The effect of provisions on the mental health of young adult care leavers. A systematic review
| Date | 01 May 2023 |
| Pages | 81-103 |
| DOI | https://doi.org/10.1108/JCS-02-2022-0010 |
| Published date | 01 May 2023 |
| Author | Emily Rice,Shelley O'Connor |
The effect of provisions on the mental
health of young adult care leavers. A
systematic review
Emily Rice and Shelley O’Connor
Abstract
Purpose –Care leavers are identified as a vulnerable group within UK society and, unsurprisingly,
are more susceptible to mental health problems. Research highlights inadequacies among
UK Government provisions combined with poorer outcomes for care leavers. This paper aims to
measure the effectiveness of provisions on mental health when transitioning from the care system to
adulthood.
Design/methodology/approach –A systematic review was conducted to identify and highlight the
inadequaciesof provisions in place to aid a care leaver’s transition and the effectson their mental health.
Of the 211 studies identified from the search, six studies met the eligibility criteria and were deemed
eligibleby the researcher for further explorationof themes.
Findings –The findings identified feeling isolated, training givento care professionals and caregivers,
collaboration,lack of preparation and support and access andgaps in provisions as the five key themes.
The overarching theme of interconnectedness and interplay between subthemes, mental health and a
care leaver’s transition,is strongly presented throughout. Many participants within the individualstudies
reported negative findings illustrating the weaknesses of provisions and the negative effect on their
mental health. Furthermore, the findings emphasise the unique nature of everyone’s experience
transitioningout of the care system.
Research limitations/implications –A limitation of the review is theselection of key words, which may
have restricted the results produced during the main search, subsequently affecting the amount of
relevant data extractedand synthesised. Finally, less emphasis on greyliterature and more on empirical
studies reducesthe probability of discovering null or negative findings, thereforeincreasing the chances
of publication bias (Paez, 2017). A small number of eligible studies increase the risk of not making
important comparisons, prompting a wider search to be conducted in the future. An unequal ratio
between national and international research in the systematic review restricts fresh perspectives and
strategiesconcerning the mental health ofcare leavers.
Practical implications –Care leavers are identified as a vulnerable group within society and,
unsurprisingly, are moresusceptible to mental health problems. The UK Government enforces national
and local policies to support young adults leaving the care system and transitioning to independence.
However, previous research highlights inadequacies among provisions, combined with poorer mental
healthoutcomes for care leavers.
Social implications –Following on from gaps in the current findings,an investigation into regional
disparities across provisions aimed at assisting care leavers transitioning to independence
would produce useful information for the field and policymakers. Although current research
addresses the essence of interplay between mental health and transitioning,further research is
required to help build a supporting argument for adaptations andimprovements in policies and
practice.
Originality/value –This study supports the argument for an increase in attention from the
UK Government and policymakers to improve the quality and quantity of support for a
population often underserved and marginalised, especially in terms of reducing poorer mental
health outcomes.
Keywords Care leavers, Mental health, Policies, Provisions, Leaving care, Interconnectedness
Paper type Research paper
Emily Rice is based at the
Department of Health,
Liverpool John Moores
University, Liverpool, UK.
Shelley O’Connor is based
at Nursing and Allied
Health, Liverpool John
Moores University,
Liverpool, UK.
Received 22 February 2022
Revised 10 August 2022
18 October 2022
Accepted 24 January 2023
DOI 10.1108/JCS-02-2022-0010 VOL. 18 NO. 2 2023, pp. 81-103, ©Emerald Publishing Limited, ISSN 1746-6660 jJOURNAL OF CHILDREN’S SERVICES jPAGE 81
Introduction
Background
The World Health Organisation (WHO) (2018)defines mental health as “a state of well-being
in which an individual realises his or her own abilities, can cope with the normal stresses of
life, can work productively” (para.2). As of 2020, the WHO identified nearly 1 billion
individuals diagnosed with at least one mental health disorder, with an alarming 75% not
receiving suitable treatment (WHO, 2020). In the UK, the NHS estimates one in four adults
experiences symptoms of mental illness and one in ten children (NHS, 2021). This has
increased due to the coronavirus-19 pandemic, with 21% of adults in Great Britain reporting
symptoms of depression, compared to 10% prior to the pandemic (Office for National
Statistics, 2021). Additionalstatistics identify multiple populations that pose a higher level of
vulnerability to mental illnesses, such as the prison population, members of the LGTBQþ
community, ethnic minority groups, carers and care leavers (Department of Health and
Social Care, 2014;Mental HealthFoundation, 2020).
Care leavers, policy and provisions
The Children (Leaving Care) Act (2000a,2000b) states a care leaver is an individual who
“has been looked after by a local authority for a prescribed period, or periods amounting in
all to a prescribed period, which began after he reached a prescribed age and ended after
he reached the age of sixteen”(line 15). In the UK, a care leaver will be placed under one of
four categories: eligible child, relevant child, former relevant child or a qualified leaver.
Types of care include residential care, foster care and care received in residential settings
(NSPCC Learning, 2022). Local authorities within the UK are responsible for conducting a
needs assessment to be carried out during and after transitioning out of care. Due to an
increased risk of requiring mental health support, it is essential the pathway plan contains
appropriate provisions and support (LocalGovernment Association, 2017). The Department
for Education (Department for Education, 2013) highlights current provisions such as a
team of mental health workers dedicated to supporting care leavers and health
organisations working alongside local authorities to improve provisions and undergo
frequent inspections (DfE, 2015). However, the Care Leaver Strategy (DfE, 2013) identifies
the lack of awareness of this vulnerable population, and this lack of insight potentially
explains the absence of adequateeffort within the government when improving provisions.
Following legislative amendments, the Children and Social Work Act (2017) states care
leavers in England are now eligible to workalongside a personal advisor until the age of 25.
Increasing the age of eligibility suggests the government agrees that vast improvements
are required. Care leavers across the UK are given the opportunity to stay with their foster
carers after their 18th birthdayas part of the “Staying Put” scheme (HM Government, 2013).
Action for Children (2020) highlights the impact of government cuts on the “Staying Put”
scheme despite positive outcomes. Munro et al. (2022) found only 14% of the sample
remained with their foster family through the “Staying Put” scheme, indicating a lack of
funding and availability. A lack of funding is at the forefront of Action for Children’s (2020)
report as they emphasise the importance of increased funding to allow care leavers to
maintain a supportive home environment whilst learning to become independent over a
longer period of time. Similarly, “Staying Close” offers care leavers continuous support
despite leaving residential care (Lepper, 2016). According to Local Government
Association (2017), the scheme emphasises the importance of meeting care leavers needs
through fast-tracked appointments, working with charities and frequent liaising with the
appropriate services. The Care Leaver Covenant (2016) is a national inclusion programme
providing accessible support for care leavers concerning employment, education, living
independently and mental health. On a smaller scale, Barnsley Metropolitan Borough
Council (2022) operates a hub providing accessible support to care leavers, whereas
Leeds City Council offers free gym access to care leavers until the age of 21, to promote
PAGE 82 jJOURNAL OF CHILDREN’S SERVICES jVOL. 18 NO. 2 2023
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