The girl sat on the stairs for two hours talking - but insisted on keeping the banister between them.
“That’s how she felt safe,” says Eileen, a foster carer and children’s psychiatric nurse. “So, for me it’s about being ready when they are ready.”
Moments like this are familiar to many foster carers. Young people in care often carry complex emotional experiences, and many carers find themselves supporting children through anxiety, low self-esteem and self-harm long before specialist help becomes available.
Our State of the Nation survey found that two in five carers are looking after a young person who needs mental health support but isn’t receiving it.
In conversations with foster carer and children’s psychiatric nurse Eileen, Stevie Goulding from the mental health charity YoungMinds, and Dr Eva Sprecher from the UCL Child Trauma and Recovery Group, we discussed the realities carers face - and the approaches that can help young people feel safer and better supported.
“At home, you don’t have a consultant on call”
Eileen
Foster carer and children’s psychiatric nurse
“People assume that because I work on a psychiatric ward, it helps me when I’m fostering - but it doesn’t,” explains Eileen. “On the ward I’ve got a consultant on call and support the same day. At home, none of that is available. It’s completely different.”
At home, she relies on building trust - often in the quiet, unscripted moments.
“A lot of the time young people won’t want to talk to you face to face,” she says. “They’re more likely to open up in the car, for example. One moment they can be talking about football; the next, something far more personal. It’s because it’s safe - because they don’t have to give you eye contact.”
Evenings can be another time when worries surface.
“It can look like they’re trying to extend bedtime,” she says, “but often they need to tell you what’s on their mind before they’re left alone with their thoughts.”
“Sometimes they haven’t labelled what they’re feeling. They might be frightened, but they need you to label that for them because they’re not quite sure what it is they’re experiencing. It’s asking them: Do you think it might be this? Do you think this is what you might be feeling?”
Naming the unspoken
Sometimes carers need to lead difficult conversations.
“If a child is really struggling and services aren’t responding, sometimes you have to ask: Have you thought about harming yourself? It’s not an easy question, but it’s the only way you will really understand how they’re feeling.”
One young man told her he had a suicide plan but would not act on it while she was caring for him. That honesty meant she could act quickly. Once professionals knew he had a plan, CAMHS saw him within a week.
When support is rejected
Eileen also describes supporting a girl whose anxiety caused severe physical symptoms, even though she insisted she didn’t have a mental health issue.
Rather than push counselling, Eileen reframed the conversation. She asked whether the young person would like to talk to someone who could explain why her body felt so unwell. The girl agreed - and only later realised she had been receiving counselling all along.
“By then,” Eileen says, “it had helped.”
Communication: saying something imperfect is better than saying nothing
Stevie Goulding
YoungMinds
Much of what Eileen describes mirrors what Stevie hears from parents and carers across the country.
“Carers often hold back because they’re afraid of saying the wrong thing,” Stevie says. “But saying something imperfect is better than saying nothing. And if it doesn’t go to plan, you can role model what it looks like to make mistakes, reflect and try again.”
Instead of waiting for “the big conversation,” she encourages carers to weave lighter check-ins into everyday life.
Storylines on Netflix, a TikTok creator they follow, or something happening in a game they enjoy can offer a gentle opening. Asking questions like why a character behaved a certain way or what they would do in a similar situation can help young people explore feelings without pressure.
Not all communication needs to be spoken.
A young person might feel safer sending a WhatsApp message than talking face to face. Drawing might come more easily than words. A note under the door can say what they can’t say out loud.
Even emojis can help. Some carers co-create simple emoji codes with young people for moments when they need space, reassurance, a hug or a conversation.
“All of this,” Stevie says, “is good communication.”
When anxiety shows up
Many young people need specialist mental health support, but anxiety is extremely common in day-to-day life - and carers can help young people manage it in the moment.
“These techniques aren’t replacements for therapy,” Stevie says, “but they can help a young person steady themselves when they’re overwhelmed.”
One approach she often teaches is five-finger breathing - tracing up each finger while inhaling and down while exhaling. Because it’s discreet, young people can use it in school or public settings.
Another grounding technique sometimes called five-four-three-two-one encourages young people to name things they can see, hear, touch, smell and taste. This can help reconnect the mind with the body and bring them back into the present.
