Foster Carer’s Mental Health

• 
• Author:FosterWiki
• Published:January 2022
• Country:

Foster Carer’s Mental Health

A guide to foster carer’s mental health and wellbeing

Introduction to foster carer’s mental health and wellbeing

1 in 4 people in the UK will experience mental health issues each year according to the NHS* Foster carers are no different, and are, by nature of what they do, exposed to more risk factors that contribute to mental health issues than many.

It is generally acknowledged amongst foster carers that their mental health needs are not recognised and often go untreated and unresolved.

There is some research into the impact of compassion fatigue on foster carers, however, this is only one of many contributing factors to the overall mental health of a foster carer.

Recognition, acknowledgement, and prevention are paramount, and we hope through this introduction to a foster carer’s mental health we can raise awareness and understanding of carers’ mental health issues and needs.

Mental health issues that can affect foster carers

Mental health issues refer to a very wide range of mental health conditions that affect mood, thinking and behaviour. Poor mental health can make can cause problems in all aspects of daily life.

Due to the challenging work foster carers do, it is essential to acknowledge their mental health needs.

Mental illnesses that are likely to affect carers are, but not exclusively, secondary stress disorder, compassion fatigue, burnout, depression and anxiety.

Secondary Traumatic Stress

Most foster carers will be affected by Secondary Traumatic Stress, many without even realising it. When a carer is in close contact or attuned to children and young people who have been traumatised, they are being exposed, often subconsciously, to the young person’s distress and trauma of past events. As a carer, this can feel exhausting and it is not uncommon for carers dealing with traumatised children to struggle with this, adding strain to their own mental health.

Compassion Fatigue

Compassion fatigue in a foster carer is a term that describes the emotional and psychological impact of caring for and helping children and young people who carry a lot of traumas themselves.

It can lead to a diminished ability to feel compassion for or feel empathy for the children and young people in their care.

Depression

Depression is a mood disorder; it causes a persistent feeling of sadness and loss of interest. It can affect how you feel, think, and behave and can lead to a variety of emotional and physical problems. Due to the clinical nature of depression, it is important to initially contact your GP for support.

Anxiety

Anxiety is a consistent feeling of unease, accompanied by worry or fear. Everyone will have feelings of anxiety as it is a normal and useful emotion, but anxiety that is holding you back is an issue, anxiety can be extremely severe and can be accompanied by panic attacks, an inability to keep or be still, insomnia and can lead to more emotional and physical problems if unaddressed, again discuss this with your GP.

What can affect foster carer’s mental health?

• Being exposed repeatedly to another’s subconscious trauma, disturbing stories and disclosures of traumatic events, including cruelty, abandonment, abuse, neglect, sexual abuse, substance abuse, domestic violence, trafficking and more.
• Foster carers may devote their lives to helping their children and young people and neglect themselves.
• Lack of sufficient respite or breaks.
• Coping with traumatised children and young people and their behaviours, both physical and emotional that they display as a result of trauma, including projection, manipulation, violence and more.
• Loss, Grief, Guilt.
• Allegations – both actual allegations and the fear of them in our daily lives.
• Lack of support.
• Breakdown of relationships due to fostering.
• Challenging relationships with your fostering provider or other professionals around you, including frustrations at not being included or respected in the team around the child or vulnerable person.
• Job insecurity.
• Technology and social media.

Guilt, Loss and Grief

As foster carers, we are often encouraged to be “parents” and build strong attachments with each child or young person we care for. We can often grow to love them as an integral part of our family. Foster carers often invest unconditionally, so when a child moves on we are often not allowed to see them again, so the loss is total, something we don’t just worry about for ourselves but for them too.

Often we are expected to deal with this alone, with foster carers being afraid to discuss or acknowledge the extent of their grief, as whilst we were once told to love them and invest all we are now afraid of being accused of being ‘too attached’ or ‘over emotional’.

Placements can end for many reasons, the care contract could be cancelled, fostered children may go home to parents, onto adoption, an allegation may have been made and the children removed, the child or vulnerable person may go into residential care, or onto independent living, the list is endless.

Carers may also end placements due to many reasons, such as severe and consistent behavioural issues, lack of support, unable to keep the young person safe through regular missing episodes, allegations, decisions by the care providers and more. This is never emotionally simple for the carer, and it can trigger feelings of loss, sadness, guilt, vulnerability, and shame.

Foster carers can also carry guilt in questioning whether they could have done a ‘better job’ or asking themselves, where did we go wrong? The carer may also feel the guilt and shame of feeling relieved that a child or vulnerable person has moved on.

