Historic forced adoption - scoping study: final report

5. The needs of people affected by historic forced adoption: emotional and psychological support

Introduction

Research participants emphasised the severe emotional and psychological impact of historic forced adoption, some referring to mental health conditions that they developed and attribute to their experience. This chapter summarises their needs for emotional, psychological and mental health support, discusses available services, and highlights gaps and areas for improvement.

Emotional and psychological impacts

Chapter 2 summarises the emotional and psychological impact of historic forced adoptions. For mothers, feelings of loss, guilt and shame have stayed with them throughout their lives. In some cases, their mental health has suffered with examples of anxiety, depression and complex post-traumatic stress disorder.

Adoptees described difficulties with their sense of identity and belonging, and being separated from their mother early in life can have a profound emotional and psychological impact. Adoptees also reported mental health conditions, including anxiety, depression and complex post-traumatic stress disorder.

As noted in Chapter 3, an individual’s attempts to find and reconnect with people they have been separated from by adoption can have profound emotional and psychological effects. These may be pronounced when the search process is long or complicated, the other person does not want to make contact, or establishing a relationship with the other person is difficult. Similarly, Chapter 4 discusses the emotional impact of accessing adoption records, another area where people may require emotional and psychological support.

Support needs

Research participants reported a pressing need to support people with experience of historic forced adoption with the mental health, emotional and psychological impacts of that lived experience. This was a dominant theme in the study and participants identified needs that focus on the following:

• Emotional support, advice and guidance
• Peer Support
• Creative & alternative therapies

Emotional support, advice and guidance

What support is needed?

Many mothers and adoptees identified a need for talking therapies such as counselling and psychotherapy to address the emotional and psychological impact of historic forced adoption. After years of secrecy, mothers want to talk about their experience, and adoptees would value professional support to deal with the emotional and psychological effect of adoption on them. Adoptees reported that adoption can have an emotional and psychological impact, regardless of whether it was forced. However, some adoptees felt sad about the impact of forced adoption on their mother.

“It would be nice to have some more counselling, a counsellor I could talk to really just to help me really with things when I'm struggling with everything.” – Mother

“I think just having somebody to pour it out to… I think just might take an awful weight off their mind… I think there should be more help for them. And even if it is just talking therapy, whatever.” – Stakeholder

“The Government needs to pay more for psychological support for adoptees.” – Adoptee

“I'd asked for help when I was struggling with trauma which I now realise was trauma. PTSD type stuff, [but] there was no specific support… I needed a space where I could more talk about the negative effects of how it's affecting me now, and how to live a life with the scars.” – Adoptee

Stakeholders identified a range of support that could help to address the emotional and psychological impact of historic forced adoption, including:

• advice and guidance on the emotional impact of historic forced adoption; and
• intensive mental health treatments (such as talking therapies like counselling and psychotherapy) that deliver specialist treatment to support individuals with psychological or mental health issues. These services are delivered by counsellors, psychotherapists, psychiatrists or psychologists registered with a professional counselling body, such as COSCA (Counselling and Psychotherapy in Scotland), the British Association for Counselling and Psychotherapy (BACP) or the British Psychological Society.

People with lived experience and stakeholders felt that both advice and guidance, and counselling and other therapies delivered by registered counsellors or therapists are important for people affected by historic forced adoption. We explore this issue further in our separate service delivery paper.

“There are no dedicated counselling organisations. There are non-statutory organisations and some of the local authorities that offer advice and support. They do not offer... I would say dedicated counselling, that is professional counselling with a capital C.” – Stakeholder

“There are no counsellors or mental health services locally who specialise in adoption and we feel it is a very specialist subject.” – Stakeholder

“I would love to be able to have somebody that I can talk to and just empty my head, of all these years’ worth of pain… one to one, it wouldn't need to be, a psychologist, but somebody who is trained in some sort of listening, wellbeing type skills. I think it'd be really helpful.” – Adoptee

What support is available?

NHS Scotland offers psychologist and psychiatrist support. However, interviewees reported mixed experiences with this service. A few described it as effective, but others felt their psychologist or psychiatrist did not understand or appreciate the impact of historic forced adoption. Some talked about their feelings with their GP, however, GPs are also not always fully aware of the potential impact of historic forced adoption on individuals, and this can be a barrier to accessing the help required.

Long waiting times and difficulties scheduling appointments with NHS staff are also challenges with NHS services.

Some interviewees have accessed private psychologists, psychiatrists, counsellors and therapists. Individuals generally found these helpful, but the cost of such services was prohibitive for others. Some post-adoption support services said they had supported individuals to access counsellors in the past, but the cost means it is not always possible.

“Private therapy is expensive and not easy to access.” – Adoptee

“I did have a counsellor for a while but it was private and it cost a lot of money and I just couldn't keep up with it.” – Adoptee

Advice and guidance is delivered by post-adoption support services and local authorities. This includes support, delivered by skilled practitioners such as social workers, to help individuals prepare for and deal with the emotional nature of search and reunion activities and to address the psychological impact of historic forced adoption more widely, where appropriate.

