to go and get that advice and help from?

[Barriers to accessing support] 

Nicole: Not specifically for care leavers. Like, I know there is community teams and stuff like that but even I feel like they don't really understand the care leaver experience because they haven't experienced it themselves. So, I tend to reach out to, like, Drive Forward, which is not dedicated to mental health because I don't know where else to reach out to in terms of specifically for care leavers. But just the fact they have the same lived experience, we, kind of, bond over that.

Jasmine: Me, personally, I know that, I hear a lot that you can go to NHS but, of course, as we know the waiting list on the NHS which I'm currently still on the waiting list but especially during coming out to, like, living independently, I didn't have a clue. I mean, I didn't even have a clue, yes, I didn't have no clue on even there was such a thing as Drive Forward or other care leavers' charities. So, I literally was in this bubble of thinking, 'I'm the only care leaver.'

Victoria: No, I agree. I think, you don't know where to start or where to go because no one’s really told you about that. And, like you said, the waiting lists are ridiculously crazy, especially in South London. And yes, you're right about the lack of knowledge about care experienced people and it can be pretty daunting going in and especially going in to mental health and you might think that it's not seen as serious condition or a serious problem. I know that, in the past, I've used 111, or I've gone to my GP but it's, kind of like, if you really, really, needed that support, what would you do? Where would you go? And it can be daunting to just walk into A&E and say, 'I'm here for this.' What do you think would help in terms of getting that information to young people? Like, how do you think they can access it?

Jasmine: I think what I find useful, like, even though I said I didn't have a clue on where to reach out or what sort of help, I mean, you hear a lot, 'Oh, you know, you can go counselling etc.' So, it's only been the last couple months that I've tried counselling, I mean, I've tried it in the past and said to myself, 'This isn't for me.' And then, I gave it a try again because just from advice from, like, friends and family, they're just like, 'It takes time.' And it just got to a point where I'm just, like, 'No, this is not for me because I can talk to friends about this.' Whereas, like, how I view counselling is that you have an hour session and it's quite limited. And then, after you leave that they're just, like, 'Oh, you can call the crisis number,' which then it's not as-, I find a friend's support is better because they're not there 24 hours but they're probably more reliable depending on your friend, what do you call it, connection that you have. So, yes.

Nicole: Yes, like, linking to Jasmine's point, I feel like, if they are going to put care leavers into counselling, the counselling should be more accessible. Like, they shouldn't have the same three strikes and you're out rule like other people do. They should be more accommodating to the conditions that care leavers can face.

Victoria: Yes, no, I agree. You're definitely right about those crisis numbers and it's a whole process of firstly, getting a number and then knowing how to speak about it because it is a stranger at the end of the day. And friendship groups can really be helpful with that. I think, I know that some local authorities have a in-house counsellor for young people, but I do know that is only limited to a few sessions and if you're really struggling with something then, you know, you're going to need more time. And it's not easy talking about this stuff. And then, after those sessions are done, it's, like, what do you do now? Where's the follow up from that? What do you think, like, the NHS can do in terms of providing stuff for young people? Or, like, just making it easier for them?

[How could access to support be improved for care leavers?] 

Jasmine: I find my personal experience with NHS, as I said, I'm currently still on the waiting list but when I first approached them to say, 'Can I be on the waiting list?' I mean, bearing in mind, I've gone to them to get signed off from work for depression and anxiety but not once have they recommended, 'Oh, would you like to join the waiting list?' It's always been, 'Do you need medication?' So, as in antidepressants, which I've always rejected antidepressants. So, I find that GPs could improve their approach on mental health with not-, I mean, depending on the circumstances of individual, I find that they should focus more around their wellbeing of, like, what they need. So, recommending, you know, there's books out there around wellbeing meditation. So, there's other resources that they can then say, 'Even though you're on, you know, we understand,' to just empathise the fact that, 'Yes, the NHS waiting is a long wait, however, in between this, how can we support you? Will this support you?' So, just digging deeper into a young person's, well, not just young person but in this case, yes, just around their wellbeing.

Nicole: I would say, like, not just the NHS but other professionals. So, like, ambulance crews and police officers should be more aware of how to support a care leaver in a crisis.

Victoria: Yes, no, I agree, that's a really good point. Especially about waiting while, like, what do you do in the meantime before you're given treatment and things like that? Medication isn't always the answer, there are other therapies out there, like, talking and just other ways of coping with whatever you have and stuff. And, I think, there should more help if you have a diagnosis, like, ADHD or depression or anxiety and how to deal with that in the long term, how to live with it, what to do in a crisis and things like that.

Jasmine: And also, I find that NHS, I'm not sure if it is an option currently now, but I find fitness, even though, I mean, at one point I was anti-fitness. But I find now, like, fitness, it doesn't necessarily mean going to the gym but also going to a spa or just having that option. So, I find that the NHS should make that as an offer as well. So, just, you know, try and do a membership, probably not as a long term but maybe let them try it for a month or something just to support them that way.

Victoria: Yes, no, I agree. I think that would help with mental health in general. Like, if you're at home and you're bored and you've got nothing to do or you might not have any money to go out or your friends are busy, you know, that's something that you can do to take your mind off of things in the meantime. I also think there should be more stuff in the community. Like, obviously, you've got care leaver hubs but that's not a Monday to Friday thing. It's not like you can just rock up any time but I feel like there should be groups, activities, arts, and things for young people to do in their local area so they're not stuck at home and thinking about, you know?

Nicole: Yes, and linking to that, like, I feel like supporting care leavers into employment is a big one as well because they may not have the school experience that their peers have. So, they may not have the qualifications. So, supporting them to gain employment as well is something that PAs and stuff can do.