Why carers’ insight matters
Dr Eva Sprecher
UCL Child Trauma and Recovery Group
Research is increasingly backing up what many foster carers already know from experience.
Current screening approaches that local authorities use (e.g., only using the carer-completed Strengths and Difficulties Questionnaire) can miss significant numbers of young people experiencing serious difficulties. Some children with PTSD are not identified until much later, and many with significant anxiety or depression are also missed.
“Carers often tell us they were worried long before anyone picked it up,” Eva explains. “Their insight is essential because they know the child best.”
Her team’s ReThink study, led by Professor Rachel Hiller and Professor Lisa Holmes, which followed more than 450 young people in care, highlights why early recognition matters.
When young people were assessed in early adolescence, many who had emerging mental health symptoms still reported reasonably good overall wellbeing – feeling life was pretty good. By late adolescence - around 16 or 17 - that gap had closed. Most young people at 16 or 17 with mental health symptoms felt like life was not going well for them. Difficulties that once sat alongside stable wellbeing had become more entrenched and were affecting multiple areas of life.
Eva describes this as a window of opportunity.
“It’s never too early,” she says. “If we’re worried about young people’s mental health, we want to start those processes. Difficulties won’t go away by themselves, and by late adolescence we often reach a crisis point where many areas of a young person’s life are affected.”
Advocating for support
Eileen believes foster carers’ expertise must be recognised.
“It’s really hard sometimes because other professionals don’t always see us as professionals - but we are. We live with that child 24 hours a day. We see everything. The social worker might have known them longer, but we know them best because they live with us.”
Because of that, she says carers must keep raising concerns - even when the process is exhausting.
“You have to keep repeating yourself. Keep going back to the GP, the hospital, CAMHS, the social worker. Keep everyone in the loop.”
Crucially, she adds, carers should not carry the responsibility alone.
“Keep handing things back to the people responsible. Say: This is what’s happening. We’re not coping. What support can you give us? Eventually they will listen. They have to.”
If a situation feels like it could escalate, she encourages carers to be clear.
“Tell them the worst-case scenario. They need to understand what’s at stake so they act.”
Sometimes the barrier is not access to a service but whether the young person feels able to talk to the person offering help.
“Sometimes it isn’t that they don’t get the service - it’s that they can’t relate to the person,” she says.
“Care-experienced young people come into contact with so many adults throughout their lives, all asking uncomfortable questions. As soon as you mention therapy, alarm bells can go off - especially if they’ve had a negative experience before. It’s a fine line between supporting them and unintentionally making them shut down.
Sometimes it’s about finding the person they can talk to. If that’s the foster carer, then other professionals need to listen to that - that the child can’t talk to you, but this is what they’re saying to me - and take it on board. Supporting the family to support the child often works better than trying to work with the child alone.”
Therapy: evidence, discomfort and continuity
Eva emphasises that therapy can feel uncomfortable before it starts to help, particularly when trauma is involved.
“It’s like medical treatment,” she explains. “It isn’t always pleasant, but sometimes you have to open the box of difficult memories in order to process them and move forward.”
“Remind them that they get to choose what they talk about. And when possible, attend appointments with them - even older teens or care leavers. Having trusted adults around can make a huge difference.”
Carers should also feel confident asking questions about the treatment being offered, the evidence behind it, and how it aligns with NICE guidance - just as they would with physical health treatment.
And when young people move home, continuity matters.
“Moving should not mean losing a place on a waiting list” - a principle reflected in NICE guidance on mental health support for children in care.
Key takeaways for carers
• Be ready for the quiet, everyday moments when young people choose to talk.
• Help them find the words - naming feelings can make big emotions easier to manage.
• Ask directly about safety if you are worried.
• Let communication happen in the ways young people prefer, whether that’s WhatsApp, drawings, notes or emojis.
• Simple grounding techniques can help young people manage anxiety in the moment.
• Your insight matters - you know the child best because you live with them.
• You are not expected to hold everything alone. Involve professionals and ask for the support you need.
Ongoing support
We regularly bring together foster carers, practitioners and researchers to explore topics important to foster carers and children in care. You can find information about our upcoming webinars on our website at: Training and Events Calendar | The Fostering Network
For more information about how to access support for children and young people, the following organisations provide further advice, guidance and information:
• YoungMinds
• Mind
• Childline (CAMHS information)
