Introduction

There are assorted reasons for children being ‘looked after’. A proportion will have suffered physical, sexual or emotional abuse, and parental mental illness. Marital violence, relationship breakdown and parental imprisonment are not uncommon experiences. These children can be seen as enmeshed in a matrix of developmental disadvantage, and have a higher number of risk factors predisposing them to mental health problems. They may already have significant mental health problems as they enter care (Dimigen et al, 1999).

The care system presents these young people with further challenges and difficulties, particularly frequent moves and placement breakdowns (Quinton & Rutter, 1984; Minty, 1999), which may influence their already vulnerable state, interacting with and interrelated to social, educational and relationship difficulties. A cycle evolves whereby children with mental health problems are less likely to achieve placement stability, and therefore become more vulnerable (Barber et al, 2001).

A study in Oxfordshire, which looked at the mental health needs of looked-after children, found that 97% of children living within residential care and 57% of children living in foster care were found to have significant mental health problems (McCann et al, 1996). In their research on the mental health of looked-after children aged 5–17 years of age in England, Meltzer et al (2003) discovered that 45% of these children had a mental disorder, 36% a conduct disorder, 12% an emotional disorder and 7% were rated as hyperactive.