The move may be sudden, you will often not know where the child or young person has gone, sometimes it may be several children and often you will be told not to contact them. This can exacerbate feelings of guilt, feelings that the child thinks you have abandoned them.

We may have guilt around our own birth children too, at difficult challenging times we seem to be spending all our time on our foster child and all that surrounds them in terms of services, professionals, meetings and more.

Another difficult emotional conundrum is bought about by the perpetuated fostering narrative that the minute a child arrives we love them. This is simply not possible, we are human beings, and we have inbuilt instincts and behaviours. While we may grow to love a child over time, and they grow to love us, it is a process, and it takes time.

Foster carers begin from a place of giving, loving and care, but sometimes they will not love a child in their care, that doesn’t mean they won’t care for them, but for whatever reason, at that time, they do not ‘love’ that child.

This can also produce feelings of guilt, anxiety, confusion and stress, and more importantly incongruence, an unpleasant and anxious feeling derived from our own expectations of ourselves that we ‘should’ love these children, plus the expectations of society and our fostering providers versus how we actually feel, and the two things not matching up.

Projection and transference

Projection and transference are complex psychological and psychotherapeutic terms; however, they are a very common occurrence in foster care. Simply put it means that a child or young person is unconsciously transferring their feelings about someone else onto you, the foster carer.

In foster care, it can mean that in the absence of the birth parents the child will ‘project’ their feelings of anger, loss, frustration, confusion, grief and more onto the foster carer.

What does that look like in real terms? It may feel to the foster carer that there is disproportional or unwarranted anger, resentment, rejection, and sadness towards them by the child when they feel like they have not done anything. However, it can still feel very personal at times when you have been overexposed to this projection and are exhausted, even when you do have a good understating of attachment and trauma.

Allegations

How many times have foster carers heard from other professionals around them that “allegations are just part of a foster carer’s life?”. However, this seeks to minimise the impact of allegations and the fear and anxiety they carry for foster carers.

The impact of allegations is not just when foster carers have an allegation made against them, foster carers often live and work with the fear and anxiety of allegations as a constant backdrop to their daily lives.

This fear can also result in hypervigilance and anxiety in their own homes and daily life. It can also result in frustration and anxiety when that feeling prevents us from advocating properly for our children, or when things go wrong.

Foster carers can also experience feelings of injustice and unfairness in their roles in comparison to their fellow care industry professionals, who undoubtedly have many allegations made against them but far fewer are investigated and when they are they have the full protection of their own professional bodies, unions, and employment rights.

Allegations themselves cause carers immense distress, trauma, and anxiety. Mental health issues arising out of a mixture of feelings around powerlessness, fear of being deregistered, losing children and livelihoods, injustice and not knowing what is happening.

Lack of support

Support across care providers varies hugely. The one thing that is imperative when caring for traumatised vulnerable children or young people is first-class support, when this is not in place, or it is substandard, it causes foster carers many issues.

Good fostering providers will deliver excellent support, but when this is not in place it is hugely stressful for carers, who are also left vulnerable by having to make day to day decisions and left to cope on their own, often in extremely challenging circumstances.

In working with care providers foster carers can sometimes find themselves working in a “blame culture”, with authorities and agencies protecting themselves at all costs. This too can cause us anxiety and stress. Good local authorities and agencies will operate in a climate of reflection, learning, accepting responsibility and working together. When your provider does not meet these criteria it can be very stressful and leave you feeling anxious and fearful.

Relationships

This area of your life is crucial for your mental and emotional health yet often gets neglected. Our partners or families are very often ‘just there’, putting time and attention into those relationships gets put off until we have ‘more time’. The difficulty is that carers often don’t get to that point, they do not get adequate respite from the caring role, and relationships suffer as a consequence.

Something else that gets overlooked and should never be underestimated is the impact that caring for a vulnerable child or adult can have on foster carer’s relationships. The stress and strain of a more challenging placement can cause an enormous impact at times on our relationships whether they be partners, birth children, immediate or extended family, or friends.

Challenging relationships can also extend to those we have with our fostering providers. When foster carers are not being treated as part of the team, this can also be hugely distressing and diminishing for the carer. This is a common issue and theme that foster carers talk about, feeling on the outside of the team, and despite being the person who nearly always knows the child best, not being listened to or taken seriously.

Another challenging area for foster carers’ mental health can be when social workers or managers exercise a power dynamic and create a power in-balance, the foster carer can feel anxious, which is not helpful or constructive and will affect teamwork, carers, their relationships and ultimately their mental health.

