Transcript Health briefing pack

Mental health of children and young people in
the youth justice system
Derbyshire Mental Health Summit
Wednesday 25th June 2014
‘Lifestyles and habits established during childhood, adolescence and young
adulthood influence a person’s health throughout their life.’
(Healthy Child Programme, DH 2009)
Half of life time mental illness starts by 14 yrs of age.
More than 50% of 15-16 yr olds had consumed more than 5 alcoholic drinks in the
past month.
More than 8 out of 10 adults who have ever smoked regularly start before 19 yrs of
age.
8 out of 10 obese teenagers go on to be obese adults.
(Children and Young People Health Outcomes Forum, 2012)
‘Children face a stepping-stone pattern of risk, where risks during infancy increase
the chances of antisocial behaviour during childhood, which in turn amplify the
likelihood of convictions during adolescence’. (CMO Report, 2013)
…early identification and intervention is key to prevent
behaviours becoming entrenched
Mental health in the youth justice system
Young people in the youth justice system have three times the prevalence of
mental health needs compared to the general population.
YJB research (2005), involving 300 young people from six YOTs and six custodial
units, found that 31% had mental health needs, which included:
• 18% having problems with depression
• 10% suffering from anxiety
• 9% reporting a history of self-harm within the last month
• 9% suffering from post-traumatic stress disorder
• 7% having problems with hyperactivity
• 5% reporting psychotic-like symptoms
• 25% identified as having learning difficulties
Rates of suicide in boys aged 15–17 in custody in England and Wales may be as
much as 18 times higher than the rate of suicide in boys aged 15–17 in the
general population
On entering custody…
Snapshot data provided by Youth Offending Teams to the YJB at the time
of placement (03 August 2012) reveals: This is a on.
•Previous history of self-harm - 33%
•Non-Acute mental health or psychological condition - 43%
•Acute mental health or psychological condition - 6%
•Substance misuse which is cause for concern - 52%
•Detox for drug addiction - 5%
•Non-Serious medical or health complaint - 36%
•Taking any medication - 24%
•Serious medical or health complaint - 4%
The health and well-being needs of children and young people tend to be
particularly severe by the time they are at risk of receiving a community
sentence and even more so when they receive a custodial sentence (1)
We know from the latest available evidence about children and young people in the
YJS that:
Over 75%
• have a history of temporary or permanent school exclusion (custody)
• have serious difficulties with literacy and numeracy (custody)
Over 50%
• have difficulties with speech, language and communication (custody)
• have problems with peer and family relationships (community and custody)
• of young people who commit an offence have been a victim of crime – twice the rate for
non-offenders
Over 33%
• have a diagnosed mental health disorder (custody)
• of those accessing substance misuse services are from the YJS (community and
custody)
• have been looked after (custody)
• have experienced homelessness (custody)
The health and well-being needs of children and young people tend to be
particularly severe by the time they are at risk of receiving a community
sentence and even more so when they receive a custodial sentence (2)
Over 25%
• of young men in custody (and a third of young women) report a long-standing
physical complaint
• have a learning disability (community and custody)
A high proportion
• of children from black and minority ethnic (BME) groups, compared with others,
have post-traumatic stress disorder (community and custody)
• have experienced bereavement and loss through death and family breakdown
(community and custody)
Parental Offending
• approximately 200,000 children had a parent in prison at some point in 2009
• with 90,000 at any one point
a ‘thicker soup’ - clustering of vulnerabilities and complexity
Examples of risk factors in childhood associated with
offending and other adverse outcomes
…the costs of failing to respond are high: the lifetime costs of crime amount
to around £1.5 million for each prolific offender.
Why invest in youth justice?
