Barrow Cadbury Report2013

Same Old...
the experiences of young offenders

with mental health needs
Research by Sarah Campbell Senior Lecturer, and Stephen Abbott, Research

Fellow at The School of Health Sciences, City University London
In partnership with the Transition to Adulthood Alliance
Funded by The Barrow Cadbury Trust

Foreword Acknowledgements
I am pleased to welcome this report YoungMinds would like to thank all

and its addition to the evidence that those who contributed to this research
spotlights the lack of appropriate help and report.
for vulnerable young people in the 16-25
age group. The particular vulnerability In particular, the funders, Barrow Cadbury Trust,
of the 16-18 age group comes through and also:
very strongly. They experience so many The Transition to Adulthood Alliance
different transitions at the same time,
its not surprising that their situation Sarah Campbell, Professor Alan Simpson, Sally
Hardy and Dr Julie Rowe at City University London
worsens. I have personally worked with
this age group for over twenty years and Sarah Anderson, Revolving Doors
am saddened that we seem to do no Marcus Roberts, Drugscope
better now than then.
Jenny Talbot, Prison Reform Trust
This is a personal report, written from the Anna Saunders, Centre for Mental Health
perspective of young people involved in the All the T2A, CAMHS and AMHS staff and
youth offending system, their support workers commissioners.
and health clinicians. Although this may be a small
Lastly our sincere thanks to all the young people who
number of individuals, the stories they describe
gave their time to tell us about their experiences.
will be familiar to all of us with experience of
working with these young people. This report We will ensure your voices are heard.
succeeds where others have not, by providing the
detail of the individual stories and experiences, As Albert Einstein said;
the frustrations with the system that seems insanity is doing the same
to work against rather than for them, and the thing over and over again and
consequences for young people and their lives. expecting different results.
We must remember there is a huge cost to us
and society too. We continue to create situations
where services are forced to respond to crises
rather than prevent them developing, where we
pay for imprisonment or inpatient care rather than
help when times were tough. As Albert Einstein
said; insanity is doing the same thing over and
over again and expecting different results.
Its time we changed how we do things for
young adults.
Sarah Brennan
Chief Executive
YOUNGMINDS
2 Same Old... the experiences of young offenders with mental health needs YoungMinds 2013 3
Executive Summary & Recommendations
YoungMinds is delighted to publish the findings of the research into the provision of This report highlights five critical issues:
mental health services for young people and the relationship to offending behaviour in
order to contribute to this vital debate. 1. T
he need for consistency of relationships with 4. Who holds the ring? Young people reported
young people. It takes time for trust, mutual a chaotic mix of health care pathway
respect and empathy to develop and is the management with the young persons mental
However, we are not delighted about the findings of this research which are, as the name of our report core requirement for positive developmental health being the cost. Assertive health care
suggests, that very little has changed in the last 20 years. work to take place. pathway management is crucial for these
Despite the numerous reports, enquiries, policy documents, expert reference groups, working parties, young people whose life circumstances are
2. A
ll staff delivering services to this client group
consultations, white papers, Bills, Acts of Parliament and changes of government, we are still repeating the changing rapidly. If one individual or agency
need greater knowledge and skills regarding
same old story - that the provision of mental health services for young people at risk of or engaged with took the lead they could actively monitor the
the identification and awareness of mental
offending behaviour is woefully inadequate. clients care pathway, hold other services to
health issues.
account, ensure medical case reviews happen
This report sits aside from its many predecessors in that it cuts through all the policy and legislation and 3. Lack of any coordination or collaboration regularly, medication is actively monitored and
talks directly to those people who matter the most: the young people and the professionals that work between services. Young people reported how the young person actively engaged as well
alongside them. changing personnel and agencies, short term as improve coordination.
They told us that: treatments, unclear expectations and different
5. Easy access to accurate information for young
job roles undermined their progress. Improving
Waiting lists are too long resulting in young people self-medicating with drugs and alcohol people, families, advocates and services is
the coordination, access to and transitions
while they wait to access services thus exacerbating their mental ill health and offending essential. Confusion and uncertainty leading to
between services would have a significant
behaviour. a lack of confidence caused by not knowing
impact on young peoples experiences and
was consistently reported. Information about all
Rigid criteria for mental health services means young people have to be enduring a severe and care pathways.
services, referral processes and confidentiality
debilitating mental illness before they can access any type of help or support. must be available which explains simply what
can be expected and when.
There is still a gap in service provision between young peoples and adult mental health
services
meaning many young people are slipping through the net and lacking support at a vulnerable
time in their development.
If a young person manages to receive support, it is largely centred around medication. Following
prescription, young people are left lacking medication reviews, support or intervention.
In the rare occasions where intervention extends beyond medication, professionals have little
time for young people and a high turnover of staff means a lack of staff continuity making it
4%
difficult for the
young person to establish rapport or trust.
In other words, they told us the Same Old...

Alarmingly, the professionals we interviewed described a discriminatory service provision in some areas
where professionals saw the crime first and the young person and their mental health needs second. At the
95%
same time, professionals working with young people felt their problems could often be predicted meaning
young people could undoubtedly benefited from early identification services, had they been offered. only 4% of young people reported a good of imprisoned young offenders
transition from CAMHS to AMHS have a mental health disorder
Key Recommendations List of Contents
We are calling on politicians, local government, commissioners, CAMHS and AMHS, magistrates, GPs and
the childrens workforce to grasp the nettle, take on board our recommendations and work with young
people to ensure they get the mental health support and intervention they need. Young people deserve
1. Introduction 8
better and society deserves better. We should not be writing these young people off at the age of 20 with
a bleak outlook of becoming engulfed in a life of crime which will dictate their futures because they did not
receive the help, support and intervention they needed during adolescence.
2. Vulnerabilities of young people
We all have a duty to work with young people to ensure they have a brighter future where they are in the criminal justice system 9
contributing to society rather than rebelling against it and to ensure that we are not sat here in 20 years time
reading about the Same Old...
Key recommendations are: in their mental and physical health care. GPs are well
placed to fulfil this role as they are the only person
3. Methodology and ethics 14
1. Implement existing strategy
who sees whole families and whose services span all
As the title of our report suggests, a lot of the
issues we have raised have been highlightedin
ages. They also have clinical accountability.
4. Research Findings:
previous research. Implementing existing 5. Joint Commissioning
policy, namely the Mental Health Strategy
Implementation Plan and the Caldicott 2 Review
Health and Wellbeing Boards should ensure joint
commissioning across offender mental health a) Part 1 Problems with existing provision 16
(2013), would go a long way to mitigating some and local CAMHS to ensure joined up services.
of the problems we have outlined. We urge the Clinical Commissioning Groups (CCGs) should b) Part 2 How ideal services might look,
Youth Justice Board and Ministry of Justice to
ensure existing policy is implemented as a matter
appoint a mental health lead at senior level.
6. Targeted Commissioning for at risk
according to young people and professionals 24
of urgency.
2. Training
16-19 year olds
Consideration should be given as to how services
c) Part 3 Implications for the criminal
All professionals and specifically education
professionals working with children and young
can be targeted at the 16-19 year olds most at
risk given the apparent inability of CAMH or AMH
justice system 28
people at risk of offending should receive services to respond appropriately. Contracting with
training to gain baseline knowledge and skills
regarding the identification and awareness of
local community services demonstrated success,
as did engagement with the client group such as
5. Recommendations for Achieving Excellence
mental health issues to ensure children are not
written off as trouble children. Both police and
those supported by Youth Access and Transition to
Adulthood (T2A), and co-location with other services. What key agencies need to do 34
magistrates need training in mental health to deal
7. Easy access to services and information
with the young person appropriately and ensure
appropriate sentencing. All professionals in the
criminal justice system must understand any
A single point of access to services should be
extended to include young people involved with 6. Examples of Best Practice 45
the criminal justice system. CAMHS websites
mental illness issues and not just see the crime.
should develop better information, targeting this
3. Senior Clinicians Role group to provide a shared point of information for 7. Appendices
Make the best use of expensive senior clinicians young people, social workers, health professionals,
time and expertise by enabling them to provide
supervision and consultation for a large number
criminal justice professionals, parents and police.
1) Acts of Parliament/Bills processing
of the youth and young adult workforce providing
treatment for young people; thereby also
8. Raise awareness
Local government should appoint an elected through Parliament 46
member to be a mental health champion and
providing on the job training in a practical way.
4. Lead professional
this role should include raising awareness of
mental health problems. YoungMinds is one of six
2) References 48
Responsibility to actively monitor a young persons national mental health organisations supporting
case needs to lie with a lead professional: an member champions in local government. To take
individual or agency that ensures that medical case up the mental health challenge visit the website
reviews take place regularly, medication is actively www.mentalhealthchallenge.org.uk
monitored and the young person is actively engaged
1. Introduction 2. Vulnerabilities of young people
in the criminal justice system
The need for the Same Old... research came about because of a shared concern by Number of young people in contact There are a number of risk factors that increase
YoungMinds and the T2A Alliance about the relationship between mental health services with the justice system the chances of children and young people getting
and youth offending. Our concern was that a lack of provision of mental health services Young adults make up less than 10% of the British involved in crime, and many of these are similar
exacerbates offending behaviour in young people who are in touch population, but account for: to risk factors for mental health problems (Centre
with the criminal justice system, and leads to further marginalisation from society for Social Justice, 2012). A recent evaluation
more than 33% commencing a community of the Youth Justice Liaison and Diversion pilot
and greater hopelessness. sentence scheme (Haines, A. et al. 2012), found that
33% of the probation services caseload 80% of young people had between one and five
The resulting report is a partnership between the T2A Alliance and YoungMinds funded by the Barrow vulnerabilities, which range from mental health
Cadbury Trust. The research was undertaken by City University London during 2012-13. almost 33% of those sentenced to prison issues, behavioural issues, and social problems.
every year (Transition to Adulthood
This research project explored whether provision or non-provision of mental health services to young These risk factors can be split into three groups
Alliance, 2012).
people (aged 16 to 25 years) had any impact on their offending behaviour. and some of these are listed overleaf. The more risk
It is well known that many young people who are involved in the criminal justice system have mental health Complex Lives of Young People in factors a person experiences the greater the risk of
problems, some have a diagnosis, others dont, some have accessed CAMHS services, many havent but Contact with the Justice System that young person getting involved in anti-social or
need support, some are referred to adult services but many are not accepted. The way mental health We know that children and young people who criminal behaviour. It is not always easy to address
services are commissioned and configured makes it very difficult for young people who are offending to come into contact with the justice system often the risk factors. For instance, there is no easy fix
get the support they need. For example, young people who are diagnosed with disorders like ADHD, mild have very chaotic lives, and experience a whole for poverty or poor housing. However, there are
learning difficulties, autism spectrum disorders and personality disorder, even if seen by CAMHS services, range of negative life experiences such as seeing also protective factors (shown overleaf), which
will not be taken on by adult services. Sadly the prison system has a high proportion of young people with their parents divorce, living in poverty and in a can mitigate the risks, and help reduce the chances
these disorders. deprived environment, where violence and gangs of a young person getting involved in crime. For
are everyday experiences or where their parents instance, evidence-based parenting programmes
Many young people in the criminal justice system have a host of other vulnerabilities including being the
have mental health problems. improve outcomes for children who display
victims of sexual and physical abuse, neglect, school exclusion, drug and alcohol addiction, unemployment
behavioural problems (Brown, E.R. et al., 2012).
and homelessness. The relationship between these vulnerabilities and mental health problems are well
known and therefore poor provision of mental health support just adds to all these issues.
The ages between 16 and 18

years are the period where
the majority of offending
takes place, it is also one of
80%
the most vulnerable periods
in young peoples lives in
relation to their futures.
of young people had between one and

five vulnerabilities, which range from
mental health issues, behavioural
issues, and social problems
Risk Factors Protective Factors
ENVIRONMENTAL HEALTHY STANDARDS

