"Hard to know what to do": how residential child care workers experience the mental health needs of young people

Over the last decade there has been mounting evidence of the high level of mental health difficulties that exist in the population of looked-after children accommodated in residential settings in the UK (McCann et al., 1996; Dimigen et al., 1999; Meltzer & Lader, 2004; Kendrick, Milligan & Furnival, 2004). Compared to the general child population, young people in residential care have been found to be between four and seven times more likely to experience mental health problems that can seriously interfere with their capacity to make positive and close relationships or succeed in an educational environment. Although many of these difficulties are the result of disadvantage, neglect or trauma within their own families or communities, they can also be exacerbated by failures of the systems designed to protect, care for, educate or treat young people. Although there is now a substantial body of literature that identifies the prevalence of various disorders among looked-after and accommodated children, there has been far less focus on the experience and perspectives of those adults who provide direct care for young people in residential settings. One focus group study looked at the interface between social care and mental health and identified the importance of partnership working and some of the difficulties that carers experienced in gaining access to mental health professionals (Callaghan et al., 2003). Recent research has also highlighted that the difficulty in retaining residential staff is, in part, a result of having to work with increasing numbers of children with emotional and behavioural difficulties, and in particular dealing with physical and verbal aggression (Colton & Roberts, 2007).