Victoria: Yes, no, that's a really good point. I think helping them do something that is proactive and keeps them busy will help. I also think maybe support for the employers so that they know how to support young people with mental health. And understanding, you know, some of the difficulties that care leavers face as we have a whole different life outside of work. So, just being a bit understanding with that. Do you think that care leavers' mental health is, sort of, prioritised as a key issue? Do you think it's recognised either on questionnaires or when you're asked about it?

[Awareness of care leavers’ mental health challenges] 

Nicole: I feel like when you present to A&E, there should be more support given to care leavers and it should be recognised that just because they're over the 25 age gap, that they still have the issues they had because of their upbringing. So, for example, they could have, like, a mental illness such as borderline personality disorder because of their experience. And that disorder is not going away at 25 like their care leaver title is. So, I think, that should be recognised, yes.

Victoria: Yes, no, I definitely agree. I think doctors in A&E don't see it as often and might not recognise it when they see it. So, I don't know, for example, if you have PTSD and you're in a flashback or whatever, it might not be as easily recognisable. And, I think, they generalise it, like, ask questions like, 'Have you tried breathing exercise? Have you tried a sleeping one?' I'm, like, 'No, there's actually an underlying thing that I need support with.' Yes, and I hope that this isn't still going on but I hope that they don't just go straight to, 'Okay, we're going to put you inside,' and not section but just do things that you didn't want to happen as an outcome. I think they should have different strategies.

Jasmine: And also, I find, I don't know if we can touch on workplaces as well, I feel like mental health should be, like, an essential thing a workplace to be trained on mental health. Even though they've got, like, outside parties and stuff that's involved in that, but recently I've opened up with my workplace, of course, not to disclose anything to do with work. I've been there for X amount of time, and I've only been able to open up about my mental health but on a positive note, they are supporting or are willing to support me. However, I do find, especially around mental health, people tend to look at mental health as quite a common, like, they look at more physical. Whereas, mental health should be promoted as, you know, sometimes it is internally as well. So, if someone's quiet, you know, straight away someone's going to think, 'Oh, that person is shy,' or, 'That person is rude,' or so and so. But I find, like, in a workplace, that should be a check-in. They should do more workshops and just checking in with individuals at work as well.

And I find, ADHD, I mean, in a workplace, it's something that's not being touched on and a lot of people don't know about ADHD. And, even though I've opened up to my workplace personally about ADHD, I mean, I didn't know what it was. I didn't have no clue whatsoever until one of my friends actually pulled it up and said, 'Oh, Jasmine, do you think you have this?' Or, 'We recognise this.' I'm quite fortunate to have that close connection with my friends who are able to know me better than myself basically. So, like, when I did flag that up with the workplace, they just more follow it up as what I tell them. So, I find that, you know, from that workplaces should take that initiative to, like, do research. And actually, you know, ADHD is not just about following up on a task or when you do one task and then not finishing and stuff like that, the consistency of it. Sometimes it is to do with, well, not sometimes, it is to do with how you regulate your emotions as well. And it puts on that pressure on each individual as well at work of, like, their performance if a workplace if they feel like they don't receive that support. And me, personally, I just find that from my experience, to know that even though the workplace, they don't have that knowledge exactly on ADHD but I find that I feel more comfortable now that, 'Okay, if I feel this way, I feel comfortable to go to my workplace and say look, this is how I feel.' But I just find that mental health in general shouldn't be a topic where someone feels awkward how to approach it. Even if you just, you know, have a normal conversation not so much, 'Oh, how are you feeling today and just having that approach.'

Victoria: Yes, no, I agree it definitely should be informal and natural and like that. And, I think, in the workplace, when you first start, and they give you all the forms to sign and things like that, like you mentioned earlier, you said, 'Do you have any diagnosis or do you have any mental health?' I think, i.e. care experience should be part of that too. And, I think, in the past, like, I may have put, 'Do you consider yourself to have a mental condition?' And I was, like, 'Yes.' And then, they came back and asked, 'What medications are you taking?' And I'm like, 'I'm not taking any medications.' I think it should be a lot different, put in a different way. And when you do start, like you said, the stuff about having one-to-one catch-ups. One thing that I did in this other group that I was working with is we had this checklist of, 'This is what it looks like when I'm not okay. This is what you could do to help support me.' And things like that. And that made it easier for them to recognise it when I wasn't feeling a certain type of way. So, they would pick it up and it's not like this big in your face embarrassment kind of thing. And I think if more employers did that it would be helpful. Do you think there are gaps in support for care leavers? And if you do, what are those gaps?

[Gaps in support for care leavers] 

Nicole: I think there are. Like, I feel like there should be an embedded provision within the leaving care team to support care leavers with their mental health. So, it's like an actual structured support rather than some boroughs do it, some boroughs don't do it. Some PAs will do it, some PAs won’t do it. It should be, like, a legal thing.

Victoria: Yes, no, that would be really helpful. So, it's not something that they can get past and, you know, that each young person is supported in that way. I think, like you said about boroughs having one thing and some boroughs not, I think all PAs should be mental health first aid trained so they know about different diagnosis and things like that and how to support it. I think, it's quite common to think on, like, you might see something and be, like, 'Oh, do I have this?' And you can get carried away with searching your symptoms on Google coming up with a different diagnosis completely. So, I think, there should some, sort of, support where if you thought that you had something, a way of going around that, a way of, you know, getting the right answers to your questions and finding out that way and just being supported to work towards getting a diagnosis if you really wanted to help yourself do that.

Jasmine: Yes, definitely. I just find that it should be an essential, especially when you move independently. Just that whole pressure of coming out because I find that I didn't learn about myself until probably now, like, ten years in of living independently. It's only been a recent thing where I've focussed on my mental health. So, I find that it should be an essential thing coming out of care that we should be on, like, a fast-track kind of thing rather than being on the waiting list. So, it should be an offer so then it's up to the young person to either accept or decline because definitely mental health, the earlier it's touched up on, the-, I wouldn't like to say easier, but yes, just to make it a bit easier for them.