Lack of commitment to school (including truancy) Living in a deprived neighbourhood/community Promotion of healthy standards within school
Aggressive behaviour (including bullying) disorganisation & neglect Prevailing attitudes across a community
Low achievement beginning in primary school Growing up in a low socio-economic household (ie school disapproval of drug misuse)
Attending a school with a high delinquency Poor housing Positive behaviour & views of parents, teachers
rate/school disorganisation High population turnover & lack & community leaders (who lead by example &
of neighbourhood attachment have high expectations of young peoples behaviour)
Associating with delinquent & drug misusing friends
Opportunities for involvement, social & reasoning
skills, recognition & due praise
FAMILY SOCIAL BONDING

Criminal or anti-social parents/history of criminal activity Stable, warm, affectionate relationship with one or
Large family size both parents
Poor parental supervision & discipline Link with teachers other adults & peers who hold
Child abuse & neglect positive attitudes & model positive social behaviour
Parental conflict & family disruption
Parental attitudes condoning anti-social
& criminal behaviour
PERSONAL INDIVIDUAL
Personality & temperament Positive, outgoing disposition
Low intelligence High intelligence
Lack of empathy Resilient temperament
Alienation & lack of social commitment Female gender
Impulsiveness & hyperactivity Sense of self efficacy
Attitudes that condone drugs misuse
Early involvement in crime & drug misuse
At Risk Groups Young peopleofin
youngthemenjustice system
entering custody had
Some groups of young people are over represented in the justice system. who have mental health
the literacy skills of a problems
seven year old, and
23-32%
Between of young people in custody have
a generalised learning disability
compared to just
2-4% in the general population

(Hughes, et al., 2012)
1 in 10 of 5-16 year olds (Green, 2005), will experience a mental health problem at some point in their lives
(HM Government, 2011)
65-76%
Between of young offenders Up to half of the young
had a traumatic people held in Young of children who have mild or moderate
conduct problems go on to commit half of young people in
compared to between
brain injury Offender Institutions are,
or have previously been in 45% of all crime at an annual cost of some 43% prison have ADHD
5-24%
37 billion (Sainsbury Centre (Young, et al., 2011)
in the general care (Blades, R. et al., 2011)
population for Mental Health, 2009)
(Hughes, et al., 2012)
In a Some mental health problems are particularly prevalent in young

survey of reported witnessing reported emotional, sexual offenders. Early intervention prevents mental health problems
offenders,
41% violence in their
home as a child and 29% or physical abuse as a child
(Williams, et al., 2012)
becoming more severe and helps reduce the risk of these young
people becoming involved in crime or antisocial behaviour
of young men were rated as A study from the of young people in Young Offender Institutions,
entering custody had underachieving at school Office for National aged 16-20 years, had a mental disorder and
1% the literacy skills of a
seven year old, and
46% (Summerfield, 2011) Statistics (ONS)
found that
many of them have more than one disorder
(Lader, et al., 1997)
Nearly of young people in of young people had Most adults with anti-social of the most persistent adolescent
Young Offender been homeless in the offenders showed marked
Institutions had been
excluded from school
40% six months before
entering custody
personality disorder had a
conduct disorder as a child
(NICE, 2012)
anti-social behaviour in early
childhood (NICE, 2012)
(Berelowitz, 2011) (Berelowitz, 2011)
3: Methodology and Ethics
Design Focus Groups

