Camden and Islington: A psychotherapy service for care-experienced young adults

Care-experienced young people, including unaccompanied asylum-seeking children (UASC) and refugees, are a particularly vulnerable cohort with complex health needs. Mental health need is very high, with high levels of post-traumatic stress disorder and trauma. This group of young people has higher rates of suicide than their peers.

Despite this, there is limited specialist mental health support for young care leavers. Adult services have long waiting lists and are often not designed to meet the specific needs of this population, where extra effort is needed to build engagement and trust over a period of time. As a result, care-experienced young people can struggle with the transition. There is a risk of them falling through the gaps when they reach adulthood, at a very vulnerable time in their lives.

In both Camden and Islington there was a targeted child and adolescent mental health service for children who were looked after/UASC, but no equivalent service once they turned 18.

In 2017-18, two young Camden men lost their lives to suicide. Marta Calonge-Contreras, Strategic Commissioning Manager (Children and Families) at Camden Council, said: 

Both were care-experienced young men who had come to Camden as unaccompanied asylum-seeking children. Despite improvements to mental health transitions, we knew there was still a gap in provision for this cohort.

Camden and Islington applied for funding through the NHS England suicide prevention fund. As part of the North Central London Sustainability and Transformation Partnership, the funding was shared across three boroughs. In 2021, targeted psychotherapy support was put in place for care-experienced young people aged 18-24 living in Camden and Islington. Each borough has 1.5 days a week of this psychotherapy service. The remainder of the funding was allocated to Haringey for suicide prevention work.

Despite being only a small resource, seeing between 20-25 young people a year, the psychotherapy service is proving valuable and achieving good outcomes. It is delivered by Anna Clifford, an Integrative Psychotherapist, at two existing community settings – the Brandon Centre in Camden and the Lift Youth Hub in Islington. Young people can self-refer or be referred by a professional, such as their leaving care personal advisor. Following a clinical assessment they receive 20 to 24 sessions of individual psychotherapy, tailored to their needs.

Goals are used to structure therapy. These can be a mix of practical/behavioural goals, emotion-based goals and relational goals. They might be, for example, ‘understand triggers to my anger and how to manage this safely’, or ‘work towards returning to college in September’. Progress is evaluated through goal-based outcomes and standardised measures.

Young people have said they really value having in-person mental health support delivered in community settings. Anna Clifford said: “By ringfencing this service for care-experienced young people, we have been able to shape the service for their specific needs. This includes a focus on providing engagement support to enable them to make use of psychotherapy. The practical and psychological obstacles to doing this can be significant, leading to disengagement from mainstream services.

Due to the large number of care leavers in Camden and Islington, often with complex needs, ongoing funding would mean supporting more young people through mental health difficulties – which could otherwise lead them towards secondary mental health and crisis services.

Camden and Islington’s suicide prevention funding ended in April 2023. In Camden, Marta Calonge-Contreras said it was a matter of “scraping through budgets” and pulling together the money to fund it for another year. Islington found another year’s funding through the health inequalities fund.

The psychotherapy service has been recognised as an asset across both boroughs and has demonstrated the added value that the voluntary sector can bring. Marta said: 

We really don’t want this service to finish in April [2024]. It is addressing a gap for a very high-need and very vulnerable cohort. On top of that, it’s not easy to recruit to a post like this. The Brandon Centre managed to recruit a brilliant and very experienced therapist but she could choose to find another job that provides more security.

The ideal scenario would be to have recurrent funding – and potentially to expand the service. Marta said:

While we welcome any grant funding, it is always limited. A lot of effort goes into setting up the processes, systems and referral pathways. Grant funding is often just for one year – by the time you have recruited and got things going, the funding ends.