Some of the most vulnerable children and young people in care are deliberately self-harming to avoid being abandoned when they get better or turn 18 and face a “cliff edge” of no further support, according to research. Abi Booth, a psychotherapist who works with children and young people, said some were in a “catastrophic situation” in which they were hurting themselves to keep their place in therapeutic facilities. Booth said this group of young people believed the only way they could stay safe was not to “get better” from their mental health conditions and to become more ill by severely self-harming or attempting suicide.
A government review into the deaths of 112 care leavers in England aged 18-24 in 2025 identified a dramatic drop in support at the age of 18. The Guardian revealed in April that there had been an almost fivefold increase in children in unregulated social care settings in England. Booth said: “Society’s system around the most vulnerable people in the UK is failing them at every level … Of the hundreds of young people I have spoken to in the course of my work in recent years, every single one has told me that the system is pushing them into patterns of risk.
Some are so badly scarred from self-harming there isn’t an inch of their bodies left untouched. They see self-harming as a route to safety. They are living in a state of terror, which may be hidden underneath layers of bravado.” Booth said that while not all children and young people in the care system fitted this description, she feared the number was growing, as indicated by the proliferation of private care units.
There are 400,000 children in the social care system in England with nearly 84,000 looked after by local authorities. Booth said that paradoxically they saw self-harm as a route to safety because while they were undesirable to financially overstretched local authorities, they were a valuable commodity to private care companies. It was only by being high-risk that they could maintain their place in the care system.
Councils often outsource these complex cases to private companies that can charge £20,000 or more per week per young person. Booth, who has carried out in-depth research into 12 children, said that while in inpatient psychiatric units, these children and young people were “learning the tricks of the trade” in terms of more severe and sophisticated methods of self-harming and suicide attempts. They are more profitable the riskier they are,” Booth said.
She is calling for change to better protect this group of young people without leaving them as “commodities” for the profit-driven private care companies. A report from parliament’s joint committee on human rights has found that the accommodation model in children’s social care is broken. The report, published on Thursday, found that a lack of capacity has resulted in children being placed in expensive and wholly inadequate accommodation, often far from support networks.
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