A cross-sectional qualitative study design was Semi-structured individual interviews were T2A staff and local mental health service providers
undertaken to explore the experiences and views chosen for data gathering to allow and encourage were invited to take part in a focus group. Each
of key stakeholders taken from across three young people to talk in detail about their focus group was facilitated by two researchers and
different study sites. experiences and views. contained between three and twelve members of
Stakeholder groups were identified as: Young people were recruited by research staff at staff, who were asked to discuss the support provided
the London, West Mercia and Birmingham T2A and required for these young people.
Young people who had contact with
study sites. T2A staff chose suitable clients and T2A and local mental health staff were recruited by
criminal justice services and who may/
approached them to find out if they would be the City University London researcher who provided
may not have had access to mental health
willing to take part. An information sheet was written information about the study and obtained
services (achieved via personal interviews)
provided for them to give to clients. When clients consent to participate.
Staff providing services and support to were willing to take part, T2A staff then arranged
these young people (achieved via focus Two types of focus group were held: one for T2A
interviews on behalf of the researcher. Before
groups) staff and one for health professionals.
the interview began, the researcher checked that
Commissioners of such services (achieved the young person understood what was involved, In London 12 participants were recruited into the
via email interviews). particularly the fact that participation was T2A focus group and 3 participants were recruited
voluntary and answered any questions. Consent for the health professionals focus group.
Ethics forms were then signed by both parties. In Birmingham 3 participants were recruited into
Ethical considerations surrounding this research In London, five interviews were held in three the T2A focus group and 7 participants were
study undertaken at City University London are sites between September and November 2012. recruited into the health professionals focus group.
stringent and in line with City University Londons In West Mercia 7 participants were recruited into
In Birmingham, one interview was conducted at
ethical code of conduct. This is particularly the T2A focus group and 7 participants were
the end of November 2012.
important due to the significant vulnerability of recruited into the health professionals focus group.
some of the participants. Nine interviews were achieved at two sites in
West Mercia at the beginning of August 2012.
Ethical approval was successfully applied for Commissioner Interviews
through the formal processes involved at the Ten young men and five young women were We were unable to recruit local commissioners
Senate Ethics Committee, City University London interviewed, ages ranging from 16 to 25. Ten but were able to recruit senior health professionals
and the National Offenders Management Service were White British, one was White other, in national commissioning and policy roles within
(NOMS) at the Ministry of Justice following the two were Black Caribbean, one Black African, mental health service provision. This was achieved
Integrated Research Application System (IRAS) and one of mixed race. Numbers of offences via email responses to posed interview questions.
procedure. Further approval and full consent was ranged between none and forty-two (those Commissioners were recruited by the City University
sought from all participating organisations and with no offences had nevertheless had contact London researcher who provided written information
agencies. Copies of all information sheets and with police because of their association with about the study and obtained consent to participate.
consent forms are listed in the appendices in the young criminals). Eleven were single, four in an
established relationship. Eight lived with a family We received two email responses to posed interview
full report.
member, four in their own accommodation, questions from 2 commissioners.
Interviews and three in a hostel. Eleven reported drug and
alcohol problems, and twelve reported mental
Participation
Young people using T2A services were invited
health problems (most frequently depression In total for this study, 41 adults and 15 young people
to participate in face-to-face semi-structured
was the diagnosis cited, although one reported were interviewed totalling 56 participants in all.
interviews, which explored the young peoples
experiences of offending, criminal justice services, bipolar disorder and borderline personality
mental health and other support services. disorder, and one reported schizophrenia).
Interviews were audio-recorded with consent.
4: Research Findings
PART 1:
Problems with existing provision
Rigid criteria Waiting Lists Services, so that gap between 16 and 18 is a I think what were looking at is the discrepancy
In the main, Child and Adolescent Mental Many of the young people interviewed for crucial nightmare to be honest because they between service criteria and the challenges that
Health Services (CAMHS) were criticised by this study were not engaged with mental health just get lost in the system. And waiting lists to that presents for this age group in terms of their
practitioners for the lack of provision for young services and the professionals who were working try and access these services are horrendous. maturity, and their needs including mental health,
people who are not suffering from severe and with them reported problems accessing services Particularly if theres substance misuse, a dual and I think one of the particular challenges is
enduring mental illness as their referral criteria for young people. A long waiting list for CAMHS diagnosis. (T2A Staff) where there is dual diagnosis of mental health and
are too rigid. This was said to be reflected was frequently stated as a contributory factor to substance misuse and the challenges that that
Health professionals expressed how different
systematically in CAMHS provision of early increasing offending behaviour. Many examples presents for service provision in the absence of
boroughs or trusts had different priorities and that
intervention as if a family did not attend the were given to support the difficulty of getting transitional service in mental health. (Professional)
provision of services could be a post-code lottery
initial assessment appointments they were adequate service provision due to the long
with some areas rationing services and support. The issues regarding referral and diagnostic
discharged. It was identified frequently that waiting lists and how this encouraged young
classification were relevant within adult services
specific outreach or community CAMH services people to look for alternatives. An important I think its quite sad that we only have one
too and the consequences and relation to
only exist if locally supported, prioritised reason for service discontinuity, was waiting lists CAMHS worker across the whole of the
offending were far reaching.
and commissioned and that service funding for mental health services once referrals had been (borough) working with the Youth Offending
grants come with specific conditions that can made, although this was sometimes facilitated by Team (YOT) and you go to boroughs next If were dealing with the 16 to 24 group, they
be exclusive of many young peoples mental T2A staff. door who have a psychologist service and hit 18 and medication stops. Adult services
health needs. a forensic service for young people, of a wont acknowledge or treat Attention Deficit
There is a long waiting list for CAMHS which
smaller population. Like a post-code lottery. Hyperactivity Disorder (ADHD) in adults. There
The rigid and high threshold for referral to means things like offending can get worse
(Professional) is no specific service for young people when they
CAMHS was felt by professionals to be a because no one is giving them the right attention.
become that age. ADHD causes impulsivity, so
factor contributing to more severe mental (Professional) It was expressed that young people are vulnerable
the young people are not necessarily aware that
health problems. not only because of their health but also that their
Participants expressed concern around CAMHS theyre going to offend, that they would suddenly
transitional age made accountability, parental
There is a problem with referral mechanisms, as resourcing and the pressure on streamlining do it, because the disability is inattention,
involvement and guardianship confusing, and their
young people only get assessed if they meet the and local determining of service provision to distractibility and hyperactivity, and so they can
rights to welfare and services and criminal law was
criteria. Often young people only meet criteria accommodate managing CAMHS waiting lists easily manipulate, be manipulated. If they have
unclear to them.
when they are older and the problem is more which can carry penalties. These factors were Aspergers syndrome or autism as well as ADHD,
severe and the transition from one service to felt to be detrimental to a comprehensive CAMH ..also legally young people are very confused which is a common co-morbidity, they can be
another happens when the young person is at service provision. at 16 to 18 as to what they can and cant do, nave, trusting and extremely vulnerable. ... its
their weakest point. (Professional) because you can do some things but its illegal to often common for a perpetrator with ADHD and
The long waiting lists exacerbated a difficult
do other things. And the decision-making is very autism to also be a victim. (Professional)
In general, referral criteria was seen to block transitional stage between child and adult mental
confused with parental responsibility in the eyes
service provision access. health services.
of children and young people. (Professional)
Eligibility criteria, because they dont have a
Transition between services Disengagement was discussed as a consequence
mental health problem that is long-term and
Participants expressed general concern that there of poor service transition.
is severe enough for mental health services,
they only have their GP... its very difficult to is a gap in mental health service provision for There are some services, for example, targeted
get someone into longer-term counselling. young people aged between 16 and 18 years as youth support that will continue to 19, but a lot There is a long waiting list for
they are at a transitional stage between child and
Particularly if theyre under 17 and not eligible of the time you find disengagement happens CAMHS which means things like
for psychological services. (Professional) adult services. It was felt that they do not receive a when theres a transition between agencies,
mental health service although need is identified. offending can get worse because
when they leave childrens services and linking
Participants also raised concerns about referral no one is giving them the right
Mental health is a real big one as well, into adults. I think thats a particular issue for
criteria with some disputes about what falls
within mental health and what doesnt meaning especially between the ages of 16 and 18 CAMHS because, ... its often perceived as a child attention.
because, from 16 theyre no longer under and family [service]. (Professional)
young people were left without support especially Professional
when they left school. Child and Adolescent Mental Health Services. Serious concerns with dual diagnosis were
And then from 18 they then go on to Adult reported within CAMH service provision.
Referrals sure Ive taken my medication so I dont lose it. Pressures on existing services Time limited relationships
Most of the young people interviewed mentioned (YP10) T2A workers described how professional mental In general young people did not report lasting
the help they received from T2A and other It was getting on the medication in jail, being health services are unable to give individual care relationships with mental health workers. Rather
services, in the form of referrals or introductions stable, having a safe environment to be in where and the quality of contact as a major concern. more of them did so with probations officers
to other services. Most also valued support in I knew everything that was going on. It got me or voluntary sector workers. Though some had
I find as well that even with time constraints,
accessing services including mental health, GP, that sense of security and safety that I can start had the same GP for a long time, they did not
if you go to other organisations, not even
college, benefits, housing and solicitors that they getting better. (YP2) report sustained support beyond the prescribing
just organisations, but statutory bodies and
found difficult to access alone. Again and again, of medication. Few had had much contact with
However, mental health services were not even YOTs that we work with, theyve got
young people mentioned times when workers mental health services, though one (YP10)
reported as being involved directly in providing such an immense workload that they cannot
had helped them to complete application forms reported a long though discontinuous history of
such support. give considerable due time to each case. So
or to make phone calls, had accompanied them contact. This included a helpful relationship at the
for example if someones on a YOT order and
to appointments and had acted as an advocate. Some young people interviewed showed an age of 11 with a psychiatrist, and a wait for seven
they have to see the YOT worker once a week
Some young people lacked the confidence to do awareness of debates about the appropriateness months when the latter retired for a replacement,
they will do a workshop where they get 10 or
such things on their own, often with disastrous of prescribing medication to younger people. One whom YP10 did not find helpful and did not
12 people and theyll talk about knife crime.
consequences, so the help of staff was critical. had wanted medication but was denied it. Two continue to see. She had also been an in-patient.
So theyre not talking about their individual
others felt that their medication needed review, problems, its as a group. (T2A Staff) Its interesting, Ill give you that. I was on section
but found it difficult to get one. and volunteered, I went in at first voluntary
Participants felt that professional and
Well, they put me on diazepam, which is from because I knew I was losing it. It was interesting in
practitioner resources are very limited.
the benzodiazepines, and Ive been on that now there because its not that it makes you more
for over a year. And youre not supposed to be Some organisations theres a quota that they crazy. Watching the crazy people when you dont
on it that long because its a very addictive drug can take on, even with us, we cant take on too feel that crazy I dont think its a place that
The medication they put me on, many heavy caseloads because its intensive
[My GP] cant lower my dosage and he cant helps anyone. Everyone that I know that I was in
it was making me that drained do anything about that because its the mental work that youre doing with each client and hospital with is still in a bad way now. (YP10)
and I was dribbling all the time, health services and the consultant decides what there isnt enough budget to get another paid
A major emphasis was lack of staffing continuity.
member of staff. (T2A Staff)
I couldnt even care for my son. I take ... But hes very upset with the mental YP1, for example, reported having had six different
Thats why I had to send my son health services, hes sent them a couple of emails The pressure school systems are under and probation officers in three months. Discontinuity
now saying, she shouldnt be on this anymore, the quality of the training teaching staff receive disrupted relationships with staff and made the
to his dads its affected my because, in the long run, its really going to mess was felt inadequate for identifying mental building of rapport difficult. Several suggested that
life even more losing him, really. her up. But they havent emailed him back or got health problems and learning difficulties and changes in staff tended to de-motivate them.
in contact. (YP10) was a concern.
YP8 My problem is opening up to people I dont know.
Im trying to say, look, my medication needs to If you look at the pupil referral units, the I like to work with the same person all the time
be looked at all the time, you cant just give it me numbers have grown immensely because at the because once Ive met that person, you know me,
and then leave me for two years. It needs to be end of the day if the child is not conforming and I know you, theres no need for 23 introductions
As discussed in an earlier theme around rigid
moderated, we need to look at it, make sure that doing what you want to do you want them out, and then each time I work with them I get to know
criteria and high thresholds, it was often hard
its still working. Because this was the problem theyre holding back the rest. Because theres them a bit better, so by the end weve got a good
for young people to be referred for services and
that I had with the medication before, which is pressures on the teachers who have targets, its rapport. But I dont want to have to keep being
if they were, the referral pathway was often
why I stopped taking it, because it wasnt working like a vicious circle here. How do they expect thrown to and from this person, that person. (YP2)
blocked. If they received a referral and saw a
Then I obviously plummeted down into a bout a teacher whos just come out of university a
professional, the most common experience young When professionals [in this case, school staff] did
of depression. (YP2) couple of years ago, who doesnt know anything
people had of mental health services related to not listen, the results could be damaging.
While for some young people the medication about the ghetto- because thats what its all
the prescribing and taking of medication.
helped, for others the consequences of side about, being in the ghetto to talk to these They never sat down and said to me, what is the
Medication effects had been far-reaching. kids? How are these teachers meant to control problem? They never took up the issue of my
them? (T2A Staff) dad dying and of giving me that sympathy, or
Some young people recognised the contribution The medication they put me on, it was making not even just the sympathy, they never gave me
that this could make to their stability and me that drained and I was dribbling all the time, the time to even grieve. They just wanted me
enhanced life skills, and some praised those I couldnt even care for my son. Thats why I had to do exams and exams, exams and they never
people or structures that had supported them to send my son to his dads its affected my life took it into consideration that I was grieving for
to take their medications prescribed. even more losing him, really. (YP8) my father. (YP12)
My case worker here always calls me to make
Voluntary sector workers confidence Complexity of need Participants expressed concern that the legal
around competencies Drug and alcohol abuse was discussed as a very status of Intentionally Homeless reduces
T2A staff often felt competent at identifying common experience for most young people. options and precipitates further offending
critical issues for their clients but expressed Many young people used illegal drugs such as behaviour, criminalising young people. These
concern about passing these issues on to other cannabis or skunk to self-medicate to try to young people often come from high risk and
services due to the reception they received. manage their own mental health problems in the abusive backgrounds which are traumatic and
absence of alternatives. precipitated them being in need and in care.
I think were all more competent at realising
theres something that needs more investigation. Yeah, Ive got a young lad at the moment. I And a lot of the behaviours particularly around
What were not so confident in is actually then chased up a mental health appointment for offending, also around things like becoming
phoning the services and saying, Hi, Im so and so him on Friday and I was told that there is an Intentionally Homeless through housing law,
from T2A, and weve identified X. Because again 18 months wait.... and you can see why young start closing doors for your future at that age.
its the reception that you get from the person people tend to self-medicate with either And for people, for example, leaving care, fine,
on the end of the phone, well what do you know cannabis or alcohol purely because they cant Im homeless on my 18th birthday, thats good,
about it? Not, who are you? (T2A Staff) wait that long to get the help. (T2A Staff) isnt it, because Ive blown, got an arson offence,
I smoke weed all the time, and Ive been kicked
Many T2A workers felt comfortable identifying Worries were also highlighted around young
out of three hostels, therefore Im Intentionally
mental illness most of the time and they had people copying their parents substance misuse
Homeless. May as well say, OK, youth offending
learnt this from experience. Their role demands and participants were particularly concerned
institutes over there, your honour, just walk
a lot of contact with young people and they felt about the dangerous quality and the cheap
to the gate and admit yourself, because
this was useful in terms of identifying problems or availability of substances.
unfortunately thats where a lot of them (care
mental illness. These young kids are smoking skunk and dont leavers) are going. (Professional)
And you see them (young people) for a prolonged realise the effects of it and then theyre drinking
period of time whereas again other services might alcohol on top of it. Its easier to buy a bottle of
have 10, 15, 20 minute appointments, when cider than it is to go to the cinema. Theyre just
youre spending 1 hour, 2 hours, 3 hours at a time committing crime, they dont even realise that
a couple of times a week with somebody you can theyre committing crime until the next morning
notice those changes. (T2A Staff) until theyre in the police station and their
parents are being called. And a lot of the time These young kids are smoking
Some participants expressed concerns about
recognising a learning difficulty. However
its because their parents are actually smoking skunk and dont realise the effects
weed and thats why theyre getting into it as of it and then theyre drinking
participants felt that illiteracy in this client group is
well. (T2A Staff)
extremely high and should be distinguished from a alcohol on top of it.
learning disability, although it increased vulnerability. Professionals felt that often a young persons Its easier to buy a bottle of cider
problems could be predicted. Homelessness,
Sometimes a young person is classified as having
substance misuse and child abuse were frequently than it is to go to the cinema.
a learning disability when really theyve just never
cited together as identifiable factors contributing Theyre just committing crime,
really learnt how to write properly. But that isnt
a learning difficulty Thats a big problem Im
to the young persons offending behaviour and they dont even realise that theyre
this was considered a growing trend.
telling you because Ive seen it and its hurtful to committing crime until the next
see somebody 20 something years old and they There was also considerable concern that many morning until theyre in the police
