Foster care and mental health By Martin Barrow In the conversation about the mental health of children and young people, one significant group of people is generally excluded. As foster carers, we share our lives with some of the most vulnerable youngsters, helping them come to terms with trauma or to manage mental health conditions that have proved difficult for their own families. Yet our voices are rarely heard, and our work is largely unrecognised. Nor is there concern for the impact it has on our own lives. There are some 55,000 foster families in the UK, caring for almost 80,000 children and young people who are unable to live with their birth families, for a multiplicity of reasons. Many of these boys and girls suffered neglect or abuse for some years before the authorities intervened, and have lived at the fringes of the care system. Many will remain in care until adulthood, and will likely spend time with two, three or even four families along the way. Not every child in care will suffer from mental health issues. But many will, and the mere act of being forced apart from mum and dad to live with strangers, even if it is only for a matter of weeks, raises profound questions. Many children blame themselves for what has happened, and struggle to live with the burden. There are some 55,000 foster families in the UK, caring for almost 80,000 children and young people who are unable to live with their birth families, for a multiplicity of reasons. In a fairer society, all children taken into care would be entitled to an assessment of mental health needs, soon after a placement begins. Of course, the reality is very different. CAMHS is severely under-resourced for all children and young people, and there is no fast track for children in care. What’s more, the system presumes that any significant intervention cannot be effective until a foster child is placed in permanency, which usually means settled with the family they will stay with until adulthood. In theory, this is a sensible approach. In practice, it takes no account of how long the process towards permanency can take. Our current "short term" placement will have lasted almost two years, assuming everything goes to plan. That is an unacceptably long wait for a child or young person showing symptoms of distress, which might include problems with eating or sleeping, or self-harm. Until these issues are addressed they risk undermining progress at school and the ability to make new friends, crucial building blocks towards reclaiming their lives. Many children blame themselves for what has happened, and struggle to live with the burden. So long as professional support remains out of reach, the burden of care falls on foster carers. We are a game bunch, willing to offer sanctuary to the sons and daughters of other people, for as long as it takes. But we are not mental health experts, and we receive no specialist training. We are mums and dads, no more and no less. Our response to symptoms of poor mental health is rooted in our experience as parents, and augmented by what we read in books. Sometimes we know so little about a child's history that our assessment of a problem must be based on guesswork and instinct. We hope we are doing the right thing, but we may actually be doing more harm than good, or delaying recovery. As we navigate around a child, trying different approaches, we manage disruptive behaviour that is challenging, mentally and physically. The state, as corporate parent, owes a duty of care to children who are fostered, which should include an urgent assessment of mental health needs, followed by appropriate support, regardless of the proposed plan for permanency. Most of the children in our care make extraordinary progress. The reasons are easy to understand. Children are removed from the risk of violence, live in a home that is warm and dry, wash regularly and wear clean clothes, have regular meals and sleep in a cosy bed. But that's the easy stuff. What happens after that troubles us deeply, for it is mostly beyond our competence. Yet, far too often, there is nobody else. No child should have to wait to receive the medical support they need, whether it is for physical or mental health. The state, as corporate parent, owes a duty of care to children who are fostered, which should include an urgent assessment of mental health needs, followed by appropriate support, regardless of the proposed plan for permanency. No child should have to wait to receive the medical support they need, whether it is for physical or mental health. These are children who have already suffered a grave injustice. Society has duty to begin to put things right, as soon as possible.