Victoria: I agree. Like you said, being independent and living in your own flat, you could definitely learn a lot about yourself. Like, you're living alone, you have a lot of time on your hands and things like that. But, I think, being new to that, like, loads of things can happen in your adult life, like getting a new job, or being fired from a job or quitting a job and you've never had to deal with those things before. And they can bring up, like, new emotions and you're not sure how to deal with it. Or it could be anything, like, a family issue or a friend issue, and you're not sure how to deal with that and those things are new to you. Whereas, when you were in care, you have that support around you, you know, you can go to your key worker, and you have people around you for that sort of thing. And, I think, it's different, obviously being in care and then being a care leaver and how you deal with things.

Nicole: Yes, like, linking to that point, when I started uni for the first time I was like, 'Oh, you know, everyone's telling their parents,' and I was like, 'I don't know who to tell that I've reached this milestone.' So, that kind of thing. I feel like we should be supported in that aspect as well.

Victoria: Yes, no, I agree. I think, relationships is a key thing with that, like I said, you don't have the same amount of people around you. So, things like birthdays can be really hard, anniversaries can be really hard, especially dealing with it by yourself for the first time. I think that support staff and key workers should prepare young people for some of this stuff before they leave. Just so that they have an idea of what they're going into and it's not a complete shock. I know that some residentials, some, have an in-house therapist and things like that and they should support the young people and talk with them as part of their session or whatever. Like, 'Okay, you're moving out soon. Do you have any questions?' Let them know what they're in for, sort of thing. Yes, I think a lot of pre-work could be done.

[The impact of trauma] 

Jasmine: Yes, definitely. Just going back to what you said Victoria about it should be an essential for PAs to be mental health trained because even situation where I've been, for example, like, running away from when I was in care. The new PA after that, there was no follow up. So, I just felt, like, it's been dismissed. Yes, it's maybe a sensitive topic and yes, they might have taken me out of that situation, but even during that process of running away, when I called Childline and police had to pick me up from an address. And then, they were actually, you know, well, I'm assuming they knew the circumstance, well no not circumstance, situation, they were still willing to bring me back to where I came from, like, from where I ran away from. It was only myself, I mean, I'm only thinking of other young people where they don't feel that they're able to speak up and be like, 'No, I can't go back there.' It was only fortunate that I was able to say that, if not I would've just been put back to square one. And I'm pretty sure that police are, or I don't know correct me if I'm wrong but police are, well, should be mental health trained. But in that situation, like, there was no empathy in that situation either.

Nicole: I think, linking to Jasmine's point, like, a lot of us when we first go into care, the first professional we see is a police officer. So, that can traumatise us as well. So, I think, then when we run away from care, they shouldn't send the police because although they're not as mental health trained as say, like, a mental health nurse. So, I think, it should be set out clearly who deals with mental health.

Victoria: Yes, no, I definitely agree about the police issue. It's the first, sort of, point of contact to when you return home for the police to come and visit you. But my experience with it was they would be, like, we have other issues to be dealing with instead of you running away. And my response to that was, 'I didn't call you, they did.' And it was just very annoying for them to come and make me feel like I was a burden and not really understanding, like you said, why I ran away in the first place. I think, like you said about when you first came into care, the police are the first people you see but no one is really there to support you about how do you feel that you've now come into care. Like, this is a huge thing and, sort of like, hold your hand during that process because you've been taken away from what you know to be home and your family and things like that. And you're greeted with a whole bunch of new strangers. So, that mental health and that transition into that should be a lot smoother because, you know, you can get anxiety and didn't things can come from that later on down the line from that experience. And these things stick with you. Like, you remember the memories and that can lead into something else, you know, later down the line. So, I think, yes, you're right, the transition of when you come into care, leave care, should just be better.

Jasmine: Yes, and especially where you mentioned about, like, mental health or trauma that each individual go through, people straight away think, 'Okay,' what can they see physically. Where I find that's where the gap is, is they need to break that vicious cycle of, like, it is more common to be emotionally abused than actually physical abuse when it comes to mental health as well.

Nicole: That's why, like, self-harm and suicide rates are so high in care leavers because they need to make it physical to be heard. That's how they feel at least.

Victoria: No, I agree.

Jasmine: It's a good point, yes.

Victoria: I think it's harder to talk about it if you can't find the words for it and you really feel like you need to do something physical to, sort of, release that. I think, when you leave care, obviously, when you're in care you're under 18 so you can't buy anything but when you're over 18, you have access to alcohol and all of these different things. And because you haven't done that before, you're not sure how to use it safely and that can go down to, you know, using drugs or drinking irresponsibly and that affects your mental health massively. What do you think your PAs can do to help support you if you went to a PA and you said, 'I'm struggling with my mental health. Can I have some support with this?' How do you think they should approach it and what to do?

[What kind of support has been helpful?] 

Jasmine: Me personally, I just find that PAs should just ask the question, what does the young person need rather than thinking, 'Oh, you know, we've got these resources, do you want me to sign up to this?' Or just asking, just empathising with them and just listening to what they need because sometimes some people might not need that professional help at that stage. Some might just say, 'Can we go for a walk?' Or just suggesting, 'Do you want to go for a walk?' And then make it as a regular thing. And then, the more bonding during that time because you'll be very surprised how much a walk, I mean, me personally, when someone said to me, 'Shall we go for a walk?' And I'm like, 'Oh, that's pointless, what am I going to go for a walk for? I walk every day.' But just prioritising and making that time of walking, you would be very surprised on what that can do with you opening up. I mean, I've been in situations where I'm just like, 'Oh my god, these are the things I would not, you know?' My friends have said that to me before, I'm like, 'What's the difference? Why can't I just sit on the sofa and then sit in a quiet room?' They're like, 'No, it's not the same.' So, just that difference a walk can do. So, if you were to just go for a walk, if a PA was to offer that to a young person, of course, the first time they might not open up fully to them. But, I mean, the more regular and showing that consistency, which I believe that care leavers, that's one big thing that they are missing in life and that constant rejection in life. So, just to form that through bonding with your PA that would really support each care leaver.

