Looked After Children and Mental Health

1
Looked After Children and Mental Health

• Dr. Zeev Levita
• Consultant Clinical Psychologist
• Options Institute

2
The Scale of the Problem

• 60,000 LAC in England (Majority in Foster Care)
• Higher incidence of Mental Health Disorders
• 19-31 enter further education (68 in general
  population)
• 4 times likely to be unemployed
• 60 times likely to be sent to prison
• 30-40 of women in prisons have spent some
  childhood in care.

3
Challenge

• The physical and mental health problems of
  children in care and leaving care may be deeply
  rooted in their pre-care experiences and
  circumstances, the very factors which led to
  their coming into care but the worrying issue for
  care providers is the evidence that the period
  in care can actually exacerbate rather than
  reduce existing problems and can even create new
  dangers
• Chambers et al (2002)

4
Definition of Mental Disorder(from DSM IV)

• A mental disorder is a clinically important
  collection of symptoms (behavioural or
  psychological) that causes an individual
  distress, disability or the increased risk of
  suffering pain, disability, death or the loss of
  freedom.

5
Diagnostic and Statistical Manual of Mental
Disorders (DSM-IVR)

• Axis I clinical disorders, including major
  mental disorders, as well as developmental and
  learning disorders
• Axis II underlying pervasive or personality
  conditions, as well as mental retardation
• Axis III Acute medical conditions and physical
  disorders.
• Axis IV psychosocial and environmental factors
  contributing to the disorder
• Axis V Global Assessment of Functioning (on a
  scale from 100 to 0 GAF score)
• Common Axis I disorders include depression,
  anxiety disorders, bipolar disorder, Autism,
  ADHD, and schizophrenia.
• Common Axis II disorders include borderline
  personality disorder, schizotypal personality
  disorder, antisocial personality disorder,
  narcissistic personality disorder, and mental
  retardation.

6
ADHD

• Inattention
• Hyperactivity
• Impulsivity

7
Autism

• Qualitative impairment in social interaction
• Qualitative impairments in communication
• Restricted repetitive and stereotyped patterns of
  behavior, interests and activities

8
Conduct Disorder

• A repetitive and persistent pattern of behavior
  in which the basic rights of others or major
  age-appropriate societal norms or rules are
  violated, as manifested by
• Aggression to people and animals 
• Destruction of property 
• Deceitfulness or theft 
• Serious violations of rules 

9
Anxiety Disorders

• Acute Anxiety Disorder
• Agoraphobia without history of Panic Disorder
• Anxiety Disorder due to general medical condition
• Generalised Anxiety Disorder
• Obsessive Compulsive Disorder
• Panic Disorder with Agoraphobia
• Panic Disorder without Agoraphobia
• Post-Traumatic Stress Disorder
• Specific Phobia
• Social Phobia
• Substance-Induced Anxiety Disorder

10
Depression

• Major Depressive Episode
• Manic Episode
• Mixed Episode
• Hypomanic Episode
• Major Depressive Disorder
• Dysthymic Disorder
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder

11
Identifiable Mental Health Disorders in General
Population(Great Britain) Meltzer et al (1999)
Half of the cases are Conduct Disorders Boys
twice as girls presenting Conduct Disorder or
Hyperkinetic Disorder
12
Identifiable Mental Health Disorders in Looked
After Children(Great Britain) Meltzer et al
(2003)
13
Identifiable Mental Health Disorders in
LAC(Great Britain)Meltzer et al (2003)

• 66 of LAC have at least one physical complain
  (most common eye-sight, speech and language,
  co-ordination and asthma)
• 42 of LAC Boys and 31 of LAC Girls present
  Conduct Disorder
• 33 of LAC with MHD are 3 or more behind
  intellectual development
• 60 of LAC have difficulties with reading,
  spelling or maths ( those with MHD twice as much
  literacy difficulties that other LAC)
• LAC with MHD are 4 times more likely than other
  LAC to report not spending time with friends

14
MH of LAC (England)2002 (Office of National
Statistics)
15
MH of LAC (England)2002 (Office of National
Statistics)

• 16-17 aged Girls Only
• 10 Major Depressive Disorder
• 7 Post Traumatic Stress Disorder

16
MH of LAC (England)2002 (Office of National
Statistics)

• Boys 5-10
• 18 Oppositional Defiant Disorder
• 16 Hyperkinetic Disorder
• Boys 11-15
• 22 Conduct Disorder and Oppositional Defiant
  Disorder
• 8 Pervasive Developmental Disorder

17
What does it all mean?

• Look at the individual young person
• The sad story is not the whole story
• Many of the presentations are pervasive
• Many of the circumstances are pervasive
• Significant number of LAC do not present MH
  disorders

18
Food for Thought

• Undoing or Creating
• Healing or Coping
• Past or Present and Future
• Same Story or New Story
• What makes us ill or what makes us healthy
• Pessimism or Optimism
• Despair or Hope