cant read, they cant write. In prison you see a lot young people the participants worked with
of people, they drive a big BMW car, got a lot of struggled with housing issues. The majority
station and their parents are being
clothes, got everything, but when you see them of these young people are care leavers with called. And a lot of the time its
in jail, they cant read or write and they just sink. identified mental health problems as well as because their parents are actually
...theyve got to ask a man, Ive got a letter from young offenders. T2A staff reported having very smoking weed and thats why
my girlfriend, read it for me. (T2A Staff) few supported accommodation options and the
lack of suitable accommodation and the risks of theyre getting into it as well.
young people taking what is on offer seems a
T2A Staff
current national picture.
Stigma get a young person sat down I can explain my black some people want to be white, if your A real lack of alternative safe and supported
Issues surrounding stigma arose constantly within role in such a way that they want to engage, friends slim you want to be slim. Peer pressure is accommodation for troubled young people
different contexts. The local community was ... Half my job is just getting them to sit in a a big, big problem for children, so to go to school can increase the risk of further mental health
frequently described as a hostile place for children chair for a moment of time and give them the ... and wear the wrong shoes... And when they problems and offending in young people.
and young people to grow up in. The absence opportunity to choose. (Professional) cant get some, well some of them will go out
So one of the people I was working with had no
of community support was commented upon and nick it. (T2A Staff)
Participants stated that they experienced CAMHS accommodation, he was a young lad leaving care,
and a lack of activities such as youth clubs was as having preformed ideas regarding young There was general consensus amongst health I think he was 19, he had an order to go back to
mentioned by professionals. people who had offended. Both of these aspects professionals in their group that social pressures prison and he just said, Im going to kill myself or
Children arent accepted in the community and that created difficulty in providing services and making had changed. Im going to commit an offence. He felt they were
comes back to the stigmatisation and the labelling. services accessible to meet the need. his options. He went out and burgled a family
Understanding something of what it must be like
Because communities see a group of youngsters members home, and he was then sentenced
Speaking with some of my colleagues within now to be an adolescent, 16 to 25 say, in 2012. I
playing in the street and even if theyre building a back to custody and he was remanded. He did
CAMHS to kind of dispel the whole criminal think the pressures have accumulated massively
go kart out of planks of wood that theyve found get released from custody and got a community
aspect of young people and that actually theyre ...the whole idea of how they place themselves
theyll get done for criminal damage because order, but then was re-arrested the next day
not as dangerous as they sound,... the kind of within a peer group, has just become so complex.
theyve nicked the planks of wood. (T2A Staff) for being under the influence of alcohol and
myths that these types of young people are very Some of that is all to do with the modern
assaulting a police officer. And unfortunately
In schools, young people with mental health hard to engage with, and theyre never going to technology that they have to face, you know, we
a really traumatic incident happened to him
problems or learning difficulties were labelled as turn up and theyre not going to respect you and all used to perhaps have a bit of bragging and a
in custody the previous time round, which he
trouble children and did not receive the support theyre going to trash the place, you still have bit of bullying in our lives, now its sort of viral, its
disclosed to his solicitor who disclosed it to the
they needed. The T2A workers felt there was a these attitudes in this day and age. I would like sort of networked and its Tweeted. (Professional)
judge, who on that basis said that he wasnt
lack of identification of mental health problems to say that actually if a young person is involved
Participants discussed the impact of absent going to send this young person back to custody
and learning difficulties in school environments. with the Youth Offending Team then actually no
parents or parents who are overstretched and because it wasnt a safe place for him. And he
This was further remarked upon as being an one really wants to touch them. (Professional)
trying to make ends meet as factors contributing self-harmed very badly. (T2A Staff)
early factor in the development of delinquent to young peoples situations. Young people had a
behaviour because of the lack of attention to Social factors
lack of rules and boundaries and little attention
identified difficulties. Health professionals and T2A staff in both from their busy or absent parents. Participants
We have these children who are dyslexic and sets of focus groups recognised that many of also felt that there is an increase in vulnerable
its not recognised theyre left to the back of the problems for the young people they were families that need support.
the class eventually theyre going to think, working with had started from a very young
age. Social, economic and psychological factors ...there is a lack of early intervention when
you know something, no one even gives a shit, problems have escalated and there is lack of
so you know something, Im not going to give played a big part alongside the environment the
child was raised in. The economic climate also services to support vulnerable families. There Children arent accepted in the
a shit. ADHD is being recognised, there was a
time when it wasnt being recognised. But even impacted upon young people, with professionals has been an increase in vulnerable families. community and that comes back
(Professional)
now I dont think its up to scratch where it identifying that young people they worked with to the stigmatisation and the
had limited opportunity. There was also considerable concern that many
should be. But to even get them a statement labelling. Because communities
is a mission. Its a mission and a lot of parents I think financial difficulties play a part. Ive had young people struggled with housing issues. The
majority of these young people are care leavers see a group of youngsters playing
will give up. Because most of them that you see clients in the past that have felt they had to
with a statement are trouble. Theyre put down offend because their parents couldnt afford to with identified mental health problems as well as in the street and even if theyre
as being trouble children. and because theyre buy them things, because they cant get jobs young offenders. building a go kart out of planks
trouble kids theyre put to the back of the class or because theyve only just got to stay in the Weve got very few supported accommodation of wood that theyve found theyll
and you do what the hell you want to do, youre country. And the kids have felt that due to options in. Weve had young people refused get done for criminal damage
already labelled as, youre never going to achieve financial difficulty that they need to commit access to one young persons supported
anything. (T2A Staff) crime. (T2A Staff) accommodation/hostel because theyre too low
because theyve nicked the
Young people did not want to engage with Peer pressure was identified as a massive social risk to go into the adult hostel at 18 but theyre planks of wood.
CAMHS because of the stigma around having a issue for young people and that combined with too high risk to go into the young persons
T2A Staff
mental health problem and accessing services. financial worries led to offending behaviour. hostel at 18, so where do they go then? I dont
know, but we cant help them. (T2A Staff)
I think young people dont access mental health Everyone wants what they cant have. If youve
services simply because of the name ... Once I got curly hair you want straight hair, if youre
PART 2:
Creating the ideal services;
according to young people and professionals
Trust and rapport with practitioners Meaningful and regular engagement they werent so much on the polices radar, but as Authenticity
T2A participants repeatedly acknowledged the Young people described the short appointments soon as that stopped ... it (offending behaviour) Improved service reliability and consistency are
reasons why trust takes time to develop with as insufficient to tackle their multiple problems and gradually started creeping in. Then one got sent seen as crucial factors in service provision. This
young people and that short-term interventions asked how they could talk about changing their down, got remanded, one had a court appearance, featured more regularly than distinct specialist
are unable to develop this vital aspect of lives around in a 15 minute appointment? They their offending started to repeat. It would be great services. An authentic, sincere approach is also
recovery. also gave accounts of discontinuous or intermittent for some of these projects if they were, certain, needed because as a professional pointed out
services if they managed to receive a service. really long and sustaining in terms of maybe six young people are so skilled at picking up whats
Its actually about relating,... So most of these
kids have had trust issues from the beginning, The psychiatrist put me on the medication, months to a year ... rather than six to eight weeks authentic and whats not.
for a long time, they dont trust people in and then he said, Ill see you three months, four worth and involve their families, because very often
..whatever we offer its got to be consistent,
authority... for them to speak to somebody and months and that will be it. Left me. There was if youre able to engage the family, some of the
reliable and appropriate. And in that I think it
open up its not going to happen overnight. Its no therapy then, there was no CPN (Community behaviours which may be reinforced by the family
should be completely long-term, that allows
going to take a long time to build that rapport, Psychiatric Nurse), there was no social worker, slow down or stop. So if we kept it to the same
sustainability... (Professional)
so to build quality support, a real support and there was nothing. I was left on my own with all time, same day, every week, they knew that was
the support youre talking about, not just a these tablets. And he was giving me a months coming up whereas you know if its not then it kind It was felt by all the participants that any
minor intervention, but a major transformational worth of tablets. I did OD, I think, twice on them, of loses its momentum and pace. (Professional) provision is not going to work unless the care
change, you have to be able to go into and they still gave me them. And then I just provider is genuine and can be relied upon.
somebodys life and go back and understand stopped taking them (YP8) Consistency and motivation
why they are the way they are and then rebuild It was recognised that when young people get
[On another occasion] the community crisis team
a life. (T2A Staff) let down this can have a negative impact on their
were working with me at home and stuff, monitoring
Young people were clear, and often emphatic, that me. But that only lasts four weeks, so they only work motivation and aspiration. Participants discussed
having a good relationship with service staff was with you for a short period of time. And that was the impact of this service and worker withdrawal
I remember more than one young
crucial to the successful offer and acceptance of perfect then with them there. Everything was fine, I on the young person.
support. was on my medication, it was good, but only for that person asking me, so how long are
I remember more than one young person asking
This young man gave an example of someone
four weeks, and then they go. And then there was me, so how long are you going to be here for?
you going to be here for? .... but young
who had understood how to build rapport.
nothing else put in place after. I was left to my .... young people do want to access support, but people do want to access support, but
own devices, and someone that ill shouldnt really
[My alcohol worker] actually asked me how my be left on their own, you know? (YP8)
like weve been saying, I think trust is a massive, like weve been saying, I think trust
massive thing and if they open up and trust is a massive, massive thing and if
week had been, how my daughter was getting
Providing the right sort of substantive care that is someone and then all of a sudden theyre pulled,
on, before we even started the session And
effective was discussed in relation to short-term ... its just that actually young people become they open up and trust someone and
then shed start the session, once shed got me
interventions. mistrusting of those sorts of services, because then all of a sudden theyre pulled,
in a good space of mind, which was quite good
As soon as someone tries poking and talking An example I can give, this time last year we had
they dont feel that theyre going to be there long ... its just that actually young people
enough for them to actually do a piece of work or
about something I dont want to talk about, I get a group of six young boys who offended over the become mistrusting of those sorts
support them in the way that they actually need.
agitated, my barriers go up, I get defensive, and I summer, ...robbing people in parks and stuff.... of services, because they dont feel
Thats quite difficult. (Professional)
close myself off. (YP6) we did some quite intense thinking around their
offending behaviour, we put aspects of mental Young people said that they felt GPs in particular
that theyre going to be there long
If the person thats involved doesnt feel any enough for them to actually do a
health in there, ...So therell be three of us with had no time for them with one describing an
trust or that they can relate to that worker you
can give them all the support in the world, it is
these young boys and we would talk to them about appointment as his GP clock-watching. piece of work or support them in the
whats going on and whats happening, why they A strong direct link was repeatedly made between way that they actually need. Thats
not going to mean anything. (T2A Staff)
think theyre offending? ...for the period of time
that they had that, they werent out robbing. It was
access to ongoing support and re-offending rates. quite difficult.
only once a week, it wasnt kind of an intensive five Professional
day programme or anything like that and the rate
that they were offending definitely came down ...
Quality relationships Informal/non-clinical
T2A staff felt very strongly that the quality of the Young people recognised that voluntary sector Rapport was generally associated with a degree
relationship between the workers and the young workers had more flexibility in the service they of informality.
person was paramount. offered.
Working with [T2A staff] and having
Stability, thats all, and boundaries set. And Whats she [T2A staff] got thats extra? Time. conversations, because its not really in a
I think the help and support that they could No-one ever had time for me before that. And formal setting she just, we just have normal
do with is having somebody they can trust in, the time she gives me is quality time because conversations and it just, she just works it in with
somebody they can communicate with, and in our time we do a lot of things, like we all go the normal conversation and it works that way.
somebody that believes in them, that they can out for lunch, and just talk about normal day- Probation could take a leaf out of T2As book.
achieve. A lot of them, think that theyre just no to-day, basic things, like, what have you been The reason why people are re-offending is because
good. (T2A Staff) doing today? How was today? (YP12) a lot of them have the wrong attitude, so you
need to change their attitude. But you cant do
Young people were clear, and often emphatic, that
that by sending them to speak to somebody that
having a good relationship with service staff was Non-judgemental they dont like, can you? You need somebody there
crucial to the successful offer and acceptance of Many of the young people valued the opportunity that you can go in, talk to, have a laugh with, a bit
support. to discuss their problems with service staff. of a giggle in a less formal setting. (YP2)
Im one of those people if I dont click with [T2A staff], he was the first person I properly Participants cited Jobcentre staff using inaccessible
someone, then Im like a closed book, I wont talk, opened up to about my past, about the way that language for young people, especially those with
Ill just sit there in silence. But then the thing is I felt and stuff like that, about the things that learning difficulties and literacy problems. Participants
Ill get in trouble for that. So its better for me Ive done in the past, and a lot of things that I made a direct link between these attitudes in service
well, it would be better for everyone - if they didnt get caught for, the way it made me feel provision and the emotional wellbeing, self-esteem
can find down to earth people instead of people and stuff. It helped a lot to come out with these and offending behaviour of young people.
that are in your face all the time. I know youre in things, to tell him these things, to get it off my
the wrong, thats why youre on the order, but it chest. And he always reassures me that at the Some young people highlighted staff going the extra
makes it a lot more comfortable for the person end. I was always worried about people judging mile for them. This young woman went on to talk
to try and talk about their problems if they can me, whereas he never did, never did judge me about how her T2A worker demonstrated concern.
seem to get on with the person I need to build about the things that I used to do. What he used She just bonds, you know like someone that cares,
a rapport with someone before I can be open to do is just say, how much better it is that Ive like she cares and I know she cares because she
with them. (YP6). come away from that now and sorted it out. just checks up on me Are you all right? Are you
Now that was a massive help. (YP3) staying out of trouble? (YP12)
Availability Young people valued having a rapport with their
It was felt by all that any provision is not going to worker and this was generally associated with
work unless the care provider is genuine and can a degree of informality. Service staff whose
be relied upon. manner was non-authoritarian were more able to
establish rapport and young people appreciated
Being available is definitely 100% a massive
being treated like youre an equal.
thing. (T2A Staff) Whats she [T2A staff] got thats extra?
Quite a few people I know, in the end we stop
Young people noted the importance of
going for help because theres no point sitting
Time. No-one ever had time for me
relationships and said they wanted workers who before that. And the time she gives me
there in front of someone whos just going to
had time for them, who were accessible, who
listened and who didnt speak down to them. They
judge us all the time. (YP10) is quality time because in our time we
often spoke of the importance of having someone do a lot of things, like we all go out for
to talk to and people providing constructive advice. lunch, and just talk about normal day-
She nags at me, shes bossy, yeah! My mum to-day, basic things, like, what have you
shouts at me, she just shouts, screams. [T2A been doing today? How was today?
staff] just tells you in a nice way, she explains it to
you. My mum just skips the explaining and starts YP12
with the screaming. (YP11)
PART 3:
Criminal Justice Implications
Re-offending exacerbated by a lack Offending behaviour can be a barrier A clear link was made by participants that most Early intervention
of care to services young people who are in custody in the criminal Professionals felt early intervention was an
Participants in the focus groups expressed how A young persons criminal behaviour was seen justice system were having contact with CAMHS essential ingredient to improve current service
the lack of co-ordination of care was striking as a barrier to healthcare services due to the prior to being imprisoned. provision. Schools were identified as a place that
despite different care co-ordinators being practitioners seeing only the criminal behaviour Quite often, to be honest, if a young person might encourage early intervention.
involved. There did not seem any evidence of and not offering a comprehensive CAMHS goes inside, very often theyre discharged from There needs to be a bit more interaction between
adequate individual care planning in several assessment despite a risk assessment being a CAMHS service, with the expectation that the the teachers and the families. Most schools have
examples presented, where it appeared the completed. Mental health care was not perceived locality or the prison will contain and do some of one family day maybe every year or so, they
young person was suffering from enduring and as a human right. those services. (Professional) should be on a regular basis, if you bring the
serious mental health problems.
It can be quite difficult just to get a general mental parents in, you find out whats going on within
Im working with one person, diagnosed with health service for some young people. Straightaway Court orders the family home. (T2A Staff)
personality disorder and bipolar, she was on a many people will ask whats the crime that theyve There was a consensus that young peoples One young woman, who regarded her probation
load of medication which I dont understand, done? For me actually a young person coming into mental health needs are best met when dictated officer as a key support for a period of five years,
which medication is for what and what the the system should have every right to the same by the court through their order and not left to was unclear of the process whereby she had been
dosages are. But to get the mental health team service as anybody else, whatever crime they the service providers. put in touch with her, though she realised that the
involved with her was so hard and it was her have committed. (Professional)
The best way for a young person to get mental referral had been preventative in nature.
probation officer who kept on, they wouldnt
General concern was expressed surrounding health services is if the court orders it. If the court
return calls. Shes had four care co-ordinators, I think it was because I was gang-related, and
referral pathways and that the young persons orders it, then its going to happen by someone
shes been left, and when she was in crisis when police kept coming to my mums house and
right to healthcare became a secondary factor independent who, although its an incentive for
we needed the mental health team they shut raiding my mums house. They obviously noticed
when in prison or a Young Offender Institution. them because theyre paid out of the normality
her case because one of her things was shed that I was young and I was a female and they
Now the only time it (referral) gets activated of the CAMHS system, the young person will get must have picked it up. Somebody referred me to
shut down and she would shut off all agencies,