NHS England /
Health and Wellbeing
Boards / CCGs
/PCCs
Shared
outcomes
Public Health Outcomes Framework
• Violent crime (including sexual violence)
• First-time entrants to the youth justice
system
• Re-offending
• Statutory homelessness
• Hospital admission as a result of self-harm
• Successful completion of drug treatment
• Alcohol related admissions to hospital
NHS Outcomes Framework
•Potential Years of Life Lost (PYLL) from
causes amenable to healthcare for children
and young people
Youth Justice
Services
Children and Young People's Health
Benchmarking Tool
• Followed recommendations of CYP
Outcomes Forum Report 2012
• Developed by Chimat
• Indicators from PH OF and NHS OF
most relevant to the health and
wellbeing of CYP in an easily accessible
way to support local decision making
• Includes First-time entrants to the
youth justice system
As well as key triggers for offending inc:
• School attainment, truancy and NEETs
• Smoking
• Teenage conceptions
• Poverty
If interventions to address a young person’s needs and vulnerabilities are
delivered at an early stage, the potential benefit could be very significant.
The Case of James (Audit Commission (2004) : A review of the Reformed Youth
Justice System) illustrates the financial cost of not intervening to support speech,
language and other educational and social needs at an early age.
Actual interventions and costs were estimated at £153,687 (including 2 custodial
terms in secure units before the age of 16).
The cost of providing speech and language support and an educational
psychologist from the age of five to 15 was £42,243.
Assuming that the “crime route” was avoided, a saving of £111,444 in criminal
justice costs is made through early diagnosis of learning difficulties and
intervention to address them.
The scale of the sums involved suggest that services would need only to divert a
small number of young people into appropriate services and away from a “criminal
career” in order to be cost effective.
Pre and Post
Court
Onset Youth Justice
Prevention
Resettlement
Enforcement and
Custody
Support
Asset
Targeted Youth Support
CAF
Universal Services
Young Person’s Life Journey
Prevention
Punishment
Seriousness and
Repeated offending
Early identification of risk
Specialist Service: Youth Justice Services
CHAT and Assetplus
Comprehensive Health Assessment Tool (CHAT)
• Developed by YJB and Dept. of Health
• Evidence based tool specifically for under 18s in the YJS
• Both community and custody versions
• Covers Physical health, mental health, substance misuse,
neurodisability and TBI
• CHAT will ease and improve the collection and aggregation of
information about health needs in the YJS
• Critical that care pathways are established to refer into for specialist
assessment and intervention / treatment
Assetplus
• Mandatory youth justice assessment
• Screening questions in Assetplus link to CHAT
Considerations for commissioners
To counter risks, it is important to take a life course approach and to
strengthen the protective factors in children themselves and their
surrounding environment. Many opportunities exist to change the trajectories of
children’s lives.
Earlier intervention and closer links with an array of local health and social
services and smarter commissioning are necessary to ensure that service
models and funding streams better match the pronounced needs of these
young people.
Better access to continuity of care through the offender journey, and integrated
delivery of services, can help reduce offending and re-offending, benefiting the
health and wellbeing of the wider local community.
Young people with mild-to-moderate needs may not meet the threshold for support
from specialist services. Therefore, effective ‘lower tier’ interventions need to
be able to be delivered by non-specialist services (but with support available via
training and consultancy from local networks of specialist practitioners).
Essential to ensure key transition points are bridged to avoid gaps (‘the cliff
edge’), especially youth to adult transitions and resettlement from custody
Engaging voluntary sector services offering wraparound support can provide
important support to help young people make progress towards healthy adult lives,
but these must be evidence based.
For those who have not benefitted from early intervention, YOTs
offer an opportunity to turn around the lives of children with multiple
and complex needs.
Priority should be placed on developing and resourcing more robust pathways to a
range of engaging specialist services.
Children and young people in the YJS often have poor records of engaging with
largely clinic-based community health services. Traditional service models are
not designed to meet their multiplicity of need; nor are funding streams
which create gaps during critical transition points during the teenage years.
Youth justice agencies and professionals often have detailed insight into the
individual health and social care needs of people in contact with the YJS.
Utilise the knowledge that youth justice agencies have of evidence-based
interventions that produce the most effective and cost-effective health and
wellbeing outcomes at the local population level.
Consider that youth justice services have highly trained and experienced
staff actively involved in a wide range of physical and mental health, substance
misuse and social care work.
Build on relationships that already exist at a local level between health and
youth justice services, including shared membership of Community Safety
Partnerships and of local criminal justice boards.
Thank you
Howard Jasper (Senior Development Adviser – Health)
[email protected]