Nicole: Yes, I think, like, they should be able to signpost you more to people with lived experience. So, me personally, I find talking to someone with the same lived experience, helps me a lot because they understand. And it's the same with anything, like, you're not going to understand someone who has an addiction unless you've had an addiction yourself. So, I think, they should signpost you to more support groups of people with lived experience.

Victoria: No, that's a really good point. I think consistency is definitely important. A lot of failed relationships when you're in care and just throughout. I think, obviously, that the whole thing of the gap between when you turn 25 and that ending of support, I think it would be dealt with a lot more compassionately. So, it's not, like, you already feel when you're 18 that that's the edge of care and things have ended and then you come to 25 and it's that same feeling again. So, I think, just yes, treading carefully with that. I think, a positive experience with mental health is having a good support network, like, people around you. I know that when I've, like, struggled with my mental health, my PA would ask who is the people that I'm more comfortable with and then they reached out to my old carers and my old carers came down. And that was really, really, helpful because that was the people that I was more comfortable with and it was a great solution for that. And, I think, you should have a circle of support around you when things don't go well so you know who to contact and they know you best. I know we've, kind of, touched on it already but is there anything you'd like to see PAs do or put in differently to help support with your mental health or anything that could've been done better?

Nicole: I would say, like, there's three main things. So, ideally, having, like a provision set up within the leaving care teams to support care leavers with their mental health would be a massive one. And like, also, from personal experience I would say sibling support as well. Like, I can't see my sibling because of stuff my parents did and I feel like that's really unfair. Like, PAs and also social workers should connect those siblings together. There should be, like, a protected characteristic for care leavers to support them in many aspects of their life. So, to make sure they're not discriminated against in workplaces, like we touched on earlier, and in other areas of their life.

Jasmine: And me personally, mine's not personally about PAs. Mine is just generally just finding that community or creating that community of just-, because I find especially social media, I mean, we'll be here all day talking about social media and stuff and the insecurities, the impact that social media can have to our insecurities and mental health as well. But I find when I scroll through Instagram it's all these perfect, you know, pictures of people. And then, like, everyone else will, it'll just be a domino effect where everyone thinks they have to be perfect to post it and stuff. Whereas, you know, I try and break that stigma, is that the right word? Yes, just breaking that stigma on social media and just being unique and the normalising of what people don't see behind screens rather than just following that domino effect of, you have to post a particular post of what's common on social media. So, then hopefully that will then make it natural to form a community where people will be like, 'Oh, that person has posted what I'm going through.' And that will give them some, sort of, confidence eventually. They might not necessarily soon post the same post but at least then they don't feel alone looking behind that screen sitting at home, just so they can then have someone to relate to and inspire them and support them.

Victoria: No, those are really, really good points. I really liked your point, Nicole, about siblings and I think, it's really important. Especially if you have a sibling that is in the care system. Like, that could be very difficult because you know, kind of like, what they're going through but you might not be sure how to support them because you're a sibling or if they come out of care, and the whole thing with family contact, I think they could help support young care leavers with that more. I think, healthy relationships and just knowing, like, good signs and bad signs and knowing what to do if you need help and just making sure that care leavers don't feel stuck or that they can't reach out for help and things like that.

[Transparency and positivity in care records] 

Jasmine: I agree in that what you just said as well, Victoria, in regards to siblings. I understand there can be situations where PAs can't disclose certain information just due to GDPR purposes. But I find that it should be taken into consideration that the more transparent PAs are with the young person, the better approach they're going to have to certain situations, especially because, eventually, after they've left care, they're going to receive their care pack. And, you know, they're going to find out certain information. So, I find that without one of my foster mums that I had, if she wasn't as transparent to me, even though at the time, certain information that she disclosed hurt me within my feelings but at the same time, I appreciate her for that. So, I find, like, yes, just being transparent with the young person will really help rather than keeping that information away and then for a care leaver to then find out after when they've left care because that's going to have more of an impact.

Nicole: Thinking back to, like, the care leaver records as you said, I just think a lot of them are just negative. They don't really focus on what the young person is doing well, they just focus on what the young person did wrong. And, I think, when they leave care they read that, you know? And then, it can, kind of, affect their mental health after they've left care.

Victoria: Yes, no, both really good points about their care records. I think, you're right, professional key workers, social workers even, should be more considerate about how they write about the young person because, you know, they're going to read it at the end of the day. Not using words or, like, labels to label them. Trying to summarise their personality and things like that. I think it can be difficult if you've had a really relationships with a key worker or members of staff or your foster carer and then you get your file and you realise that they've written something completely different. And it's, like, what was that whole relationship. I think PAs should support care leavers when they go through the file because it can be very traumatising or, like, having things redacted and you know something was taken out but you're not sure what it is and that can be irritating to go through. I just think, yes, it should be more sensitive around care files and how that information is taken in can change a lot of things about your identity and things like that. I think another good point is that when young people do, like you said, do positive things, they should be praised for it. If you know that a young person has gotten a new job, congratulating them, letting them know that they've done really well just in general. Like, building them up so that they know that they've done well is really good. Well, I think, we have mentioned some really good points and talked and covered a lot of stuff. Thank you very much. Yes.

Jasmine: Thank you as well, Victoria, you've been an amazing host. It's been great.

[Outro] 

Thanks for listening to this Research in Practice podcast. We hope you've enjoyed it. Why not share with your colleagues and let us know your thoughts on X (formerly Twitter) @researchIP and LinkedIn. 

[Intro] 

This is a Research in Practice podcast, supporting evidence-informed practice with children and families, young people and adults.