or realised is when funding comes into play, a good assessment with recommendations. Now, her and she came out to see me, and she was like
wouldnt speak to anyone. There were a few
because obviously if theyre Out of Borough for me that works quite well because a young my support worker from then on, like even until
serious incidents with her where she needed the
and you want to do an assessment, the locality person is going to get pretty much what they now. I think it was the police. They could see that
support of the mental health team. (T2A Staff)
service will say actually, hey weve got your need, or the court is going to hear what they need I was slipping into the system slowly. (YP12)
The health professionals identified undiagnosed and maybe put it as part of their licence or part
young person, we want to do an assessment,
serious mental health problems and learning of their order, so thats one way. (Professional)
that will cost you a few hundred pounds and
difficulties as a factor of their clients developing
then people kind of fluster and then the next A number of young people talked about the role
offending behaviours.
issue is, well whats the crime? Whos going of the criminal justice system in their personal
... One reason could be that they have an to do it? I havent got the time and you know, development. Some mentioned court orders or
undiagnosed autism spectrum condition or so on and so forth...and it doesnt happen. referrals by probation and Youth Offending Teams I committed this offence, which
that they have ADHD and it is not understood... (Professional) to mental health services, alcohol services or T2A.
Theyre not given any support or advice for
obviously ended me back up on
I committed this offence, which obviously ended me probation. But in a way I am grateful
their condition and because of their vulnerability Integrated working
back up on probation. But in a way I am grateful
they go into crime. (Professional) There was general support amongst participants because Ive got to work with T2A and without T2A because Ive got to work with T2A
A strong direct link was repeatedly made for more integrated working particularly because I wouldnt have got myself sorted. So, although Im and without T2A I wouldnt have got
service uptake and communication improved.
between access to ongoing support and very sorry for the crime that I committed, there myself sorted. So, although Im very
re-offending rates. If a young person is inside very often the are good things that have come out of it. (YP2)
sorry for the crime that I committed,
I think in terms of the repetition of crimes, communication between the prison or the
Young Offender Institution and either CAMHS there are good things that have come
young people who dont feel supported or are
not supported, generally re-offend. I think thats or the Youth Offending Team, is not very good. out of it.
the reality whether or not theyre on a court And one of the good things about having
a CAMHS worker within the YOT, is those YP2
order or not. (Professional)
lines become a lot straighter and a lot easier.
(Professional)
Reliance on the voluntary sector When the service is no longer available, the young In addition, some spoke of how they had been Prison, probation, Youth Offending Teams and T2A
Many of the health participants expressed a people have few choices and get back in with helped to reflect on their own behaviour in ways were all mentioned as having provided or facilitated
reliance on voluntary agencies to carry out vital their old friends who encourage them back into that motivated them to attempt to change. access to training and education (literacy, gym
work that they are not able to do due to stigma, the gang. (Professional) instruction, painting and decorating). Undergoing
[Victim Support offered] just loads of victim
competing demands and professional confines. these had increased confidence and self-esteem as
stuff and that, how victims feel and its like you
well as improving chances for employment.
Because, you know, if we cant refer onto a learn how they feel and if they did it to you,
mentoring service or a boxing club which does how would you feel. I even wrote a letter to one It just got worse and worse and the route that I
mentoring service or various different aspects, of them, saying how sorry I was and explained was heading was jail or I would be dead. Then I
then actually we dont have the ability to sustain what I was going through. (YP8) got onto a course, an apprenticeship, which the
everything, so it is about using the services we probation officer helped me get on, which was in
have. (Professional)
I think its relationships and Another spoke of how her probation officer had
customer service and hospitality. I completed the
helped her manage her anger better.
resilience which is a big thing for course and then I got my certificate, it was the first
Concern was expressed about these agencies I thought the whole world was against me, like
being able to sustain this work. me. So its not what necessarily time Id ever been rewarded and I graduated from
I didnt care at all. And she showed me that the something positive. I then realised that I wasnt just
I link with a (voluntary) service that does
happens to young people, its how world isnt against me, Im against the world. She another statistic, I was somebody. (YP12)
incredibly good and very sensitive work around theyre taught to cope and their showed me that I could deal with my anger by
street workers and particularly around early resilience to whatever it is that just coming out of the room wherever I am or
prostitution. This service really will be there just going outside, breathing in and out. Learning
happens to them.
and help, and its living, honestly, from hand not to swear as much, being able to have that
to mouth.... think of the good it could have T2A Staff balance, she showed me that balance. (YP12)
been achieving had it been reliably certain of Most of those interviewed mentioned the help I cant find a job, its really hard,
its funding? And I dont understand how we they received, from T2A and other services, in the and its really hard for ex-offenders,
can be reliable if were not based ourselves on form of referrals or introductions to other services.
something reliable. (Professional) because as soon as theyve seen your
Education, training and skills Though this was generally much appreciated, this
was not invariably the case. One reported many
criminal record on your CRB check
Comment was made regarding the stress this put
the voluntary agency staff under and how these
Young people had received a range of help with instances of not taking up opportunities because and stuff, people just dont want to
life skills, either in prison, from the probation
resources, which statutory service often depend
service, from T2A and other voluntary sector
he didnt believe they could help. employ you.
on for referral, are reduced and put under strain I just didnt think it would help, to be honest.
organisations, or from specialist services they YP6
due to their need to write continuous applications Well, I just think, if I need to stop drinking and
were referred to. Topics included thinking skills,
for funding. change my life Ive got to do it myself at the end
anger management, controlled drinking, reasons
Sometimes you get projects where the actual for drugs misuse, reason for offending and of the day. (YP15)
staff have to apply for their own funding. Its Two mentioned that T2A was helping them to
consequences of offending for victims. Prison also provided opportunities for some, for
very difficult because there are some really good get Construction Skills Certification Scheme
Some young people spoke of how such courses example, learning to read, obtaining qualifications, cards to enable them to work in the building
workers who are really able to do the work and courses on drug use and thinking skills, all
had helped them to think about themselves industry. Though many wanted work, there was
get young people engaged, but you know, if mentioned by YP1, who added that he was sure
differently and consequently behave more recognition that opportunities were few.
youre worrying from day to day whether youre that he would not have accepted any of this help
constructively. Most often, just feeling able to
going to be able to survive yourself then the had he been offered it earlier in life outside prison. Like now I dont think Id ever get a job and things.
spend time thinking about and discussing past
impact of that mental health issue on the worker Another described how prison had encouraged Whos going to employ someone whos bipolar with
behaviour seems to have helped them to see
is enough, let alone trying to work with a young him to take a constructive approach to life. a borderline personality disorder? To me I feel for
the disadvantages of old behaviour patterns and
person. (Professional) the rest of my life I will be stuck at my home, and
motivated them to change. Thats when I started to apply for extra courses in
There was a definite link reported between the never getting anything more out of life. And thats
I found it a bit hard at first because part of my own time and stuff to try and keep the time a pretty sad thought, isnt it, at 25? That your life
poor sustaining of service provision and a negative busy, keep busy. Thats why my time flew, because
it was delving into my past, why I offended, is finished really. Youve got no opportunities and
impact on young peoples offending behaviour. from seven in the morning till eight at night I was
why I did these things. But Id got to the stage nothing to look forward to. (YP8)
Support is short-lived because of funding. Some where I could explain the reasons why I got into out of my cell busy doing something. (YP2)
support has been cut so there is nowhere to refer I cant find a job, its really hard, and its really hard
cars and drove, it was a release for me, it was Naturally, not all responses to prison were so
young people. This has an impact on offending for ex-offenders, because as soon as theyve seen
a coping mechanism for me to calm down. I constructive. YP9 spoke of thinking: Well, it cant
behaviour. For instance there may be mentors to your criminal record on your CRB check and stuff,
learnt a lot from that course, which I do believe get any worse, know what I mean, so why should
help young people get out of gangs. people just dont want to employ you. (YP6)
would help a lot of people. (YP6) I bother carrying on?
This young man had thought about how work In terms of gangs, some professionals expressed And it can be a very difficult place for that young
opportunities could be increased. the view that they felt inadequately trained to person to leave. So in terms of mental health,
work with girls who are experiencing sexual feeling part of something, feeling more powerful,
The government keep banging on about all
exploitation and with the boys who are or have being a part of a whole, of a group - that can
the prisons being full and that. But if theyd do
been involved in exploiting them. Trying to help actually bolster a persons self-confidence and
something about it, give them [prisoners]help.
the young person to identify their resilience was self-esteem and make them feel considerably
Why dont they buy derelict farms and get loads
considered an important factor. more at ease within their world, and therefore
of ex-prisoners to build them into new, nice new
the thought of leaving that culture and that
places? Just simple things, which would put jobs I think its relationships and resilience which is
group can actually trigger anxiety and feelings
out there for ex-prisoners, give them a chance. a big thing for me. So its not what necessarily
of rejection and separation and loss and a whole
If they fail then thats their problem, but as long happens to young people, its how theyre taught
range of other psychological issues. (Professional)
as theres the chance there for them to prove to cope and their resilience to whatever it is that
themselves. (YP6) happens to them. (T2A Staff) Does this indicate that the gang culture in
our cities may be acting as an alternative or
T2A staff were also concerned with the exposure
Gang Culture substitute to community mental health care?
and dependency of young people to certain
Participants from the city focus groups groups involved in organised crime and that
expressed their understanding of how the this would exacerbate their offending behaviour
involvement in organised crime and gangs offered further. Peer pressure was identified as a social
disenfranchised young people a credible option issue that seemed important to determine
for their sense of isolation. difficulties young people had.
Theres been a lot of research on gang culture, Peer pressure, the area that they grow up in, they Theres a lot of kids that get into
... particularly, young men who become involved live in. Sometimes the surroundings and the people
with gangs and have a diagnosis of ADHD
gangs because they want to look
around it will pressure them into going into things
or various other disorders including autistic that they probably wouldnt normally go into if
good in their area. Because if youre
spectrum disorders and various other personal they were living somewhere else. (T2A Staff) in a rich area to look good, you
issues. Individually they may be as scared of have to go to school, you know, you
the world as their peer group, but together in Hooking children into gangs from a young age with
a group of other young people become, find a a promise to be looked after and protected and have to go to college, you have to
social group identity. They find a place within given a bigger, better status was also discussed. go to uni, you have to have a car
that gang, whereas they may feel alienated The gangs, the kids can be like recruited from a to look good. In a poor area you
from their local community because they may young age, so if theyre young this is where the
be regarded as anti-social simply by the way
have to carry a gun and a knife to
problems start, they could just be in the hood and
they look. So issues around feeling rejected someone could just come along and go, Hey, can be able to look good. And if you
and wanting to feel part of something bigger, you just take that there for me? And he knows dont and you dont look good,
and sometimes this can lead to a culture of hes one of the big boys and he might just say, then youre the one thats going
anti-social behaviour because the group norm you know what, its nothing, Ill do it for you. And
is to do that. (Professional)
to be on the receiving end of it.
he knows from then on hes got his little clout,
Theres a lot of kids that get into gangs because hes got his little power, and then as hes growing YP10
they want to look good in their area. Because if up its like, dont worry, little man, weve got you.
youre in a rich area to look good, you have to go (T2A Staff)
to school, you know, you have to go to college, The participants added that for this group of
you have to go to uni, you have to have a car to young people to leave a gang could well trigger
look good. In a poor area you have to carry a a hostile response from fellow gang members,
gun and a knife to be able to look good. And if but in addition it was stated that leaving the gang
you dont and you dont look good, then youre could potentially exacerbate mental health issues.
the one thats going to be on the receiving end
of it. (YP10)
5: Recommendations for Achieving Excellence
What key agencies need to do.
Introduction Critical Issues: Key recommendations:- 5. GPs are well placed to fulfil this role as they
This research exemplifies very clearly how 1. The need for consistency of relationships with 1. Implement existing strategy are the only person who sees whole families
systems that are trying to offer effective help young people. It takes time for trust, mutual As the title of our report suggests, a lot of the and whose services span all ages. They also
can in fact exacerbate already problematic respect and empathy to develop and is the issues we have raised have been highlightedin have clinical accountability.
circumstances. Too often the result for young core requirement for positive developmental previous research. Implementing existing 6. Joint Commissioning
people is increased cynicism, further loss of work to take place. policy, namely the Mental Health Strategy Health and Wellbeing Boards should ensure
self-esteem, motivation, confidence and basic Implementation Plan and the Caldicott 2 joint commissioning across offender mental
2. All staff delivering services to this client group
skills. For the state it can mean spiralling costs of Review (2013), would go a long way to health and local CAMHS to ensure joined
need greater knowledge and skills regarding
welfare dependence, health problems, policing mitigating some of the problems we have up services. Clinical Commissioning Groups
the identification and awareness of mental
and custodial sentences as well as the loss of an outlined. We urge the Youth Justice Board and (CCGs) should appoint a mental health lead at
health issues.
active, working citizen. Ministry of Justice to ensure existing policy is senior level.
3. Lack of any coordination or collaboration implemented as a matter of urgency.
The Governments cross-departmental 7. Targeted Commissioning for at
between services. Young people reported how
strategy No Health Without Mental Health 2. Training risk 16-19 year olds
changing personnel and agencies, short term
Implementation Framework (HM Government, All professionals and specifically education Consideration should be given as to how
treatments, unclear expectations and different
2011) states: professionals working with children and young services can be targeted at the 16-19
job roles undermined their progress. Improving
people at risk of offending should receive year olds most at risk given the apparent
Effective mental health interventions the coordination, access to and transitions
training to gain baseline knowledge and skills inability of CAMH or AMH services to
can improve the health of some of between services would have a significant
regarding the identification and awareness of respond appropriately. Contracting with local
impact on young peoples experiences and
the most excluded people in our care pathways.
mental health issues to ensure children are not community services demonstrated success,
communities and address some of the written off as trouble children. Both police as did engagement with the client group such
4. Who holds the ring? Young people reported and magistrates need training in mental health
factors that contribute to offending as those supported by Youth Access and
a chaotic mix of health care pathway to deal with the young person appropriately
behaviour. Improved awareness, Transition to Adulthood (T2A), and co-location
management with the young persons mental and ensure appropriate sentencing. All
support and evidence-based training with other services.
health being the cost. Assertive health care professionals in the criminal justice system
for criminal justice professionals pathway management is crucial for these must understand any mental illness issues and 8. Easy access to services and
can also improve the experience of young people whose life circumstances are not just see the crime. information
changing rapidly. If one individual or agency A single point of access to services should be
people with mental health problems 3. Senior Clinicians Role
took the lead they could actively monitor the extended to include young people involved
accessing the criminal justice system clients care pathway, hold other services to
Make the best use of expensive senior with the criminal justice system. CAMHS
as either a victim or a witness. clinicians time and expertise by enabling websites should develop better information,
account, ensure medical case reviews happen
them to provide supervision and consultation targeting this group to provide a shared
Following Lord Bradleys (2009) report, the regularly, medication is actively monitored and
for a large number of the youth and young point of information for young people, social
strategy emphasises the importance of ensuring the young person actively engaged as well
adult workforce providing treatment for workers, health professionals, criminal justice
offenders (including young offenders) have the as improve coordination.
young people; thereby also providing on the professionals, parents and police.
same access to mental health services as the 5. Easy access to accurate information for young job training in a practical way.
rest of the population throughout their journey people, families, advocates and services is 9. Raise awareness
through the justice system, and that mental 4. Lead professional Local government should appoint an
essential. Confusion and uncertainty leading to
health problems, substance misuse and learning Responsibility to actively monitor a young elected member to be a mental health
a lack of confidence caused by not knowing
disabilities are picked up as early as possible. persons case needs to lie with a lead champion and this role should include raising
was consistently reported. Information
professional: an individual or agency that awareness of mental health problems.
From the interviews in the research some key about all services, referral processes and
ensures that medical case reviews take place YoungMinds is one of six national mental
themes emerged which provide the basis for the confidentiality must be available which explains
regularly, medication is actively monitored and health organisations supporting member
recommendations and practical steps that follow: simply what can be expected and when.
the young person is actively engaged in their champions in local government. To take up
mental and physical health care. the mental health challenge visit the website
www.mentalhealthchallenge.org.uk
Achieving Sustainable Improvement: Current Government Policies
Implementation of Existing Policy impacting on the report findings:
To achieve sustainable improvements for young No Health Without Mental Health
people who are in the youth justice system (HM Government, 2011)
and experience mental health problems there
No Health Without Mental Health
are a number of practical steps that individuals
Implementation Framework
and agencies can take. It requires change and
(Department of Health, 2012)
collaboration from all affected agencies in order
to embed new practices. NICE guidance
There are a number of existing government National Youth Agency Commission into
policies and strategies that impact on many the role of youth work in formal education
of the key issues above. Some, such as the Health and Social Care Act 2012
cross-government Mental Health Strategy
Implementation Framework were developed with The Inclusion Health programme
YoungMinds and we believe, would, if enacted, Dame Fiona Caldicott Information
greatly contribute to addressing the issues and Governance Review (Caldicott 2 Review,
needs of this report. 2013)
Sometimes small changes can have a big impact Preventing Suicide in England; a cross-
on the whole system. Therefore the practical government outcomes strategy (HM
steps are aimed at being as specific as is possible. Government, 2012a)
For clarity and where appropriate, the Ministerial Working Group on
recommended actions from relevant government Homelessness
policy will be repeated here for the sake of
The Children and Young Peoples Health
comprehensiveness.
Outcomes Strategy
Support and Aspiration: A new approach to
Special Educational Needs and Disability
The National Diversion Programme
The need for consistency of Comprehensive Health Assessment Tool