Burn out, lack of breaks/respite

Foster Carers also have the added pressure of the narrative created by society and providers (through advertising) that the sun is always shining in our foster families, and we shouldn’t need “respite” from our children, or if we do there is something fundamentally wrong with us and our ability to be carers.

Foster carers get inadequate breaks considering that they foster 24/7, 365 days a year many for years on end. Foster carers are often overworked and undersupported whilst caring for some of the most traumatised children in the UK.

Each individual setting is unique so there is no hard and fast rule. However, as a general rule, the need for respite is not recognised as it should be. Many carers are afraid to ask for respite for fear of their ability or dedication to caring being called into question.

The warning signs

There are a variety of symptoms that can alert a foster carer to mental health issues, this list is not exhaustive but an idea of some warning signs.

• Excessive fear, worry or anxiety.
• Tired all the time.
• Feeling hopeless or powerless.
• Thinking about giving up fostering.
• Long-lasting sadness or feeling overwhelmed.
• High and low moods.
• Socially withdrawing.
• Inability to sleep.
• Eating more, or less, than usual.
• Tearful.
• Panic attacks.
• Feeling guilty.
• Sore back/neck.
• Imposter syndrome – doubting your skills or talents.
• Fidgeting, unable to keep still or be still.
• Inability to feel empathy.
• Obsessing.
• Apathy.
• Constant frustration.

Spot the warning signs

Foster carers cannot separate their life from their work so there can be little work/life balance.

The expectations may feel huge and the pressure to present the ‘happy families’ narrative may be great. This is because it is what society expects and the narrative perpetuated around foster care. It is the narrative that is presented as ‘acceptable’ by people who do not and have not fostered themselves.

Foster carers feel huge pressure to present as ‘fine’ all the time as any other presentation makes them feel vulnerable to having their ability to do their job called into question.

Good fostering providers will understand and acknowledge the importance of their foster carer’s mental health, it safeguards and retains good carers and is important for the children in their care.

Fostering Providers

“Good fostering providers will welcome discussions on mental health as standard. They will recognise, just as they do with their wider social care staff, that a foster carer can be subjected to higher-than-normal mental health risk factors. They should inform their carers that this is acceptable and normal and provide good support.” [Sarah Anderson, founder FosterWiki]

Early intervention and mental health maintenance

It is important for fostering providers to recognise that the work undertaken by every foster carer exposes them to a higher number than average mental health risk factors on a daily basis. Foster carers should be provided with mental health support as part of the providers’ foster carer support package.

When mental health issues are ignored they can reach a crisis point, mental health maintenance is crucial to prevent foster carers from reaching this point as it will not only impact the foster carers’ health and well-being but affect placement stability, retention and can be a high determining factor in placement breakdowns.

Safe space

It is imperative that a safe space is provided for foster carers to discuss their mental health,
either by the provision of counsellors or if it’s with members of the agency with the proviso that the conversations are positive, proactive, non-judgemental and will not threaten their jobs.

The alternative is not that foster carers don’t have mental health issues, but admitting to them can make them feel vulnerable, fear looking weak, or be worried that their fitness to foster will be called into question. Foster carers will be reticent to go to their GP as they are aware this will all be reported to their fostering provider on their next medical report.

Fostering providers should make provisions to support foster carer’s everyday mental health and accept that the role of foster carer automatically exposes carers to increased stress on their mental health. Denying foster carers’ mental health can impact the carer, their families, and the children they care for, ignoring it does not mean it’s not there or goes away.

Counselling

If local authorities or agencies provide counselling for foster carers it must be
on the proviso that it is independent and completely confidential. If neither of these is in place foster carers will not feel confident enough to engage in the process. Specifically, if these professionals write reports or report back to the fostering team.

Appropriate help

The right help is crucial for foster carers. Much of the self-help and
standard recommendations from health care professionals surrounding mental health are focused on “self-care”, such as regular exercise, a healthy diet, sufficient sleep, activities such as yoga or meditation, taking time away from the stress-inducing situation, spending time with family or friends or focussing on a project or hobby.

Whilst these things are worth consideration and are useful, it must be acknowledged that very few foster carers can implement these recommendations. They rarely have time for practising hobbies or concentrating on themselves, and neither do they, by nature of their work, often have the capacity to take time away from stressful situations.

Holiday/respite/breaks

Having a break, holiday or leave should not be a luxury for foster
carers it should be mandatory. It is essential given the high mental health
risk factors foster carers are subject to, the intensity of their work and the fact that they work 24hrs a day 7 days a week, that they have adequate breaks.

