Care Leavers

What is a care leaver?

Care leavers are young people aged 18 to 25 years of age who have been in local authority care (foster care or residential home or semi-independent flat).

They may have additional health needs and the impact of their social circumstances may exacerbate these health issues. They may have problems with risk taking behavior, criminal activity and poor educational attainment.  There may be no significant care figure or responsible adult in their lives.

Care Leavers are defined in law by the amount of time spent in care and their age.

Why are we telling you this?

Children often enter the care system with a poorer level of physical and mental health than their peers and their long-term outcomes often remain worse.

Prior to birth children in care (CIC) are more likely to be exposed to poor maternal health, domestic abuse, cigarette smoking, alcohol, and recreational drugs. Some of these substances will have immediate effects such as neonatal withdrawal, or will lead to neurodevelopmental/learning consequences which may become apparent in middle childhood or beyond.

At birth CIC are at higher risk of inheriting blood borne infections due to parental lifestyles. CIC are more likely to have some form of disability.

Their care may have been compromised due to poverty and parental chaotic lifestyles and once in the care system, unfortunately, may be affected by frequent placement moves.

CIC are more likely to have unhealthy lifestyles including smoking, alcohol and other substance misuse. A high proportion of CIC become teenage parents.

One third of CIC are thought to have a mental health disorder, three times that of the general population. Some young people develop mental illness whilst in care, such as schizophrenia and bipolar disorder, but the most common mental health difficulties for CIC are attachment difficulties and disorders, anxiety and fears, depression and conduct problems.

Previous experiences, including trauma and abuse, can increase the risk of post-traumatic stress disorder, self-harming behaviours, and attempted suicide.

Care leavers are at risk of making poor decisions, not only because they are deprived of the traditional family support but because their cognitive and emotional development has often been impaired by trauma, abuse and neglect. This may impact on their ability to seek assistance for other problems.

It is, therefore, not surprising that care leavers often have health outcomes, both physically and emotionally, that are poorer than their peers.

Issues some care leavers may face

  • emotional and mental health needs
  • physical health needs
  • substance use
  • poor financial circumstances/debt
  • poor and unstable housing
  • homelessness/sofa surfing
  • vulnerable to criminality
  • vulnerable to exploitation.

Who supports care leavers?

In relation to general health post 18 years old these young people receive the same health support as any other young person of this age e.g. support services and ED but no extra health support from the specialist children in care teams or social care. 

Their GP may be the only health provider.

The local authority via the leaving care team offers support to all care leavers that entered care whilst living in Nottinghamshire until their twenty-fifth birthday. This support is optional. A young person does not have to access it.

What can you do?

  1. If you have contact with a care leaver, consider any additional support they may need.
  2. Ensure they have the opportunity to participate in decisions affecting them as appropriate to their age and ability.
  3. Ensure timely access to any consultations and longer appointment times.
  4. Consider the implications of non-attendance at health or other appointments.
  5. Consider your safeguarding responsibilities and liaise with relevant health and local authority professionals if required.


Department of health. (2015a). Promoting the health and well-being of looked after children. Statutory guidance for local authorities, clinical commissioning groups and NHS England. Retrieved from

Evans, J. (2013). Care Leavers and the new offender management system. British Journal of Community Justice, 11(2 – 3), 195-198.

Malvaso, Delfabbro, Hackett & Mills. (2016). Service approaches to young people with complex needs leaving out-of-home care. Child Care in Practice, 22(2), 128 – 147. Retrieved from on 18/08/17

Local Government Association. (2016b). Integrated Personal Commissioning. Emerging Framework. Retrieved from

Smith, N. (2017). Neglected Minds.  A report on mental health support for young people leaving care. Retrieved from

Prison Reform Trust, 2016

Fitzpatrick & Williams, 2017

Munro, Lushley, National Care Advisory, Maskell-Graham, Ward, & Holmes, 2010).

15 November 2018:15:17