relationships with young people. (CHAT)
It takes time for trust, mutual Dangerous and Severe Personality Disorder
respect and empathy to develop (DSPD) services review
and is the core requirement for
positive developmental work to
take place.
Detailed Recommendations: What organisations can
do locally to implement change for improvement
Government cross cutting actions justice system as they are a key high risk Use the Local Government Associations as with criminal justice agencies on the overlap
Existing policy in the Caldicott Review (2013) group who are a priority for prevention Knowledge Hub allowing members and staff to between mental health issues, drug and alcohol
should be implemented:- (HM Government, 2012a). Continuing to share innovative approaches and good practice. misuse, and offending). Pooled and community
improve the mental health outcomes for budgets offer a means for achieving this.
The Caldicott 2 Review recognised the people in contact with the criminal justice Sign up to the Time to Change campaign
importance of managed information sharing for system will contribute to suicide prevention. to raise the profile of mental health across the Involve people in all aspects of
patients. Point 7 of the Professional standards authority and address stigma among staff. development of JSNAs and Joint Health
and good practice states: The duty to share Raise the profile and awareness of key Authorities can also develop local initiatives to and Wellbeing Strategy (JHWS). This
information can be as important as the government recommendations and policies make tackling stigma business as usual. includes pro-active and meaningful involvement
duty to protect patient confidentiality. which impact on the lives of young people of the most vulnerable and excluded groups, who
Health and social care professionals should have in the criminal justice system with mental Health and Wellbeing Boards: often have the highest levels of mental health
the confidence to share information in the best health problems. need, as well as people who use mental health
Existing policy in the Mental Health Strategy (HM
interests of their patients within the framework Government, 2011) needs to be implemented:- services, their families and carers. They can also
set out by these principles. They should be Local Government: enrich the picture by involving local independent,
supported by the policies of their employers, Existing policy in the Mental Health Strategy that Ensure local mental health needs are
voluntary, community and user and carer-led
regulators and professional bodies. needs to be implemented: properly assessed, and ensure they are
organisations, which have significant knowledge
given appropriate weight in comparison
Recommendation 2 (sections 3.3 and 3.4) Appoint an elected member as mental of local mental health needs and assets. For more
with physical health needs. A robust Joint
states: For the purposes of direct care, health champion. This role might include specialist needs, they can also seek input from
Strategic Needs Assessment (JSNA) process will
relevant personal confidential data raising awareness of mental health issues, national organisations and forums.
ensure mental health needs, for people of all ages
should be shared among the registered including the impact of stigma and discrimination, and including vulnerable, excluded and seldom Consider the mental health impact of
and regulated health and social care across the full range of the authoritys work heard groups, are properly assessed building services and initiatives beyond health and
professionals who have a legitimate and with other elected members, including lead on existing information and data. This will include social care. Gaining input from organisations
relationship with the individual. Health and members for children. It can also link to the work links between mental and physical health and outside the health and care system is particularly
social care providers should audit their services of the Overview and Scrutiny Committee (OSC) implications for families and carers. important in relation to mental health. This
against NICE Clinical Guideline 138, specifically and health and wellbeing board. approach supports the governments approach
against those quality statements concerned From the Report of the Children and Young
Assess how its strategies, commissioning to tackling multiple disadvantage outlined
with sharing information for direct care. Peoples Health outcomes Forum (2012)
decisions and directly provided services in Social Justice: transforming lives (HM
chapter 4: the Forum welcome the new duty
Recommendation 14 (section 9.2) states: support and improve mental health and Government, 2012b), published in March 2012,
on the Secretary of State for Health and CCGs
Regulatory, professional and educational bidis wellbeing. Almost all areas of a local authoritys and is in line with evidence about the wider
which should increase action to address health
should ensure that: (a) information governance responsibility have the potential to contribute determinants of mental health problems.
inequalities. Whilst there are many groups facing
and especially best practice on appropriate to good mental health and wellbeing, or to disadvantage, the Forum has focused in particular
sharing is a core competency of lead to poor mental health. Decisions about on the very poor health outcomes of the 65,000
undergraduate training. And (b) information employment, housing, planning, transport, children and young people who are looked after
governance, appropriate sharing sound leisure and green spaces and other community Ensure local mental health
by the State, as many of these poor outcomes
record keeping and the important of data services all directly affect mental health. needs are properly assessed,
are avoidable. To address this disadvantage we
quality are part of continuous professional recommend: directors of Public Health, through and ensure they are given
Involve the local community, including
development and are assessed as part of those with mental health problems, their their health and wellbeing board, should ensure that appropriate weight in
any professional revalidation process. families and carers, in the co-production they include comprehensive data for all children comparison with physical
We recommend: of service pathways and in service design. and young people within their Joint Strategic Needs health needs.
This includes providing clear and accessible Assessment including those requiring tailored
Ensure cross-government strategies provision, such as those who are looked after, those
communication regarding how peoples views
and policies are understood by each with disabilities and long-term conditions and those
and priorities have been taken into account.
department and their strategies reflect an in contact with the criminal justice system.
implementation plan to achieve governments Consider using wholeplace or community
desired outcomes e.g. Preventing Suicide budgets to improve the quality and efficiency Bring together local partnerships to
Strategy requires a tailored approach for of support offered to people with multiple needs improve mental health and enhance life
identified people in contact with the criminal including a mental health problem. chances: Encourage joint commissioning
between health and health-related services (such
General Practitioners Ensure they consider the mental health Commission talking therapies which offer the criminal justice system should those young
We recommend: needs of their whole population, including the full range of NICE approved therapies. people have started their treatment pathway
seldom-heard groups. Offering a choice of providers through Any under CAMHS.
There needs to be clarity and consistency in the
Qualified Provider (AQP). This will ensure equal
management of the care pathway which clarifies This includes: Consideration should be given as to how services
accessibility for all groups, particularly older
who the lead clinician is. All young people who can be targeted at the 16-19 year olds who are
People not registered with a GP, those in the people and Black and Minority Ethnic (BME)
are in receipt of medication for mental health at most risk, and given the difficulty of CAMH
criminal justice system, and those less likely to communities.
problems, should be called for review regularly e.g. or AMH services responding appropriately.
access mainstream services.
every three months, especially on starting a new Commission for recovery Recovery- Contracting with local community mental health
course of medication. Commissioning for effective transitions - oriented services aim to support people to agencies (e.g. Youth Access member agencies
between Child and Adolescent Mental Health build lives for themselves outside of mental offering counselling along with a range of other
Lead Professional: Young people at risk of offending Services (CAMHS) and adult services, and health services with an emphasis on hope, co-located services) could be a more constructive
behaviour should have more regular contact with between working age adult services and control and opportunity. The Implementing route for commissioned services for this group.
their GP. When appointments are missed, the GP services for older people. Recovery through Organisational Change
takes responsibility for making contact with the Commissioners should ensure that services are in
Considering the role of mental health promotion programme provides tools to assess how well
young person and inviting them for a review. If place in every local area to treat and support adults
and mental illness prevention, alongside they are doing and take steps to become more
several appointments are missed or additional with ADHD to prevent them being left with no
commissioning services for people with mental recovery-oriented. The Individual Placement
concerns arise, CAMHS will be alerted and treat support at 18 years of age and thereby being at
health problems. and Support approach to employment is
the referral as high priority. increased risk of offending behaviour.
effective for working age users of mental health
Following good practice guidelines, as laid out Use specialist support and guidance for services.
mental health commissioning. CAMHS and AMHS
in shared decision making recommendations
This includes the published NICE Quality Utilise specific mechanisms to support Should work actively together to create
in Children and Young Peoples IAPT service,
Standards on service user experience in choice in mental health including choice effective pathways of care for vulnerable young
on initial prescribing of medication, clinicians
adult mental health (NICE, 2011), other of provider, where possible, and choice of people aged 16+ and ensure their mental health
will explain the reasons for choosing a specific
NICE Quality Standards, and guidance produced treatments, interventions and therapies. These care needs are met regardless of which service
medication, its purpose, strengths and
by the Joint Commissioning Panel for Mental include Advance Directives, Independent holds the casework responsibility.
weaknesses in addressing their mental health
Health. It also includes drawing on a range of Mental Health Advocacy and Independent
concerns along with possible side effects. Ideally Should actively work together to implement
specialist expertise, including mental health Mental Capacity Advocacy plus the rollout of
the clinician and young person will agree the best the governments Mental Health Strategy
networks where they are established. personal health budgets.
treatment pathway and management of taking implementation plan and Caldicott 2 Review (2013)
the medication and coping with side effects Commission to intervene early. We recommend: regarding sharing patient information effectively.
together. Evidence-based and cost-effective Make best use of expensive senior clinicians time Ensure NICE guidelines and quality standard
early interventions include early treatment and expertise by enabling them to hold overall case on ADHD (NICE, 2008 & 2013), Transitions
Clinical Commissioning Groups (CCGs) of childhood conduct disorder and early supervision and provide consultation and advice and suicide prevention are enshrined in the
Existing policy in the Mental Health Strategy that intervention in psychosis teams. CCGs may for a large number of young people who receive organisations strategies and implementation
needs to be implemented: wish to commission some of these jointly. treatment and care from across the youth and practice.
CCGs can appoint a mental health lead at Develop robust systems and structures young adult workforce. This would provide on the
Ensure NICE guidance on conduct disorders
senior level, to oversee their mental health for the local community, serviceusers job skills and knowledge training in time efficient
(2013) is implemented.
commissioning work and ensure links to other and carers to influence and lead and practical ways.
services. This could include developing mental commissioning decisions. This could be Ensure NICE guidelines on provision of training
Young people at risk who are in the criminal justice
health elements of Joint Strategic Needs achieved by strengthening relationships and for foster carers and guardians for children at
system and have mental health problems need
Assessments (JSNAs), ensuring integration joint working with local groups and service risk of or in contact with the criminal justice
access to longer term treatment if they are to have
of primary and secondary care mental health users to: assess the quality, performance and system are implemented.
sustained, improved mental health.
services, developing CQUIN7 measures for outcomes of services and the effectiveness of Ensure NICE guidelines on provision of
mental health, developing expertise in the Commissioners should review CAMH and AMH
care pathways; and to co-design new service group social and cognitive problem-solving
mental health aspectsof QIPP8, and keeping services referral and acceptance protocols for
models. To embed involvementwork, CCGs programmes are offered to children 9-14 years
up with the latest developments in evidence- the 16-19 year age group needing mental health
can demonstrate to the local community what who are at risk of or are in contact with the
based mental health practice. CCGs may also services, recognising that the current transition
actions they have taken to implement the criminal justice system.
wish to establish a sub-committee which arrangements are often detrimental to their mental
strategy and this framework.
includes mental health professionals. health. There is a clear case for the continuity of
care for a small number of complex cases involving
Local Criminal Justice Organisations:
Existing policy in the Mental Health Strategy (HM Government, 2011) needs to be implemented:
Contribute fully to JSNAs and JHWSs. Courts can ensure they are aware of
Police forces can play an important
It is good practice for criminal justice options available to them, including
role in identifying offenders with
organisations to be involved. This can also to divert offenders with mental health
mental health issues. They can ensure
set out how local work to improve health and problems from custody or the criminal
their officers are aware of the support
wellbeing outcomes can contribute to local justice system, where appropriate, so that
available to them to help identify
efforts to reduce crime and re-offending. This treatment is provided in the best place.
potential mental health problems and
could be through joint working with or even These include the use of the mental health
deal with known issues. This includes
being invited onto the health and wellbeing treatment requirement as part of a community
appropriate use of their powers under Sections
board; or through joint working with existing sentence, and secure mental health services
135 and 136 of the Mental Health Act, of local
criminal justice partnerships. where an individual requires assessment or
policies on health-based places of safety, and
treatment under the Mental Health Act.
Develop staff awareness of mental health of liaison and diversion services. Association
issues ensuring that staff have attended Probation services can work with Youth of Chief Police Officers (ACPO) has produced
appropriate, evidence-based awareness Offending Teams, mental health services, guidance and training resources to assist police
training and have access to relevant guidance and liaison and diversion services to forces in responding to mental health needs in
and information; and can build mental health develop effective diversion routes. a range of situations.
awareness into more general learning and Strong partnerships between probation
Youth Offending Teams should observe
development programmes as appropriate. and these services are crucial for timely
the statutory requirement to employa
identification of needs and effective joint
Support victims and witnesses with health worker and, in line with guidance,
working for the duration of a sentence,
mental health problems to ensure they consider whether the post should be
for the use of the mental health treatment
feel able to report crimes and go through filled by a mental health professional,
requirement, and as a means of diverting
investigation and court processes. based on an assessment of the health needs of
offenders from the criminal justice system
Consistently apply safer custody policies the young offender cohort. They can also refer
or from custody where appropriate.
and procedures for identifying and caring young people to evidence based alternatives
Prisons can ensure that offenders with to custody programmes, such as Multisystemic
for prisoners at risk of suicide and self-
mental health problems are identified as Therapy and Intensive Fostering, where these
harm. Be conscious of the evidence which
soon as possible, and given appropriate are available.
shows that people in contact with the criminal
support. This includes suitable access to
justice system are at high risk of suicide, and
health services and rehabilitation services
that the raised risk occurs at all stages within
offered within the prison, or externally where
the system, not just among those in custody.
necessary, both for prisoners with common Develop staff awareness of
The Crown Prosecution Service can mental health problems and those with more mental health issues ensuring
ensure they are aware of the options specialist needs, including personality disorders. that staff have attended
available to enable treatment for
Prisons can ensure relationships and appropriate, evidence-based
offenders with mental health problems
joint working exist with the relevant awareness training and have
to be provided as part of an out of court
disposal. This includes through a conditional
health services, local authorities and access to relevant guidance
community organisations to support and information.
caution with a condition to attend an
prisoners on release. Support should be
appointment with mental health services.
offered through the gate to provide as much
continuity as possible.
6. Best practice examples
Generic Childrens Workforce MAC-UK therapy (MST)