Breaks are essential not only for the foster carers but also for the children they care for, for placement stability, permanence, and retention. When the mental health of a foster carer goes unaddressed it escalates to a crisis point when the placement has a high risk of breaking down.

Working in a team/support

Much of the feedback from our experts by experience whilst compiling this FosterWiki page was centred on the quality of teamwork and support from the wider professionals around the foster carer. The foster carer experts who felt supported, respected, and heard by the team around the child reported significantly fewer mental health issues. Those who had not felt supported or respected reflected that this had contributed to a less robust mental health and feelings of vulnerability and isolation.

Mental health discrimination

In recent years there have been a lot of discussions and legal rulings on the status of foster carers, however, the Equality Act 2010 states that most situations are covered if people are “working for someone else in work situations, even if they don’t have a written contract of employment” (fostering agreements have been recognised as contracts by the high court recently, however, you can see in this instance this not relevant).

It even covers people who are contract workers rather than a worker directly employed by an employer. Foster carers fall into this category as they are (at present) classed as a self-employed businesses of their own, and indeed are contracted to only one organisation.

Mental health discrimination or victimisation refers to circumstances in which someone is treated less favourably than others or put at a disadvantage because they suffer from mental health issues.

This can include feeling that their fostering registration is in jeopardy due to reporting a mental health issue.

We recognise that the needs of the children and young people are paramount however providers still must refrain from discriminating, victimising, or penalising foster carers for coming forward with either requests to support their mental health, or when mental health treatment is identified on medical reports and records.

It is also important to acknowledge that just like normal parents and other employees and workers, foster carers can continue to carry out their role despite mental health issues, in fact, thousands of foster carers around the UK are doing that right now. Reaching out for help with mental health issues, engaging in counselling or therapy, or being prescribed medication should be supported and encouraged.

What can foster carers do?

Be knowledgeable about mental health

Knowledge is power. Symptoms of compromised emotional and mental health can leave you feeling isolated, powerless, and feeling like it’s “just you”. Even worse we can berate ourselves for “not being stronger” or concentrate on the children whose problems are “far worse than ours”.

Understanding what you are going through will empower you to reach out for help and feel less isolated and more normal.

There are some great ways to get more knowledge about what you are feeling. You might order a book, listen to a podcast, or watch a video on YouTube, there are good resources out there of material on every type of mental health problem. See the links at the bottom of the page.

Talk about it

One of the most powerful and helpful, yet sometimes most difficult things to do, is to reach out for help and talk to someone. Finding the right place to do that as a foster carer can also be challenging.

This can be one person or a group. You can’t fully heal from things, whatever form it takes if you don’t let yourself express how you are feeling. That’s why it’s healthy to talk to someone about it.

This is traditionally a difficult thing for foster carers to do, as they must be very mindful regarding confidentiality. They may also be afraid of speaking to anyone for fear of being judged, or worse still lose their children and registration.

Holidays/breaks/respite

It is important to understand and respect that all fostering settings and families are completely unique, and their respite requirements will be as unique as they are.

However, holidays/breaks/respite is extremely important for carers. For all the reasons already highlighted rest and recuperation are vital for continued high standards of care and placement stability.

Exhausted, burnt-out carers will not be on their A-game. It is also unfair to people who spend 24/7 giving their all to care for the country’s most vulnerable children. Good fostering providers will recognise the importance of respite. It needs to be acknowledged that we look after other people’s children, often traumatised, have high needs and carry a huge responsibility. This includes our work with our fostering providers, birth families and other agencies around the child.

We also foster 24/7 and breaks are essential to prevent compassion fatigue, secondary stress, exhaustion, and burnout. It can often be difficult to get respite and carers often are too afraid to ask.

This time is also important for the other relationships in our lives, whether it be time to rekindle closeness with a loved one or dedicate some time to birth children, family, or friends.

If you are having difficulty getting respite and are fearful of asking, contact your union or support organisation who should intervene on your behalf.

Acknowledge and acceptance of feelings for foster children

Foster carers also often struggle with feelings around children, this is something that is rarely discussed. Instead, we are told and expected to unconditionally love our foster children from day one.

However, this is not actually always possible. That does not mean we do not care for our looked after children but loving them will (and should) take time and also it needs to be acknowledged that due to many and varied very complex factors beyond our control we may not always feel love for a child, and this is not something that can be forced.

As one carer put it.

