University of Bristol: New research reveals one in five children in care were self-harming and at risk of mental ill health during the COVID-19 pandemic

The study, led by the University of Bristol, is the first of its kind to analyse the mental health of children and young people in local authority care during the pandemic and to explore which factors most influenced this.

More than 1,300 (1,356) 11 to 18-year-olds from 18 local authorities were surveyed in 2020 and 2021. Overall, 22% of respondents in 2020 and 24% in 2021 were at high risk of experiencing mental health difficulties – double the percentage seen in the general population (10%) during the pandemic, according to the Understanding Society COVID-19 Youth Survey.

One in five children and young people reported that they had self-harmed before (20%) and during (18%) the pandemic.

The report also reveals significant numbers of respondents who indicated a need for mental health support during the pandemic had not sought support or had their request denied – 18% in 2020, rising to 27% in 2021. While a quarter of those in care who were receiving mental health support just before the pandemic reported the frequency of support increased during the pandemic, 29% of respondents in 2020 and 22% in 2021 indicated they no longer had access to mental health support.

Lead author Dinithi Wijedasa, Senior Lecturer in the School for Policy Studies at the University of Bristol, said: “It is encouraging to see children and young people in care were accessing a range of informal and formal mental health support. However, it is concerning that a significant proportion of children and young people did not have the mental health support they needed.

“This has important implications for how local authority children’s social care teams assess the mental health of children and young people on a continual basis, facilitate better access to support, and educate children in care more about mental health and how they can ask for support.”

Children and young people who had more positive relationships with friends, carers, and their social workers were more likely to have better mental health. The findings showed having positive relationships with friends was twice as influential on their mental health as their relationships with carers, and three times more influential as their relationships with social workers.

Living with a relative or a sibling was also shown to be beneficial. Yet, although the vast majority survey respondents (94% in 2020 and 93% in 2022) had at least one sibling, only 35% in 2020 and 40% in 2021 reported that they were living with at least one.

Children and young people in care who liked going to school, felt safe at school, and who believed school would help them in the future were also more likely to have better mental health.

In contrast to relationship and school factors, the number of times children and young people changed placements and the duration of their time in care were not found to have any significant influence.

Dinithi Wijedasa said: “This is very interesting as our findings show that irrespective of the length of time in care or the number of previous placements, what matters most to the mental health of children and young people is the continuity, stability, and quality of relationships with key people,as well as how settled they feel in their current schools and placements.

“We hope these findings will help inform how care placements are managed, ensuring children and young people can live in the best placement that suits them, with their siblings and relatives wherever possible, and be fully supported when settling into new homes and schools. Protecting and nurturing relationships with key people in their lives must be prioritised. Our findings also highlight the importance of addressing the high turnover of social work staff.”

Contrary to trends in the general population, the level of mental health difficulties decreased as respondents became older, suggesting children in care might need greater support during the transition from primary to secondary school.

This research, funded by the Economic and Social Research Council (ESRC), also found not being satisfied with the level of contact with their social workers, spending a lot of time on screens, engaging in risky behaviours (such as smoking, drinking or taking drugs), being bullied, and being excluded from school (either temporarily or permanently), impacted negatively on mental health.

A quarter (24%) of respondents said they had been bullied and an even greater proportion (34% in 2020 and 24% in 2021) reported they had been excluded from school. Overall, respondents claimed to spend six to seven hours a day watching TV, playing computer games, and using their mobile phone, with those who spent most time on screens experiencing worse mental health. Having an interest and a hobby was a protective factor.

John Simmonds OBE, Director of Policy, Research and Development at CoramBAAF Adoption & Fostering Academy, said: “The use of the term ‘mental health’ has become significantly amplified in recent years, particularly during the pandemic and in relation to children. This is a positive development and there are groups of children where these issues are hugely important – children who can no longer live with their parents and are placed in the care of local authorities. Experiences of abuse and neglect can have profound impact on these children in both the immediate and long term.

“Such issues must be recognised in the care provided and the messages in this study could not be clearer. Services provided to children in care must be informed by detailed understanding of mental health and integrated into every individual child’s care plan. The next step must be to act – they need and deserve no less.”

At any given time in England, there are around 80,000 children and young people in care.

The mental health of respondents was measured using the Strengths and Difficulties Questionnaire (SDQ) which is a widely used screening tool for measuring the mental health of children and young people.