Fidelma: Hello, I'm Fidelma Hanrahan, from Research in Practice. This podcast is part of a series exploring support for care leavers' mental health and wellbeing. In our other episodes, we hear from care-experienced young people who tell us what they think is needed to improve support for care leavers' mental health. We also hear about current good practice from people working with care-experienced young people to support their mental health and wellbeing.

In this episode, we are joined by Lys Eden, who is Evidence and Evaluation Officer at Foundations- What Works Centre for Children and Families, and who has been involved in studies looking at the national picture when it comes to mental health support for care leavers. We hear about what contributes to mental health difficulties for care leavers, the kind of support available nationally, the barriers and facilitators to accessing and benefitting from that support, and crucially, what care leavers have told us about what would improve their ability to benefit from mental health support. Throughout our conversation today, we'll be referring to and drawing out the key messages from two research reports which detail the findings of an exploratory, qualitative study carried out in 2023 by Foundations in collaboration with peer researchers at the McPin Foundation. Lys, really lovely to have you with us. I wonder if you could tell us a bit more about those two reports?

[Overview of the research reports] 

Lys: Sure, thank you so much for having me on today. So, yes, so, essentially there are two reports that we published. So, the first report we published was an exploratory study of the emotional wellbeing needs and experiences of care leavers in England, and this is really synthesising findings from interviews that we did with practitioners and care leavers, as well as a deliberative workshop with stakeholders. We also published a second report, which is titled, 'Care Leavers' Experiences of Emotional Wellbeing Support whilst Leaving Care.' And this was produced by some care-experienced peer researchers that we worked with from the McPin Foundation. And this report really provides some additional insights and focus into the experiences of care leavers who were interviewed for this project. So, the main report was originally published on the What Works For Children Social Care website and Foundations was formed as a result of the merger between What Works For Children Social Care and the Early Intervention Foundation in December 2022. So, you can now find all of the reports at the Foundations website.

[The aims of the exploratory study] 

Fidelma: Fantastic. Thanks, Lys. So, focusing in on the main report then, I wonder if you could tell us a bit about the aims of that work? 

Lys: Yes, sure. So, this research project was commissioned by the Department for Education because there's not really a statutory duty for local authorities to provide specific emotional wellbeing support or services to care leavers. So, we don't really know what's on offer to care leavers across England to support their wellbeing, and there's just not much information or data available out there to really understand what services people are receiving and whether they're actually useful and benefiting care leavers. So, the aims of the report were really just to understand a bit more about, what are the emotional wellbeing needs of care leavers. So, what contributes to low wellbeing, you know, what are care leavers experiencing at the moment? We also wanted to look at what support is available to care leavers for their emotional wellbeing, and whether care leavers actually find the support useful and what their preferences are for support. And we also thought it was really important to look at some of the barriers and facilitators to accessing this support for care leavers. We were also really interested in understanding how intersecting inequalities might also impact care leavers' emotional wellbeing, and we also really were interested in getting perspectives from care leavers and practitioners working directly with young people on how emotional wellbeing support could be improved.

[Methodology of the research project] 

Fidelma: Fantastic. So, really, a broad reach of aims there that really drill into experiences of emotional wellbeing, mental health for care leavers and what the picture looks like nationally on provision. So, just briefly, I wonder if you can talk us through the research methodology? So, what was involved in carrying out this research?

Lys: Yes, sure. So, we actually had three strands to this research project. So, the first strand was that we commissioned the Centre for Evidence and Implementation to conduct two evidence reviews looking at the impact of interventions on the mental health of children and young people and their experiences with mental health services. And then the second strand was a qualitative study where we interviewed 46 care leavers and staff in five English local authorities. We also worked in collaboration with peer researchers from the McPin Foundation, and they delivered qualitative interviews with care leavers and also supported us with data analysis. So, they attended some collaborative coding sessions, helped us to decide themes, etc. And they also produced their own separate report that we've also published, honing in on the care leaver interviews and perspectives. And then we also delivered what's known as a deliberative workshop. So, essentially, this was just a space to get a range of academics, experts by experience and practitioners together really just to debate and discuss, you know, a certain topic and try and come up with some solutions. And finally, we also hosted a zine workshop where we created a zine with care-experienced young people to disseminate the findings of our research, and also what it means for them, which you can also find on our website.

[The challenges for care experienced people] 

Fidelma: Fantastic. Yes, I've seen the zine. Yes, it's fantastic and well worth a look. Yes, we'll add a link on the page where the podcast recording is so that people can find that. In terms of the context of care leavers' lives and situations, what did the reports highlight as the challenges that care leavers are facing at the moment?

Lys: So, I think it's pretty well known that experiences of low emotional wellbeing and mental health issues are much more common among care leavers than the general population of young people. You know, we've seen this in lots and lots of research that has come before this. And I think we're already aware of a lot of the factors that come into play. Particularly the trauma that care leavers experience, whether that be through their pre-care experiences and also experiences within the care system. But some of the contributors to low wellbeing that we found in our study were particularly around loneliness and isolation, and just having a lack of a family support network around them. And lots of the issues that were spoken about surrounded, just basic needs, essentially. Not having enough money, not having suitable housing, and just the transition our of care being a really, really unstable and difficult period in young peoples' lives. And I think what's really interesting is, you know, obviously a lot of these issues affect wellbeing on its own. But it also gets in the way of young people being able to access help. So, you know, we can view this in terms of Maslow's hierarchy of needs. You know, you've got the big triangle. You know, you need to have your basic needs like food and housing and feeling safe met, and I think particularly with care leavers often times, you know, these really, really basic things aren't being fulfilled. So, what we heard often happens is all the support and resources is concentrated right at the bottom of that pyramid. Which obviously makes sense, you know, you want to make sure that young people have good food in their bellies and have got a roof over their head. But I think the tension there is it just doesn't leave much room for emotional and social needs. Which are just as important, and I think that's what really shone through in speaking with practitioners and care leavers.