(including youth workers) http://www.mac-uk.org/ http://www.brandon-centre.org.uk/
We recommend: This includes both voluntary sector support and multisystemic/what-is-multisystemic-therapy/
MAC-UK aims to radically transform the way in
government programmes such as Work Choice which services are delivered to excluded young This is an evidence-based, intensive, community
Training, both in service and as part of the
and Access to Work. They can also ensure local people. Their model of working is called Integrate based therapy that addresses the range of
professional qualifications, is required for all the
commissioners and providers are aware of the and it takes mental health professionals out of the difficulties that lead to anti-social behaviours
children and young peoples workforce which
contribution of voluntary, community, user clinic and onto the streets to work with excluded and emotional problems.
enables an increased understanding of how to
and carer-led support available to people with young people where they are, when they need it.
support the development of good mental health,
how to identify mental health problems and the
mental health problems in their area. Right Here Newham boxing project
importance of early intervention. Support communities in holding public AMBIT http://www.right-here.org.uk/projects/newham/
bodies to account. This could include: http://www.annafreud.org/pages/ambit.html
Advocacy by generic staff and volunteers Right Here Newham commissioned a boxing
on behalf of children and young peoples Supporting people affected by mental health The AMBIT (Adolescent Mentalisation-based project, where young people can access one to
mental health needs is required in order to problems to engage with MPs, Councillors and Integrative Treatment) model was developed one mental health support whilst attending a
ensure services respond and deliver support Overview and Scrutiny Committees (OSCs). by the Anna Freud Centre and involves training boxing club. The aim is to help engage 16-18 year
appropriately. frontline workers to deliver help for young olds, who would not access traditional mental
Support local youth representatives to take up people in crisis, who are defined as hard to reach. health services.
All services working with children and young places for lay members on Boards or governing The frontline workers are training in a number
people need good relationships and support from bodies of relevant organisations, including of treatment methods and are supported by Kings Youth Violence Project
the local CAMHS and possibly AMHS teams with Foundation Trusts and clinical commissioning groups. psychiatrists and psychologists. http://www.redthread.org.uk/?projects=kings-
access to specialist advice and referral routes to
Offering mental health awareness support, college-adolescent-emergency-room-ear
access appropriate care and support. The Zone
including user-led training, for local public
The youth worker organisation Redthread have
services which have a role in improving mental http://www.thezoneplymouth.co.uk/
Magistrates: been embedding workers within the trauma centre
health outcomes.
We recommend: This Youth Information, Advice and Counselling at Kings College Hospital. The team work closely
Raise awareness of mental health amongst Service in Plymouth provides a range of with accident and emergency staff to try and
Ensure all magistrates working in the youth relevant organisations. This could include community based services such as counselling, disrupt the cycle of violence that bring hundreds
courts are trained in the issues relating to public services, businesses and other private sexual health, and drugs advice, but also provide of young people to the hospital each year.
mental health and offending as well as in the sector organisations. It could also include other a service for young people with emerging
services and help available. community groups, including those with a personality disorders, an early intervention in
Pre-sentencing reports must be complete, focus on physical health, particularly long-term psychosis service, and a service to help young
comprehensive, up to date and include conditions. In rural areas, this could also people reduce their criminal behaviour.
information about the young persons emotional include parish councils, who work with many
wellbeing and mental health needs. local voluntary organisations and are close to Brandon Centre and Multi-systemic
their communities.
Community Groups:
Existing policy in the Mental Health Strategy Schools and Pupil Referral Units
needs to be implemented:- (PRUs):
We recommend:
Inform JSNAs and JHWSs so they proactively
provide input to local needs assessments and All schools and PRUs to train their staff in
commissioning processes. mental health awareness.
Raise awareness of services and support. All schools and PRUs to ensure the Personal,
They are ideally placed to raise awareness locally Social and Health Education (PSHE) curriculum
of the services and support available, as well as includes how to look after your mental
of peoples rights and entitlements. wellbeing.
Appendices
1. Acts of Parliament/Bills processing through Parliament Timeline

