Historic forced adoption - scoping study: service delivery paper

5. Emotional and psychological support

Introduction

This chapter focuses on emotional support, advice and guidance, peer support and creative and complementary therapies.

Emotional support, advice and guidance

Participants called for more talking therapies (including counselling and psychotherapy) to help people deal with the emotional, psychological and mental health impact of historic forced adoption. As noted in Chapter 2, these therapies comprise specialist, intensive treatment delivered by a counsellor, therapist, psychiatrist or psychologist registered with a professional counselling representative body such as COSCA (Counselling and Psychotherapy in Scotland), the British Association for Counselling and Psychotherapy (BACP) or the British Psychological Society.

In addition, participants were clear that advice and guidance delivered by skilled practitioners such as social workers, is also important. This includes support 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.

Should a new specialist service be established, or existing services enhanced?

The research team suggests there could be scope to establish a new service specialising in providing mental health support for people affected by historic forced adoption. Alternatively, existing services could be up-skilled to support people affected by historic forced adoption.

The preference among research participants was for existing services to be up-skilled to deliver support sensitively and effectively. This finding aligns with literature from Australia, where Higgins and colleagues suggest building capacity among existing services rather than developing new services to better ensure sustainability and improve referral pathways^[xx].

To achieve this, an extensive training and awareness-raising programme would be required to ensure professionals have the skills and knowledge to:

• Work with people in a sensitive and empathetic manner.
• Understand the impact of historic forced adoption.
• Be able to support people affected sensitively and effectively.
• Refer or signpost individuals to other services for further support, including counselling services and help with search, reunion and accessing adoption records.

Many professionals could benefit from such training, including GPs, psychiatrists, psychologists, psychotherapists and other mental health professionals.

Other professionals, such as social workers, are also likely to have contact with people affected by historic forced adoption and may benefit from training. While these professionals do not deliver mental health treatments, they must be able to engage with people affected sensitively and to refer or signpost them to further support with search and reunion or mental health services. Birthlink and Barnardo’s deliver training and awareness raising to local authorities, so could potentially help with this process.

The costs of delivering such a training programme could be extensive and must be planned carefully.

Enlisting assistance from professional groups and representative bodies to encourage participation in training among professionals could be beneficial. Key organisations could include, for example, the British Medical Association, the Nursing and Midwifery Council, Social Work Scotland, British Association for Counselling and Psychotherapy and the British Psychological Society. Working with these organisations to promote the inclusion of topics around historic forced adoption in pre-registration and continuing professional development training requirements for these professionals could help encourage uptake and reduce costs, if it negated the need to introduce a brand new course.

A challenge here, however, will be advocating this as a priority issue alongside the many other topics already mandatory in professional training and learning.

Another suggestion could be to establish a directory of therapists and counsellors with training and expertise in historic forced adoption. In Australia, the Victorian Adoption Network for Information and Self-help (VANISH) set up a register of forced adoption informed counsellors, who were required to be ‘trauma-informed’ or have completed VANISH’s two-day training course^[xxi].

Peer support

The peer support service commissioned by the Scottish Government and recently launched by Health in Mind meets the criteria and considerations identified by research participants, including the following:

• The opportunity to take part in peer support groups or, for those who do not feel ready to take part in a group, one-to-one peer support with a trained Peer Development Worker.
• People can take part in online or in-person meetings.
• Involvement of volunteers, with lived experience of historic forced adoption and who have completed Health in Mind training, in facilitating groups. MAA Scotland has emphasised the importance of peer support being facilitated by people with lived experience^[xxii].
• Involving volunteers also helps to enhance cost-effectiveness and capacity.
• The chance to share experiences confidentially, listen to other people’s stories and provide empathy. Accounts of how individuals have moved forward and factors that help their wellbeing can also be discussed.
• Availability of groups for mothers, fathers, adoptees and other family members affected by historic forced adoption.
• Interviewees with experience of other formal peer support groups described the adverse effect that domineering members can have on groups. The service must address issues like this effectively.
• It will also be important to evaluate this service carefully. Monitoring outcomes for members will provide evidence of its effectiveness and identify any areas for potential improvement as they arise.

Creative and alternative therapies

A few research participants requested creative and alternative therapies such as art therapy, music therapy, drama therapy and hypnotherapy to be available for people affected by historic forced adoption.

There may be a need to conduct further research to identify services that offer this support, but 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 were aware of creative therapies delivered by post-adoption support services for children and young people, but none were aware of similar services for adoptees who are now adults. However, there could be potential for post-adoption support services to offer this type of support, although this is likely to require funding.

Options include providing services like these through NHS services, funding adoption support agencies or other appropriate organisations to deliver services for people affected by historic forced adoption, or providing financial assistance directly to individuals to pay for creative and alternative therapists of their choice.

Further research may be required to ascertain the demand for these services. Establishing the demand for these services may help inform decisions about whether to fund provision for this through NHS services or post-adoption support services, or to provide grants to individuals where appropriate to access services like this.