[Support available for the mental and emotional wellbeing of care leavers] 

Fidelma: Great, thanks Lys. I wonder if we can talk a bit about the kind of wellbeing and mental health services that are available to young people nationwide. So, as we've said, there's no statutory for local authorities to provide, you know, specific emotional and wellbeing services but there is guidance that they should provide emotional as well as practical support. Though, that's not specified as to what that should be. So, what kind of services did the reports identify in England?

Lys: Yes, so unfortunately, there's not a lot of data available to us because this type of information just isn't routinely collected from local authorities. So, what we did was we completed a mapping exercise of all the services available to young people by local authority for their emotional wellbeing. And this was gathered from publicly available information from all of the published care leaver local offers at the time of analysis. So, the information wasn't always up-to-date or accurate, but it did give us a general sense of what type of things were out there. And from this, we saw a huge variation in the kind of emotional wellbeing provisions available across England. So, I would say the vast majority of local authorities will have the sort of basic, some sort of offer around, you know, the personal advisor role in supporting young people's emotional wellbeing and signposting them to the relevant services as part of their care leaver offer. But having more specialised services was much less common. So, a large proportion of the local authorities did list mental health provisions that were offered by the voluntary sector. So, typically, these were things like, you know, like a local charity providing young people counselling services. But these weren't necessarily specific to care leavers. And then we also found, you know, a number of local authorities that had dedicated mental health workers for care leavers which were often embedded within the local care leaving teams. And then we also had a few examples of mentoring services. So, these were typically either sort of like a peer mentoring approach where care-experienced young people were mentoring other care-experienced young people, or more formalised mentoring programmes, such as independent visiting. And I think what we found was there are a lot less local authorities that were offering more specialised support services. So, there were a few that offered extended CAMHS support for care leavers.

So, you know, increasing the age from 18 to 25. I think there are a lot of local authorities that are doing really, really good things and have, you know, good services available. But I think the challenge is, a lot of these models are not well-defined within local authorities. So, for example, when I spoke about areas having, sort of, designated mental health workers and teams, I think this support can really vary from area to area. So, in one local authority, it might look like, you know, more intensive check-in support for a young person, and in another area it might be psychologists or trained therapists who are delivering therapeutic interventions. So, there is a lot of variability across these provisions.

Fidelma: So, it's a bit of a postcode lottery then, as to if you're a care leaver, what kind of support might be available to you?

Lys: Yes, absolutely.

[Systemic barriers to accessing support] 

Fidelma: Do the reports tell us about how easy care leavers find accessing whatever services are available to them? And maybe, you know, the kinds of things that they find helpful, or really what gets in the way of accessing those services? 

Lys: Yes, I mean, a lot of the barriers are going to be no surprise to anyone listening to this. You know, we know that NHS services are really under-resourced. That they're stretched to the limit. So, it's really difficult for young people to get that support from adult mental health services. You know, there are really, really high thresholds for acceptance into adult mental health services. And also retention within services. So, I suppose there's an expectation placed on people as to how much they should proactively engage in that intervention which might be more difficult for care leavers. And we know there are, you know, really long waiting lists to access treatment. And I think what is particularly difficult for care leavers is that cliff edge of service provisions. So, you know, when a care leaver turns eighteen, suddenly the support net that's holding them just completely gets taken away. They lose relationships that they've had with social care practitioners, they lose support from CAMHS, on top of everything else that's going on for them. And there's just not much there to fill that gap at the moment. And particularly young people who, you know, have sort of low-level wellbeing needs. They're not going to meet the threshold for adult mental health services. So, where do they go? And I think as well what we heard so strongly is, you know, services just didn't really understand the care system and the journeys that care leavers have been on. And I think, yes, just a lack of understanding of what it feels like to grow up in the care system and how different that experience is, just adds another layer of challenge in terms of stigma, trauma, and also just people not understanding how that shapes you as a person and how that influences how easily you can develop those relationships with practitioners and build trust and things like that.

And I would also say that these challenges are often compounded for those from marginalised communities, so we heard from practitioners and young people about the additional challenges if young people have a learning disability, if they're from a minority ethnic background, and how that just adds another layer to accessing those services and actually being able to engage in them in a way that's helpful.

[Barriers for professionals providing support] 

Fidelma: Thanks, Lys. So, that gives us lots of insight into those kinds of barriers on a systemic level. So, what about at a professional level? What kind of barriers did the report highlight?

Lys: Yes. So, I would say to this point, we heard a lot from personal advisors around just the lack of training in emotional wellbeing and mental health, and how they're kind of expected to be this Jack-of-all-trades to kind of fill in that gap where there's, you know, not anyone available to provide that more intensive support. And we've found there's a real variability in the level of confidence that personal advisors feel in supporting care leavers in those sorts of situations, and particularly in crisis situations. And also around when a care leaver has moved, it can be difficult for personal advisors to actually know what services are available in that area, particularly in really large local authorities where, you know, you'll have teams that split into different regions and have different services. So, again, it's kind of like that postcode lottery and just not having that knowledge to be able to support that young person.

[Barriers to accessing support] 

Fidelma: Yes, that's really really interesting and I'm sure it will resonate with lots of people. And what about for young people themselves? What are the difficulties for them that they experience in accessing services?

Lys: I think a lot of young people just don't know what services are available to them. You know, they're just not aware that there is this support out there. And I think even when they do, I think, you know, we heard from people that there's kind of this expectation to be a bit proactive in seeking that support because, you know, everyone else is under so much strain and pressure. But I think this doesn't always come easily to people. You know, when you think about, you know, the shame and stigma that care leavers already experience and that feeling that you have to do it all by yourself and, you know, seeking services is kind of admitting defeat of that you're not coping as well as you would like people to think. I think it's really, really difficult for young people to reach out. And then there are also just practical things around accessing appointments, like, you know, if it's half an hour away and you've got to pay for a bus fare to get there and back. And you know, you might feel anxious, you might have moved into a new area when you left care and you don't really know where the space is that you've got to attend. So, it's things like that that can be, you know, there's a really easy fix but that's a really big challenge for a young person.

