The impact of long-term state care on the mental health of children

Despite urgent calls for improvement, the high level of mental health needs among children and young people growing up in state care remains a persistent concern.

To effectively address this, we need to understand how long-term state care impacts the mental health of children and young people. Additionally, a better understanding of how children’s characteristics, behaviours and developmental contexts influence their mental health can help inform changes and drive improvements in policy and practice.

In this blog post, we discuss findings from two studies funded by the Economic and Social Research Council which aimed to build this evidence base by analysing national administrative data on children in care and conducting surveys with both children in care and local authority professionals.

What are the long-term patterns of mental health for children in care?

We used longitudinal data from a large number of children in the national administrative datasets to investigate whether children in care who were aged between 4 and 16 years exhibited consistent or changing mental health over five years in care.
Our analysis of children’s mental health data over five years indicated several distinct mental health trajectories:

    • Over a third (36%) of the children and young people were found to be on high-risk mental health trajectories, indicating a need for mental health support.
    • Approximately 40% of the children were at low risk of experiencing mental ill health over time.
    • Around a quarter of children were on trajectories where the risk of mental ill health either declined or increased over time.

When we separately examined the mental health trajectories of primary school-aged children, secondary school-aged children, and those transitioning from primary to secondary school, our analyses revealed that these patterns varied depending on the children’s ages:

    • Almost half of primary school children were at high risk of mental ill health.
    • In the school transition and secondary school groups, a lower proportion of children exhibited high levels of mental health symptoms.

Our exploration into the factors influencing these longitudinal patterns showed that placement instability (especially when carers requested a change), having a special educational need, and being of white ethnicity were significantly associated with children who were on high-risk mental health trajectories across all age groups.

Male children in the primary school group also displayed a higher risk, whilst in the secondary school group, those placed with non-kin carers, those transitioning between foster and residential placements, those entering care primarily due to parental illness or disability, and those excluded were more likely to be on high-risk mental health trajectories.

What factors impact the mental health of children in care?

Due to the lack of comprehensive information on children’s views and their developmental context in national administrative data, we conducted surveys of children in care in 2020 and 2021 to delve deeper into the factors affecting the mental health of children in care. The factors associated with better mental health outcomes, which include individual, placement, school, social work, and health-related aspects, are illustrated in the figure below. Interestingly, the number of placements or time in care did not significantly impact children’s mental health once we accounted for the quality of their relationships with carers, friends, and social workers.

Factors associated with the positive mental health of children and young people in care
[Figure extracted from Wijedasa et al (2022)]

What did local authority professionals tell us about how they use children’s mental health data?

Local authorities collect data about the mental health of children in care annually as part of their statutory duty. We surveyed local authority professionals to understand how they utilise this screening data. The responses were varied. Some local authorities acted promptly when children scored high on their mental health screening tests, while others waited until the next statutory review. A few were unsure if or how their local authority used the mental health screening scores to make decisions about mental health support for children in care.

Many local authority professionals who responded to the survey expressed concerns about extended waiting times and the ability of mental health service professionals to provide contextualised support that meets the specific needs of children growing up in state care.

What can be done to improve the mental health of children in care?

    • Continuous and long-term monitoring and review of children’s mental health and timely access to support
    • Children on high-risk mental health trajectories require intervention and monitoring.
    • The research also suggests that facilitating the following would promote the mental health of children in care:
        • stable and high-quality relationships across developmental contexts
        • placing children with siblings and kin where possible
        • providing high-quality and consistent social work support
        • facilitating positive school transitions and experiences
        • fostering friendships
        • addressing bullying
        • minimising the use of exclusions for children in care
        • promoting hobbies
        • encouraging positive health behaviours, such as reducing screen time and avoiding substance misuse.

Dinithi Wijedasa, Associate Professor in Child and Family Welfare at the School for Policy Studies, University of Bristol.

Please contact Dinithi Wijedasa at for further information about the research.

For a comprehensive overview of these research studies you can join the upcoming CoramBAAF webinar Learning from Research: The mental health of children in state care in England on 30 May at 2pm-3.45pm.

We will also post a link to the policy briefing (forthcoming) here, which will delve into the findings and policy recommendations in more detail,  in due course.

The author would like to thank Ms Susanna Siddiqui (University of Bristol) for editorial guidance.

Research team

Wijedasa, D., Yoon, Y., Schmits, F., Harding, S., & Hahn, R.

Funding statement

Funded by the ESRC through two linked grants:
ES/R006482/1: Longitudinal mental health trajectories of children growing up in State care in England: An exploration of patterns and influencing factors
ES/V015699/1: MH-CAT: A longitudinal survey of the mental health of children in State Care in England through the COVID-19 pandemic

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