These services do not include mental health treatment delivered by psychotherapists, psychiatrists or psychologists, although Scottish Adoption & Fostering’s Bluebird project includes a counsellor who is registered with BACP.

Interviewees who had accessed support from post-adoption support services and local authorities gave positive feedback, but some said they needed more intensive therapy or treatment.

How can the support be improved?

A common theme was the need for more counselling and therapy services for people affected by historic forced adoption. Nearly all (90%, 17) respondents to the local authority survey argued for more counselling services, and 74% (14) identified a need for more psychotherapy.

While some people affected by historic forced adoption reported positive experiences of counselling and therapy, the consensus was that psychiatrists, psychologists, counsellors and therapists need more awareness and understanding of the impact of historic forced adoption. Some of these professionals already have awareness and understanding, but it needs to be more widespread to ensure that people with experience of historic forced adoption receive appropriate counselling, therapy and treatment.

“Your average counsellor is not going to have that understanding and be able to piece those bits together, and have that impact.” – Stakeholder

“I've had counselling, a couple of times over the years… neither of them were obviously trained in dealing with someone with the emotions that an adopted person has.” – Adoptee

“[The psychologist] didn't understand, not at all. I mean the girl was nice… But she definitely didn't understand what I had went through and what I was going through or whatever, I just left it.” – Mother

Interviewees and survey respondents highlighted low awareness and understanding among many professional groups, not just counsellors and therapists. We discuss this issue in greater detail later in this chapter.

A few people favoured counselling and therapy services that specialise in supporting people affected by historic forced adoption, but the consensus was that further training and awareness-raising among services, in general, would improve the services available.

Another issue related to waiting times for NHS services, and some interviewees suggested more could be done to increase capacity. However, a few perceived that limited funding exists to support these services.

“The main point will be more funding and because there is not much help out there due to lack of funding and everything always comes down to money.” – Adoptee

Peer support

What support is needed?

Many mothers and adoptees described peer support as beneficial, saying it was helpful to discuss their emotions and experiences with other people affected by historic forced adoption. This was a recurring theme in the study. Peer support helps people to deal with the long-term impact of historic forced adoption and the emotional impact of search and reunion attempts. It also provides a vital source of moral support, advice, validation and acceptance.

“I need to talk to other women. That’s going to be one of the best therapies for me is going to be talking to other women.” – Mother

“Peer support is very important as well, because you feel that other people who have been through the experience, really do understand it, and there’s very few other people that will understand it.” – Mother

However, peer support is not suitable for everyone, particularly those who feel uncomfortable speaking or mixing with a group and require one-to-one approaches.

“For me, peer-to-peer support is definitely not helpful and I wouldn’t use it. I need highly specialised, individual help.” – Adoptee

“We have recently started a group for adult adoptees but had no response... the difficulty is that by the nature of adoption, there is often a tricky attachment pattern and so groups don’t always work for adopted people.” – Stakeholder

What support is available?

We found no evidence of any formal peer support groups in Scotland for parents, and only a few formal groups for adoptees. However, the Scottish Government commissioned Health in Mind to develop a peer support service, launched in September 2023.

Two local authority survey respondents (11%) said their organisation provides peer support services, but no people affected by historic forced adoption we spoke to reported having accessed these.

A few interviewees mentioned a peer support service previously run by an agency for parents, but this no longer exists. Barnardo’s and Adoption UK Scotland offer group work for adoptees but not currently parents with experience of historic forced adoption^[12], while Scottish Adoption & Fostering’s Bluebird project offers informal peer support and links to the organisation’s group work.

Many people with experience of historic forced adoption found informal groups and networks crucial. Mothers who met other mothers through MAA Scotland indicated that it was invaluable. Similarly, adoptees mentioned groups including SAAM and GAP Scotland. Research participants spoke positively about these groups’ value in providing emotional support and validating their experiences.

“It makes a difference, you know, when you’re speaking to [other mothers]. You know you’re not the only one. You can talk about it. I mean, for years and years you were ashamed of it.” – Mother

“I’ve met the adoptee group... There’s quite an active adoptee Twitter group, and I was picking things up on there. And just got to know people and in many ways, they are the best support because, some of them are trained counsellors as it happens, but because they’ve been through it, because they know exactly what we’re talking about.” – Adoptee

Some research participants mentioned engaging with peer support groups in other countries, for example, Origins Australia for mothers, and several online groups for adoptees.

What needs to be improved?

Peer support is important for mothers and adoptees. While many research participants described the value of informal networks, there is a need to formalise this to ensure that peer support services can help more people. Nearly four-fifths (15, 79%) of local authority survey respondents called for more peer support services.

There is optimism that the service being developed by Health in Mind will improve peer support availability. More detail about Health in Mind’s service is included in the service delivery paper that sits alongside this report.

Creative and alternative therapies

What support is needed?