Fidelma: Yes, and they're having to meet a new professional again, yes, I imagine as well.

Lys: And having to, you know, tell your story to yet another person. And yes, it's just, it's really difficult. Most of the local authorities that we interviewed for this project also had quite a substantial population of unaccompanied asylum-seeking young people. And again, this just brings another level of challenge for young people. And I think even though there are lots of commonalities in experience for care-experienced young people, you know, often this cohort of care-experienced young people are experiencing different types of traumas. You know, there is additional uncertainty around asylum claims, a lot more basic needs that kind of need to be met. And a whole lot of uncertainty which just adds more challenge and kind of means that, yes, the emotional wellbeing, it's down the priority list, unfortunately.

[What factors help care leavers access support?] 

Fidelma: Yes, that's a very good point. So we've talked about the various barriers at, kind of, different levels. Are there also insights that we can gain from the reports about what does support young people to access services?

Lys: Yes, so I think what came out really strongly was just how important the role of a personal adviser was, in terms of providing that, sort of, low level support for wellbeing, just having a trusted relationship with that young person. Essentially, that really is their main source of support when they leave care, so I think young people really valued that, you know, just regular check-ins, the signposting to services, and also that is the person that is probably advocating for that young person the most.

Fidelma: So that's going to mean having personal advisors who understand something substantial about wellbeing and mental health difficulties that care leavers might experience. That's going to be quite important then? Also, of course, that they're aware of what other services they can signpost people to, but I guess being aware of the signs of difficulties that young people might be experiencing with their mental health is going to be quite important.

Lys: Yes, I think they do play a really important role in, I suppose, recognising those signs and being able to be like, 'Hey, look, there's this service down the road that might be able to support you with this.' What was also really helpful was having flexibility around how services were delivered, and also when, particularly providing care leavers with repeated offers of support. So, recognising that care leavers might not always be ready for the support when you initially offer it, but, you know, continuing to have that conversation and revisiting that conversation with young people is really important. Services that were designed specifically for care leavers were generally preferred, and where experience is more accessible, and then I suppose there are several reasons for this. So, often they have fewer time limits on the support provided, so it was less rigid and more open-ended in how long they could receive support for. There were typically lower waiting times, and I think people just generally perceived these services to be a bit more flexible to the needs of care leavers. We also found that models of support that approached emotional wellbeing more holistically, and, kind of, recognised that young people have lots and lots of different needs, were really helpful. So, I think as well, this point really speaks to the fact that there are many different ways of providing support, beyond the traditional talking therapy model that we often see, and actually a lot of young people told us that they're, kind of, CAMHS'd out. They're sick of talking about their story, over and over, and actually what can be helpful for young people is having different types of support to access, whether that be drop-in spaces or arts, culture activities, or those more structured therapeutic approaches. It's really about providing lots of different ways of supporting young people and not just the one size fits all approach.

[Care leavers’ views on what support is needed] 

Fidelma: So, I know a big part of the report was obviously these qualitative interviews with care leavers. What kind of learning can we gain from what care leavers said about what they need to sustain and shore up their own wellbeing and mental health? Over and above the points we've mentioned about accessing services, were there other insights from those interviews?

Lys: Yes, so if we focus on some of the findings from the report that was produced by the peer researchers up at McPin, they specifically looked at the care leaver experience and homed in to some more findings for that. I would say that, again, it's around what support is being offered to care leavers, and whether it's being offered at the right time and whether it's the support that young people actually need. It was quite interesting, because a lot of professionals were saying to us that early intervention is what we need, and young people need therapeutic support to be offered, much, much earlier. But, we actually found out a lot of care leavers were saying to us that actually they wished that it had been offered later on in their journey, when they're a bit more settled, they've got the space to process what's happened to them, but often at that point, it's kind of too late, and there's just not much available to them. So, I suppose it's about being flexible, and the right time is different for every single person. I would also say that care leavers spoke quite a lot about financial support, and the challenges around potentially being unable to work because of their mental health issues. I suppose it's just another worry, isn't it, and actually some of the processes, so Personal Independence Payments, you know the application processes are just really, really challenging, so young people were really keen that actually these processes be made a bit more supportive of emotional wellbeing issues and things like that. I suppose as well, a lot of the things that we know help people is connecting with other people, getting out of the house, doing things, but when you've got no money in your bank account after you've paid all your bills, there's no opportunity to do things that make people feel connected and well in themselves.

[Practitioner perspectives] 

Fidelma: What about practitioner perspectives on this? So, from your interviews with the practitioners, what were their insights?

Lys: So, I guess a lot of them mirrored what we found for care leavers and what was spoken about previously, but I suppose one that felt really important to highlight was around inter-agency working and I think practitioners really, really valued having mechanisms in place where, where the NHS services are more embedded within leaving care teams, so like we said with specialist mental health workers, but also having mechanisms in place with adult mental health services and having a really good relationship there. So, just for one example, we heard of a local area where they have weekly consultations with the adult mental health services to, I suppose, discuss young people and their caseloads and just try and make that transition a little bit easier. I suppose as well, it's not just about the referral mechanisms and stuff that that brings, but also just the knowledge that those practitioners bring to the wider team and helping the wider team to understand emotional wellbeing needs a bit more and how to respond.

[The importance of healthy relationships] 

Fidelma: And healthy relationships are obviously a cornerstone of mental health and wellbeing. From these reports, what do professionals working with care leavers need to know about what's going to be most supportive for those young people they're working with?

