The number of children in care has steadily increased over the past decade, reaching almost 85,000 in England and Wales at the start of 2019. But what are the longer term consequences of a childhood in care? In a first-of-its kind research project looking at more than 350,000 people who had spent some or all of their childhood in care, Amanda Sacker and colleagues at the ESRC International Centre for Lifecourse Studies at UCL find their health prospects are shockingly bleak. The research suggests that thousands may have died prematurely and that thousands more face later life suffering poor health. They say the findings have strong implications for policy and that much more must be done to close the inequality gap between those who spend time in care and those who do not.
The European Convention on Human Rights 1998 and UK’s Children Act 1989 underpin the legal framework that when children need to be placed in care, priority be given to non-residential care, in particular the child’s extended relatives and friends. But how much evidence do we have that this is a good policy that could improve the life chances of those children?
In our first piece of research, we looked at more than 350,000 people in the ONS Longitudinal Study (based on the Census) to see if they had been in care at any point between 1971 and 2001 and then tracked up to the end of 2013 to see whether and if and how, they had died.
We found that adults who spent time as children in care were 70 percent more likely to die prematurely than those who did not, with the majority of deaths put down to unnatural causes such as self-harm, accidents or in some way related to mental illness.
What was particularly surprising was how much worse the issue became as time passed. For children in care in 1971, the risk of dying prematurely compared with those who were not in care was around 40 percent. This figure increased to a staggering 360 percent when comparing children in 2001. There was no difference in this figure for men and women, something else that we found surprising, as we had thought men might fare worse.
While the wider population’s risk of dying early declined considerably, the risk for children in care increased, making the difference between those in care and not even more troubling. The increase in the mortality rate could be partly explained by difficulties faced by former care children entering the labour market after the 2008 crash, something likely to prompt further concern when evaluating the current coronavirus-induced downturn.
Health and different care settings
We turned our attention next to the health of children who had been in care over the same period as for our earlier work. This time we looked at their health up to 30 years later. We also dug a little deeper to see if we could establish any differences between care settings. In other words, did they fare better or worse if they were in residential care compared with living in foster care or with relatives?
Those people who had been in residential care were between 3 and 4 times more likely than those who had lived with parents to report their health as ‘not good’ compared with ‘good’. For people who had lived with relatives, the risk was considerably lower (between 1.3-2 times).
The results from this project are very much in line with others that show that young people moving out of residential care have not overcome their ‘bad start’. The figures are really quite shocking and indicate that while the majority of us are living longer, healthier lives, this is far from the case for those who spent time as children in care. Rather, the inequalities have increased.
Overall, these are deeply worrying findings. Children in care are among the most vulnerable in our society and our research indicates that we are failing them. We must do more to understand why this is happening – a strong focus on mental health should certainly be a focus. If, as in some other parts of Europe, relative care is to become a more integral part of child welfare services, we need to encompass all relatives and the children in their care, including those with informal arrangements.
In addition, the existing guidelines for the handover from child to adult health services should be expanded to include support well beyond young adulthood.
- Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office of National Statistics Longitudinal Study is research published in BMC Public Health by Emily Murray, Rebecca Lacey, Barbara Maughan and Amanda Sacker
- Non-parental care in childhood and health up to 30 years later: ONS Longitudinal Study 1971-2011 is research published in the European Journal of Public Health by Emily Murray, Rebecca Lacey, Barbara Maughan and Amanda Sacker.