Fonagy Review Highlights Gaps in Mental Health Services for Children in Social Care

The independent review, led by psychologist Professor Peter Fonagy, along with paediatrician Professor Gillian Baird and psychiatrist Professor Simon Wessely, aimed to investigate the rising demand for assessments and services related to mental health and neurodevelopmental conditions. It highlighted unacceptable waiting times for diagnostic assessments and the urgency for more integrated services tailored to impoverished groups, including care-experienced children.

Key findings indicated a substantial increase in mental distress across the population, particularly among young people, with rising rates of anxiety, depression, self-harm, and eating disorders. The review cited that more adolescents are facing multiple, interconnected mental health issues, with projections suggesting that by 2024, 57% of 16 to 24-year-olds with a common mental disorder will also show signs of ADHD and 61% may exhibit autistic traits.

Contributing factors to increased mental distress include poverty, financial insecurity, and heightened uncertainty stemming from economic and political issues. The report noted that these trends disproportionately affect disadvantaged youths, directly impacting their participation in education and employment.

The review emphasized that remarkably little is known about the mental health of children in care, despite their increased risk of developing mental health difficulties due to adverse experiences. The most recent authoritative data indicated that 45% of looked-after children aged 5-17 met criteria for a mental disorder, with the rate reaching 72% for those in residential care—significantly higher than the 10% prevalence in the general population.

Currently, many children in social care face barriers to accessing mental health support. A study from the National Children's Bureau revealed that children on child protection plans were nearly twice as likely to have referral requests denied compared to those without social work involvement. The Fonagy Review also noted that some children were incorrectly classified as not having treatable mental health issues based on their backgrounds.

The findings echo previous reports indicating that referral rejections often stemmed from an assumption that mental health issues were social care problems rather than clinical matters. The review's recommendations included improving access to integrated mental health services and training for both NHS and social care staff.

The review urged for more investment in early intervention and prevention strategies to address underlying causes of mental ill-health, and it called for a shared approach to assessing needs across health, social care, and education sectors. The government responded by stating that a forthcoming mental health strategy would emphasize prevention and early intervention, aiming to provide timely and appropriate support based on individual needs.