Lys: Yes, so I think the McPin report really drills into this question a bit more and I think, from what we've heard, a lot of it is just about how you show up as a professional, when you're working with a care leaver. You know, those really, really basic interpersonal skills, being responsive, being attuned to that young person, and just showing compassion and empathy to young people who are often in really, really challenging times. I would also say as well, you can't underestimate how important that relationship is, and how important it is to have some consistency, and just to have someone who is checking in. You know, that young person might not be replying to their messages, but I suppose it is just about knowing that you've got somewhat of a safety net there, particularly when you might not have a close network. You might have moved areas, also just the fact that a lot of young people have really complex relationships with their family. Yes, so I think friendships and romantic partners are under-acknowledged when we think about care leaver relationships, and actually these are probably the people that they're having the most contact with, and are the people that they're ringing up, like, in the evening, when they've run out of gas and electric, or if they're feeling overwhelmed, or stressed, or in a low mood. Actually, it's a real positive that care leavers are tapping into their own support network, but I think it can also create some challenge, because those people might not understand the complexities of leaving the care system and being in, I suppose, a very different situation. But, I think it is really important to acknowledge, you know, we can't underestimate the power of friendship and what that means for young people.

[Examples of good practice] 

Fidelma: Okay, so, we've talked about practitioner perspectives, and young people's perspectives, barriers, and what's important, access to mental health services, and we've touched on this a little bit, but I wonder if you could tell us a bit more about some examples of good practice that you came across in the carrying out this research? It'd be really interesting to hear about.

Lys: Yes, sure, so, I mean, obviously we've already spoken about some local areas having mental health practitioners embedded within leaving care teams, and offering low intensity support and assisting, referring to specialist NHS services, and I think I just wanted to reiterate that having them embedded in the team means that they have a really good understanding of care leavers and their needs, and so they're really, really good at advocating for them when they're referring them on to NHS services. That cross working is really, really important, and a really good example. I also wanted to speak about some examples of practice that we've found within the English local authorities that we interviewed. So, one great example I'm sure many listeners will already be aware of is Pure Insight, which is a mentoring service that's available for care experienced young people. Yes, we just heard really, really fantastic things about what they're doing around mentoring and providing one-to-one emotional support for young people. This is provided under the voluntary sector, which a lot of these, sort of, specialist services are.

Another example is in Surrey, they have a dedicated CAMHS service for children in care and care leavers, called New Leaf. This is really great, because it means that they have a really good understanding of the care system, and it also, kind of, prevents that cliff edge of support that we spoke about earlier, so they're not just losing services at age eighteen, they can actually keep going to the same place until they're 25. I mean, the support might look a bit different, but it's more of a transition I would say, and there's not that gap to fill once they reach eighteen. But, in terms of less clinical support, we heard from Barking and Dagenham who are doing some really, really fantastic stuff in the arts and cultural space. So, they have, in their local council, they've got a programme of activities embedded for care leavers, and this is really around promoting social connection, and it was just really fantastic to hear some of the fun art projects that they've got going on and how they're engaging care leavers in a creative way, and providing them with some more informal spaces to receive some support.

[Key recommendations from the reports] 

Fidelma: So, I guess we're coming to a close really, but before we end, it would be great to hear from you, a, kind of, summary I suppose of the key recommendations coming out of these reports, that practitioners, managers, people working in organisations, local authorities across the country, and leaving care teams, can take away from this conversation and from these reports.

Lys: So, the recommendations from the main report were around having a dual focus on meeting both the practical needs of young people, but also the wellbeing needs, and further work needs to be done to improve the quality of emotional wellbeing support available across different local authorities. We also recommended building the capacity of personal advisors, so they have the time and the resources to be able to support care leavers in a way that feels meaningful, and we think it would be really, really helpful if personal advisors received more training and support in how to respond to some of these mental health needs that care leavers are experiencing. I suppose the final point is around the fact that we just don't know what's going on in local authorities, so it's something we're really keen, that there's more work done to evaluate services and to monitor the emotional wellbeing of care leavers to understand what are the most effective ways to offer support to care leavers.

[Recommendations from care leavers] 

Fidelma: So, as well as those key recommendations from the main report, were there some insights and more specifically, from the McPin report that I know focused on those interviews with care leavers and their experiences, did they have some insights as well that we could take away?

Lys: Yes, so that report really, really highlighted the need for specialist trauma informed support for care leavers for their wellbeing and mental health. They suggested things like psychological wellbeing support workers or clinicians that are embedded within leaving care teams, and I suppose the importance of that job being solely to work with care leavers, to have that capacity, to build those meaningful relationships with young people. Another key message was the professionals working with care leavers need to be empathetic and have the skills to be a part of that relational healing process for care leavers. Care leavers also spoke about the importance of having a more diverse representation, in terms of staff who are providing support, so particularly for minority care leavers, you know, having support from professionals that are from a similar background was felt really important. Finally, care leavers would like professionals supporting them to really understand their care experience and the journeys that they've been on, whether this be personal advisors, or doctors, or other professionals. So, the McPin report also details suggestions for personal advisors and local authorities specifically. Some of these suggestions were around better training for personal advisors in empathy and communication skills, and also things like unconscious bias. They also suggested that personal advisors have additional help with administrative tasks, so that their caseload's able to be freed up a bit more so that they can provide more additional support to care leavers. They also called for more preparation for their transition out of care, including continued support after turning eighteen, and finally they also suggested that local authorities be a bit more proactive in covering expenses for care leavers, to reduce any financial pressures that they might be under.

Fidelma: That's fantastic, and really, really useful to have, kind of, succinctly summarised like that, to understand really what these reports are telling us and what they're really trying to drive home to us in terms of improving services, access to services, supporting care leavers' mental health, and other ways in which local authorities, organisations, and professionals at a more individual level, can support care leavers and their mental health. Thank you so much, Lys, that was incredibly informative and amazing how you've been able to summarise what I know are some lengthy reports. We'll add links to those so that people can find those reports if they want to read and delve into those further, as well as the zine that you mentioned earlier. So, thank you so, so much for your time. I really appreciate it. All the very best.

Lys: Thank you, thank you for having me.

[Outro] 

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