Staf (Scottish Throughcare and Aftercare Forum) was established in 1998 in response to the poor outcomes for young people leaving care. We are Scotland's only membership organisation giving a voice to young people, practitioners, senior managers and other corporate parents who deliver services to care-experienced young people. All 32 local authorities and a further 35 corporate parents, third sector and private organisations are members.

We welcome this opportunity to contribute to the consultation on the 10-year vision for mental health in Scotland, outlining the proposed framework and priorities to transform mental health.

Our response is informed by and contains the views of our membership, who attended a policy review session in September 2016.

We will specifically focus on the mental health and wellbeing for care-experienced young people across Scotland and pay particular attention to priority 2. Other priorities, where discussed, have been mentioned.

Key Messages and Recommendations

• A recent study undertaken by the NSPCC found that 46.4% of care-experienced young people had a diagnosed mental disorder in comparison to 8.5% of non-looked-after children. (Achieving Emotional Wellbeing For Looked After Children 2015 Bazalgette et al)
• We know that care experienced young people have often faced trauma and neglect which will have a lasting impact on their mental health and wellbeing
• It is vital that a person-centred approach is taken with the needs of care experienced young people understood and prioritised with appropriate training in place for health professionals.
• There is little data collected or research undertaken on the mental health and wellbeing of care experienced young people. Much of our knowledge of the difficulties they face is anecdotal evidence.  It is for this reason that we recommend an additional priority area focussed on establishing robust data on the mental health and wellbeing of care experienced young people in order to inform the development of local service delivery.
• There is currently no specific recognition of the duties and responsibilities held as corporate parents, as enshrined in the Children and Young People (Scotland) Act 2014. We believe this would strengthen the strategy, and ensure that the importance of the matter informs future plans.
• We would recommend investment in Specialist Looked After Children’s Nurses with a specialism in adolescent mental health care.

The table in Annex A sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

 The following is a summary of the discussions held in relation to the 8 priorities.

 Priority 2

• It was felt that this section was disjointed and vague – it isn’t clear what will actually be in the strategy, it is not specific enough and there doesn’t appear to be any accountability.
• Who are the vulnerable groups of young people, this group needs to be clearly defined?
• Caution was advised about Evidence-Based Programmes – any intervention should be person-centred and individualised approaches are needed for care experienced young people.
• There is no mention of trauma-informed approaches. This is a big gap in the strategy which needs to be addressed.
• Care experienced young people’s views on how their mental health has been supported should be sought. Has this been considered?
• Mental Health professionals should be part of the team around the child from the start of their care experience and therapeutic intervention should be proactive, not reactive.
• How are limited resources going to be targeted?
• There needs to be a multi-agency approach with more Mental Health specialist workers attached to teams working with care experienced young people.
• Services for children and young people need to be accessible and suitable.
• Early action should include a provision to address self-harm and suicide risk.
• There needs to be inclusion and recognition of multiple placements and placement breakdown and the effect that this can have not only in securing services but also on young people themselves.

Priority 4

• What does this mean and how will this be resourced?
• There needs to be a focus on relationships and how they can benefit the mental health of care experienced young people.
• There was some agreement that this priority would work if the number of professionals delivering services are increased. It would be important not to ‘leave’ someone to manage their mental health.

Priority 5

• There is no mention of training and awareness raising for health. It was felt that this would strengthen the strategy.
• Recognition needs to be given to transitional planning as young people move from children’s services to Adult Services.
• Education services and the links to them need to be included in the strategy

 Priority 6

• Corporate parents have a responsibility for the mental health of young people as well as their physical health.

Priority 7

• This section should include mental health promotion in the Pathways to Work programmes

Priority 8

• The impact of loss and trauma on care experienced young people needs to be recognised and mentioned within the strategy.
• Some of the language used within the strategy is not useful eg ‘conduct disorder’

The table in Annex A sets out some of the results we expect to see. What do you want mental health services to look like in 10 years time?

Our membership overwhelmingly stated that there needs to be a recognition of the needs which are particular to care leavers. These need to be understood and prioritised.

• There needs to be greater access to Mental Health supports and services which are specialist and tailored to the needs of care experienced young people. Access to these services needs to be quick and available regardless of how settled or unsettled a young person is in their placement.
• Due to the nature of attachment disorders and associated mental health difficulties care experienced young people should not be adversely affected by missing appointments, there needs to be greater flexibility of services to reflect the needs of care experienced young people.
• Current assessments for children becoming looked after focus on the physical safety of a child or young person. Mental wellbeing should also be at the heart of any comprehensive health assessment taking place and should be revisited as part of a child or young person’s care plan.
• CAMHS should continue to 21 in line with Continuing Care Legislation.
• That there has been significant work towards culture change – adult services need to recognise that they have Corporate Parenting duties.
• Relationship-based approaches have been embedded throughout services in Scotland.

This strategy appears to be based on a medical model. If it is to be a success it must be refocussed on a more social model.

• Access to dedicated CPN team with specialist training on trauma and loss and attachment disorders.

Thank you for providing us with this opportunity to respond. We hope the feedback is helpful; we would be happy to discuss any aspect in further detail.

Staf members involved in consultation session September 2016.

• Aberlour Child Care Trust
• Aberdeenshire Council
• Angus Council
• Argyll & Bute Council
• Barnardos Scotland
• Care Visions
• Care Visions Why Not?
• Carolina House Trust
• Catch Scotland Ltd
• CELCIS
• City of Edinburgh Council
• Clackmannanshire Council
• Dumfries and Galloway Council
• Dundee City Council
• East Ayrshire Council
• East Dunbartonshire Council
• East Renfrewshire Council
• Falkirk Council
• Fife Council
• Glasgow City Council
• Glasgow Kelvin College
• Kibble Care and Education Centre
• Loretto Care
• North Ayrshire Council
• North Lanarkshire Council
• Perth and Kinross Council
• Renfrewshire Council
• Scottish Borders Council
• Skills Development Scotland
• South Lanarkshire Council
• Stepdown
• Stirling Council
• West Dunbartonshire Council