However, many people in positions of power, both in government reviews and non-fostering personnel in local authorities and agencies seem to say and insist that every child needs to be loved by us and that it is somehow our ‘responsibility’ and role. Love is not something that can be forced out of responsibility, love is an innate human instinct, not something that you can be trained to do or do on demand. In the same way neither can we force it on a child.

It’s important for carers to acknowledge that the people, organisations, and reviews who make these declarations do not foster themselves and have no concept of the complex emotional nuances of fostering a child.

The complexities of these issues often affect our mental and emotional health and it’s important to acknowledge this and understand that this is ok, normal, acceptable and most carers feel the same.

The end of a placement, saying goodbye

It doesn’t matter how a placement ends there will be a reaction and impact on us and our emotions, those of loss, grief, guilt, anxiety, stress, confusion, frustration, relief, anger, depression and much more, all on a scale from low to high.

However, these feelings and emotions and their effect on us are totally normal and part of being a caring human being, it is not weakness. Loss is not easily processed but it is something all foster carers face at some point and there is a healing process that goes along with it. Feel your grief, process your loss, and release your guilt.

As a professional carer, you have done the very best you could for the child, but that will not stop the feelings of guilt. Take your time, in terms of grief, loss or guilt they have no expiration date. External agencies may expect us to be over it the next day. Others will think ‘it’s only a foster child’ and no one, except other foster carers, will truly understand how you feel or what you are going through.

Remember, you are allowed to grieve, getting through it and healing is an individual journey for everyone. Take your time, do what’s right for you, talk to other foster carers, being mindful of confidentiality, who have been through the same thing as you.

Job insecurity, feeling vulnerable

Many foster carers don’t realise when they embark on their fostering journeys just how insecure their jobs are. Many people give up secure employment to become foster carers and it becomes their main source of income. It is unrealistic in today’s socio-economic climate to think that people paid to be foster carers will not be adversely affected by suddenly losing their registration, and their ability to foster again.

Many who have given up other employment cannot suddenly step back into it. Just like any other person in the UK carers have mortgages/rent/bills/living to pay for and as we grow to realise how vulnerable we are, and how our income can be taken away within hours with no notice that can make us feel anxious and overwhelmed.

Foster carers are self-employed, but our registration is owned by the fostering provider we work for, this puts us in a unique, and vulnerable position, as although self-employed the people we work for have the ability to take away our registration and prevent us from fostering anywhere else.

We can lose our children and our fostering careers overnight through no fault of our own through allegations, even unproven, and this is often keeping carers in a climate of fear and insecurity.

We can often feel an underlying vulnerability in our fostering due to allegations. There is a disproportionate number of allegations against any other workforce, and we can feel unprotected and vulnerable.

We would recommend you have help and support in place, for instance, join the foster carers own government approved and certified trade union the National Union of Professional Foster Carers (NUPFC).

See the FosterWiki page on help and support so you can weigh up your options and decide what’s right for you, and remember to put support in place immediately, as often once it’s happened it’s too late (similar to car insurance).

What foster carers say

Links

• 1 in 4 adults suffer from mental illness https://www.england.nhs.uk/mental-health/
• Secondary trauma and compassion fatigue in foster carer, Beatrice Hannah, Matt Woolgar. Published May 31st, 2018. https://journals.sagepub.com/doi/full/10.1177/1359104518778327
• Compassion fatigue and foster carers. Dr Heather Ottaway and Professor Julie Selwyn School for Policy Studies, Hadley Centre for Adoption and Foster Care Studies https://www.bristol.ac.uk/media-library/sites/sps/documents/hadleydocs/compassion-fatigue-and-foster-carers-research-summary.pdf
• Equality Act 2010 https://www.legislation.gov.uk/ukpga/2010/15/contents
• Mind – Online mental health tools https://www.mind.org.uk/information-support/tips-for-everyday-living/online-mental-health/online-mental-health-tools/
• Mind – Mental health recourses for organisations https://www.mind.org.uk/workplace/mental-health-at-work/taking-care-of-your-staff/useful-resources/
• NHS – Every mind matters https://www.nhs.uk/every-mind-matters/
• NHS – Urgent support https://www.nhs.uk/every-mind-matters/urgent-support/
• Shout https://giveusashout.org/get-help/how-shout-works/
• Time to change https://www.time-to-change.org.uk/mental-health-stigma/tips-talking
• Rethink Mental Health https://www.rethink.org/aboutus/what-we-do/advice-and-information-service/get-help-now/
• Samaritans https://www.samaritans.org
• HubofHope https://hubofhope.co.uk