A few research participants advocated for using creative and alternative therapies, including art therapy, music therapy, drama therapy and hypnotherapy, to help mothers and adoptees address the emotional and psychological impact of historic forced adoption. These interviewees explained that the impact of trauma can be hard to express in words, but creative and alternative therapies offer a different method for people to process their experiences and communicate their needs.

“I think [hypnotherapy] should be an option for mothers and their daughters and sons… I think, trauma like this, that hypnotherapy would work… for my mum especially, because it’s easy to bring stuff up to the subconscious and talk about it.” – Sibling of adoptee

What support is available?

Research participants were unaware of creative or alternative therapies specifically for people affected by historic forced adoption. However, a few described accessing effective support through private therapists.

Some people with experience of historic forced adoption were aware of creative therapies delivered by post-adoption support services as part of post-adoption support for children and young people, but none were aware of similar services for adoptees who are now adults.

What needs to be improved?

A few participants requested more availability of creative and alternative therapies.

“It’s that unconscious memory where stuff is stored. When there are triggers, something will happen and it triggers a dreadful emotional response… art therapy, music therapy and drama would actually help the likes of us as well as children but it’s not available anywhere.” – Adoptee

Other considerations and challenges

Professional awareness and training

Some participants reported receiving effective support from NHS and private counsellors and therapists who understood the impact of historic forced adoption.

However, a prevalent theme in study was that health professionals, particularly in the NHS, need more familiarity with and understanding of historic forced adoption and its impact. Some interviewees recalled that their health professionals did not ask about any adoption experience during discussions about their mental health.

All local authority survey respondents felt awareness of the impact of historic forced adoption needs to improve among those providing support (100%, 19). Nearly all (95%, 18) agreed that services must be more relevant and specific to people affected by historic forced adoption.

When health professionals were aware of the individual’s experience of adoption, it was not always taken into account when diagnosing the person’s condition, and we heard a few examples where individuals believed they were misdiagnosed due to their health professionals’ lack of awareness of historic forced adoption. One, for instance, described years of difficulties, misdiagnoses and inappropriate medication until she chanced upon a GP who happened to know about adoption trauma, recognised the cause of her challenges, and arranged effective support for her.

“[That GP] saved my life.” – Adoptee

We found no awareness among interviewees of any training materials or guidelines for GPs or mental health professionals in our fieldwork. Interviewees identified this as a critical gap.

Health professionals have many demands on their time, but many interviewees urged more action to raise awareness among GPs and mental health professionals to help them effectively support people affected by historic forced adoption.

“Adoptees and some people, they’ll go to the doctor’s diagnosed with depression or anxiety, they’re handed pills. And when really there could be other routes, different to medication, [there’s something] deeper lying within the mind, but understand the doctor’s point of view, they’re strained and when you get someone who’s in a big distress, it’s very difficult to navigate what service they need.” – Adoptee

“I do feel that awareness needs to be raised among GPs and mental health professionals about the impacts of historical adoption… to get an awareness that this person who’s been suffering most of their life, what might have caused that and, and to get appropriate help.” – Mother

Training is available for social workers and local authorities from Birthlink and Barnardo’s, for example, with information about search and reunion processes, the needs of people with experience of historic forced adoption, and the support services available. Birthlink also operates a telephone support line for post-adoption practice queries. However, medical professionals will likely require more in-depth training covering the clinical impact of historic forced adoption.

Support for wider family

Many interviewees conveyed the need to support everyone affected by historic forced adoption. This includes mothers, adoptees and adoptive families, but also fathers and wider families, mothers’ subsequent children, adoptees’ siblings and adoptees’ children.

Funding to access private support

The cost of private services was a common barrier for many. Suggestions to address this included providing financial assistance to people affected by historic forced adoption to help them access support privately. Again, however, participants acknowledged this could strain central and local government funding.

“In-person specialised psychological therapy that is available as long as needed. This should be provided free.” – Adoptee

“I think the NHS should be doing it… like getting stuff paid for them to help them... We’ve had the apology but I just feel these women have suffered in silence for so long. They should be compensated in some way.” – Sibling of adoptee

Support from family and friends

Support from family members and friends has been crucial for many mothers and adoptees. In many cases, where they have been unable to access effective professional assistance, this has been a person’s only way to process the impact of historic forced adoption.

“If I hadn't the family I've got, I don't think I would have survived, I don't think I would have got over it, but my family has helped me an awful lot.” – Mother

Chapter summary

Experiences of historic forced adoption have had a severe emotional and psychological impact on the people involved, leading to mental health conditions for many. A prevalent request among research participants was for more counselling, psychotherapy, psychiatrist and psychologist support. While some have accessed adequate support from medical professionals, many reported a need to enhance GPs and mental health professionals’ awareness of the impact of historic forced adoption, to ensure they can deliver effective support.

Peer support was also identified as crucial. Informal networks have been supportive, and Health in Mind has recently launched a more formal historic forced adoption peer support service commissioned by the Scottish Government.

A few others requested creative and alternative therapies such as music, art, drama or hypnotherapy.