The timeline sets out some of the key government bills going through parliament, acts
of parliament and initiatives connected to mental health, the justice system, and early
intervention over the last 20 years in chronological order.
2007 1999
2013 2011
Family Nurse Partnerships first 10 sites start National Service Framework for Mental Health
Age of Criminal Responsibility Bill Troubled Families Programme testing (Department of Health, 1999)
Anti-social behaviour, Crime and Policing Bill Parenting Classes Trials Mental Health Act 2007 Audit Commissions report Children in Mind
Care Bill NHS becomes responsible for commissioning (Audit Commission, 1999)
young peoples health services in Secure 2006
Child Maltreatment Bill 1998
Childrens Homes and Secure Training Centres Family Intervention Projects established, part of
Children and Families Bill Respect Action Plan Crime and Disorder Act 1998
No Health Without Mental Health-the coalition
Crime and Courts Act 2013 governments mental health strategy 2005
1997
Education (Information Sharing) Bill The National Liaison and Diversion Programme Intensive Fostering pilots No More Excuses White Paper, new approach
Offender Rehabilitation Bill to tackling youth crime
2010 2004 (HM Governement, 1997)
Sentencing Escalator Bill
Breaking the Cycle effective punishment, National Service Framework for Children,
Young Offenders (Parental Responsibility) Bill rehabilitation and sentencing of offenders Young People and Maternity Services 1995
(Lord Chancellor and Secretary of State for (Department of Health, 2004a; Department Together We Stand National Review of
2012 Justice, 2010) of Health, 2004b) CAMHS (NHS Health Advisory Service, 1995)
Draft Anti-Social Behaviour Bill
(Home Office, 2012) 2009 2003 1994
Healthy Children, Safer Communities - strategy Criminal Justice Act 2003 Working Group on High Security and Related
Children And Young People Health Outcomes
to tackle youth crime/anti-social behaviour Psychiatric Provision report (Reed, 1994)
Forum (2012) Anti-social Behaviour Act 2003
(Department of Health, 2009)
No Health without Mental Health: National CAMHS Support Service launched 1992
Youth Justice Liaison and diversion schemes
Implementation Framework (DH, 2012)
six pilots set up Review of the Health and Social Services for
Preventing Suicide in England
2002
Mentally Disordered Offenders and Others
Healthy Child Programme early intervention Youth Inclusion and Support Panels pilots
(HM Government, 2012a) Requiring Similar Services (Secretary of State
public health programme launched
Social Justice: Transforming Lives - strategy to for Health and The Home Department, 1992)
Multi-systemic Therapy pilots
help families with multiple disadvantages 2001 Health of the Nation national health strategy
(HM Government, 2012b) Lord Bradleys review of people with mental (Secretary of State for Health, 1992)
Introduction of the Intensive Supervision and
health problems or learning difficulties in the
Swift and Sure Justice Surveillance Programme
criminal justice system (Bradley, 2009)
(Secretary of State for Justice, 2012)
Legal Aid, Sentencing and Punishment of 2008 2000
Offenders Act 2012 Youth Inclusion Programme
Criminal Justice and Immigration Act 2008
Youth Offending Teams
Children and Young People in Mind National
CAMHS Review final report (National NHS Plan (Secretary of State for Health, 2000)
C AMHS Review Expert Group, 2008)
2. References Department of Health, et al. (2009) Healthy Haines, A. et al. (2012) Evaluation of the Youth
Age of Criminal Responsibility Bill 2013-14. Care Bill 2013-14. http://services.parliament. children, safer communities: a strategy Justice Liaison and Diversion (YJLD) pilot scheme:
http://services.parliament.uk/bills/2013-14/ uk/bills/2013-14/care.html to promote the health and well-being of final report. Liverpool: University of Liverpool.
ageofcriminalresponsibility.html children and young people in contact with the http://www.dh.gov.uk/prod_consum_dh/
Centre for Social Justice (2012) Rules of youth justice system. London: Department groups/dh_digitalassets/@dh/@en/
Anti-Social Behaviour Act 2003. http://www. Engagement: Changing the heart of youth Justice. of Health. http://www.dh.gov.uk/en/ documents/digitalasset/dh_133007.pdf
legislation.gov.uk/ukpga/2003/38/ London: Centre for Social Justice. http://www. Publicationsandstatistics/Publications/
contents centreforsocialjustice.org.uk/publications/ HM Government (2012a) Preventing suicide in
PublicationsPolicyAndGuidance/
rules-of-engagement England: A cross-government outcomes strategy to
Anti-Social Behaviour, Crime and DH_109771
save lives. London: Department of Health. https://
Policing Bill 2013-14. http://services. Child Maltreatment Bill 2013-14. http:// Department of Health (2004a) Promoting www.gov.uk/government/publications/
parliament.uk/bills/2013-14/ services.parliament.uk/bills/2013-14/ Health and Well-being Identifying Needs suicide-prevention-strategy-launched
antisocialbehaviourcrimeandpolicingbill.html childmaltreatment.html and Intervening Early: Standard 1 of the
HM Government (2012b) Social justice:
Audit Commission (1999) Children in mind. Children and Families Bill 2012-13 and 2013- National Service Framework for Children
transforming lives. London: The Stationery
London: Audit Commisson. 14. http://services.parliament.uk/ Young People and Maternity Services. London:
Office. https://www.gov.uk/government/
bills/2012-13/childrenandfamilies.html Department of Health. http://webarchive.
Berelowitz, S. (2011) I think I must have publications/social-justice-transforming-lives
nationalarchives.gov.uk/+/www.dh.gov.uk/
been born bad. London: Office of the Children and Young Peoples Health Outcomes en/Publicationsandstatistics/Publications/ HM Government (2011) No Health Without
Childrens Commissioner. http://www. Forum (2012) Report of the Children and Young PublicationsPolicyAndGuidance/Browsable/ Mental Health: A Cross-Government Mental Health
childrenscommissioner.gov.uk/content/ Peoples Health Outcomes Forum. London: DH_4865614 Outcomes Strategy for People of All Ages. London:
publications/content_503 Department of Health. https://www.gov.uk/ Department of Health. http://www.dh.gov.uk/
government/publications/independent- Department of Health (2004b) Promoting the
Blades, R. et al. (2011) Care - a stepping stone en/Publicationsandstatistics/Publications/
experts-set-out-recommendations-to- mental health and psychological well-being
to custody? The views of children in care on PublicationsPolicyAndGuidance/
improve-children-and-young-people-s- of children and young people: report on the
the links between care, offending and custody. DH_123766
health-results implementation of: Standard 9 of the National
London: Prison Reform Trust. http://www. Service Framework for Children, Young People HM Government (1997) No more excuses: a new
prisonreformtrust.org.uk/Publications/ Crime and Courts Act 2013 http:// and Maternity Services. London: Department of approach to youth crime in England and Wales,
vw/1/ItemID/147 services.parliament.uk/bills/2012-13/ Health. http://webarchive.nationalarchives. cm 3809. London: The Stationery Office.
crimeandcourts.html gov.uk/+/www.dh.gov.uk/en/
Bradley, K, Rt. Hon Lord (2009) The Bradley Home Office (2012) Draft Anti-Social Behaviour
Report: Lord Bradleys review of people with Crime and Disorder Act 1998. http://www. Publicationsandstatistics/Publications/ Bill. London: Home Office. http://www.
mental health problems or learning disabilities in legislation.gov.uk/ukpga/1998/37/ PublicationsPolicyAndGuidance/ homeoffice.gov.uk/publications/about-
the criminal justice system. London: Department contents Browsable/DH_4870561 us/consultations/community-remedy-
of Health. http://www.dh.gov.uk/en/ Department of Health (1999) National service consultation/draft-antisocial-behaviour-
Criminal Justice Act 2003. London: HMSO.
Publicationsandstatistics/Publications/ framework for mental health: modern standards bill?view=Binary
http://www.legislation.gov.uk/
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ukpga/2003/44/contents Hughes, N. et al. (2012) Nobody made the
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uk/ukpga/2008/4/contents
transform lives. London: Centre for Mental DH_4009598 childrenscommissioner.gov.uk/content/
Health. http://www.centreformentalhealth. Department of Health, et al. (2012) No Health publications/content_633
Education (Information Sharing)
org.uk/pdfs/chance_to_change.pdf Without Mental Health: Implementation
Bill 2013-14. http://services. Lader, D. et al. (1997) Psychiatric morbidity
Framework. London: Department of Health.
Caldicott, F. (2013) Information: to share or parliament.uk/bills/2013-14/ among young offenders in England and Wales.
http://www.dh.gov.uk/health/
not to share? The Information Governance educationinformationsharing.html London: Office for National Statistics.
files/2012/07/No-Health-Without-
Review. London: Department of Health. Green, H., et al. (2005). Mental health of children
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uk/20130805112409/https://www.gov. Palgrave. See http://www.statistics.gov.uk/
uk/government/uploads/system/uploads/ legislation.gov.uk/ukpga/2012/10/contents
downloads/theme_health/GB2004.pdf
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InfoGovernance_accv2.pdf
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(2010) Breaking the Cycle: Effective Punishment, of the nation (CM 1986). London: HMSO. Allen, G (2011) Early Intervention: the next steps. Reder P, McClure M, Jolley A: (2000) Interface
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Mental Health Act 2007. London: HMSO. http:// http://www.official-documents.gov.uk/ Singh SP, Evans N, Sireling L, et al (2005): Mind
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Same Old...

the experiences of young offenders

Research by Sarah Campbell Senior Lecturer, and Stephen Abbott, Research

In partnership with the Transition to Adulthood Alliance

Funded by The Barrow Cadbury Trust

I am pleased to welcome this report YoungMinds would like to thank all

In other words, they told us the Same Old...

The ages between 16 and 18

of young people had between one and

ENVIRONMENTAL HEALTHY STANDARDS

FAMILY SOCIAL BONDING

2-4% in the general population

In a Some mental health problems are particularly prevalent in young

Design Focus Groups

The need for consistency of Comprehensive Health Assessment Tool

Generic Childrens Workforce MAC-UK therapy (MST)

1. Acts of Parliament/Bills processing through Parliament Timeline

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