Young People in England's Care System Are Self-Harming to Avoid Being Cut Off at 18
Some of the most vulnerable children in England's care system are deliberately self-harming to avoid losing support when they turn 18 and hit what researchers call a "cliff edge" of no further help, according to research reported by The Guardian on August 27, 2026.
The research was carried out by Abi Booth, a psychotherapist who conducted in-depth study of 12 children in the care system. Booth found that these young people believed the only way to remain safe was not to "get better" from their mental health conditions, but to become more ill through severe self-harming or suicide attempts. The logic is grimly practical: if improvement leads to discharge (the formal end of treatment), and discharge means losing the only protective framework these young people have known, then getting worse becomes a survival strategy.
Booth also reported that while staying in inpatient psychiatric units (hospital-based mental health facilities), these children were "learning the tricks of the trade" — picking up more severe and sophisticated methods of self-harming and suicide attempts from peers. The implication is that the very settings designed to stabilise them may, in some cases, be functioning as environments where self-harming behaviours escalate.
The findings arrive against a backdrop of systemic failure that is now quantified. A government review into the deaths of 112 care leavers in England aged 18 to 24 in 2025 identified a dramatic drop in support at the age of 18. That review dovetails with a UK government-published study titled "You really are on your own," which examined the early deaths of young people who were in care and covered death, suicide, self-harm, and broader experiences of care-experienced young people. The title alone captures the policy vacuum Booth's research exposes from the other direction: young people who understand, often before they can articulate it, that the state's duty of care has an expiry date.
The scale of the system is substantial. There are 400,000 children in the social care system in England, with nearly 84,000 looked after by local authorities. Councils frequently outsource complex cases to private companies that can charge £20,000 or more per week per young person. The Guardian previously revealed in April that there had been an almost fivefold increase in children placed in unregulated social care settings in England — placements that lack official oversight. A report from parliament's joint committee on human rights found that the accommodation model in children's social care is broken and called on the government to end the use of unregulated spaces as a matter of urgency.
Research on self-harm among children in care, while fragmented across years and methodologies, consistently shows elevated rates. A Glasgow council study by Piggot et al. suggested that almost half the children in residential settings had deliberately self-harmed, as Iriss reported in 2013. A 2013 study by Harkess-Murphy et al. found that 24.5% of their sample of children in care had engaged in self-harm. A 2015 longitudinal study by J Gabrielli found that 21% of youth in care self-reported a desire for self-harm, with rates from both reporters decreasing over time. For the general adolescent population, a Reuters-reported study found that one in 12 young people, mostly girls, engaged in self-harming behaviours such as cutting, burning, or taking life-threatening risks. Iriss attributes the elevated risk among care-experienced children to adverse backgrounds and continuing stress.
A Nottinghamshire County Council document on supporting looked-after children with self-harming behaviour notes that very few young people who self-harm remain in foster care, suggesting a pipeline from foster placements into more restrictive, and more costly, institutional settings.
On the intervention side, the evidence base is evolving but incomplete. A 2020 review by KG Witt and colleagues found that group-based psychotherapy for children and adolescents who have self-harmed integrates techniques from CBT (cognitive behavioural therapy), DBT-A (dialectical behaviour therapy for adolescents), and MBT-A (mentalisation-based therapy for adolescents). A practitioner review published by ACAMH in May 2025 examined 18 randomised controlled trials focused on reducing suicide and self-harm in adolescents aged 12 to 18. The UK government's response to the Health and Social Care Committee report on children and young people's mental health, published in March 2022, includes a chapter focused on self-harm and suicide prevention.
The broader context here is that Booth's research exposes a perverse incentive structure at the heart of the transition architecture. If the only reliable pathway to continued state support is demonstrable deterioration, then the system is not merely failing to prevent harm; it is, in effect, rewarding it. The 112 deaths reviewed by the government in 2025 represent one outcome of that failure. Booth's 12 cases represent another: young people who survive, but only by making themselves sicker. The policy challenge is not simply about extending services past age 18, though that is the immediate pressure point. It is about constructing a transition framework in which improvement does not function as a trigger for abandonment. Until that structural issue is addressed, clinical interventions delivered in inpatient units or therapeutic settings will continue to operate against a current that the system itself has created.
