Meeting the health needs of children in the youth justice system

1. Meeting the health needs of children in the youth justice system Caroline Healy

2. 2 Introduction Policy context Forthcoming strategy: Healthy Children, Safer Communities Health needs of children in the youth justice system Alternatives to a criminal record Systemic conflicts and difficulties Structures Regional Local

3. 3 Policy context Youth Justice Departmental responsibilities: DCSF Home Office, Ministry of Justice Joint Youth Justice Unit (DCSF, MOJ) DH Offender Health CYP section Links with Children, Families and Maternity branch The Children Act 2004 the legislative framework for more effective,co-operative working between agencies dealing with children and young people. Section 10 of the Children Act 2004 places a duty on agencies that provide services for children. The duty will mean that those agencies are required to co-operate with local children�s trust arrangements to improve the well-being of the children and young people in the Local Authority�s area. The Every Child Matters:The Children Act 2004 the legislative framework for more effective,co-operative working between agencies dealing with children and young people. Section 10 of the Children Act 2004 places a duty on agencies that provide services for children. The duty will mean that those agencies are required to co-operate with local children�s trust arrangements to improve the well-being of the children and young people in the Local Authority�s area. The Every Child Matters:

4. 4 Health Strategy for CYP in Youth Justice system Healthy Children, Safer Communities Builds on the Youth Crime Action Plan Reflects Healthy Lives, Brighter Futures for improving the health outcomes of all children and young people, including the most vulnerable. Addresses Healthcare Commission findings about the inadequate provision for those in contact with the youth justice system. Integrates the vision set out in the Children�s Plan and Every Child Matters Programme Responds to three recommendations relating to children in Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system, and in particular to his recommendation that: �The government should undertake a review to examine the potential for early intervention and diversion for children and young people, with mental health problems or learning disabilities, who have offended or are at risk of offending, with the aim of bringing forward appropriate recommendations which are consistent with this wider review.� (Recommendation 3) With this as our start point, we range wider than children�s mental health problems and learning disability. We do so because the nature of child and adolescent development requires consideration of other health and well being needs which can lead to mental health problems later and can propel children into contact with the youth justice system. Lord Bradley�s review of mental health and learning disability (*) Lord Bradley concluded that his review should focus mainly on adult offenders with mental health problems or learning disabilities. His three specific recommendations about children and young people were about: awareness training in mental health and learning disability, so that all staff in schools and primary health care, including GPs, can identify individuals needing help and refer them to specialist services all Youth Offending Teams (YOTs) having a suitably qualified mental health worker with responsibility for making appropriate referrals to other services, and examination of the potential for early intervention and diversion for children and young people, with mental health problems or learning disabilities, who have offended or are at risk of offending. (*) The Bradley Report. Lord Bradley�s review of people with mental health problems or learning disabilities in the criminal justice system. April 2009. Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system, and in particular to his recommendation that: �The government should undertake a review to examine the potential for early intervention and diversion for children and young people, with mental health problems or learning disabilities, who have offended or are at risk of offending, with the aim of bringing forward appropriate recommendations which are consistent with this wider review.� (Recommendation 3) With this as our start point, we range wider than children�s mental health problems and learning disability. We do so because the nature of child and adolescent development requires consideration of other health and well being needs which can lead to mental health problems later and can propel children into contact with the youth justice system. Lord Bradley�s review of mental health and learning disability (*) Lord Bradley concluded that his review should focus mainly on adult offenders with mental health problems or learning disabilities. His three specific recommendations about children and young people were about: awareness training in mental health and learning disability, so that all staff in schools and primary health care, including GPs, can identify individuals needing help and refer them to specialist services all Youth Offending Teams (YOTs) having a suitably qualified mental health worker with responsibility for making appropriate referrals to other services, and examination of the potential for early intervention and diversion for children and young people, with mental health problems or learning disabilities, who have offended or are at risk of offending. (*) The Bradley Report. Lord Bradley�s review of people with mental health problems or learning disabilities in the criminal justice system. April 2009.

5. 5 Healthy Children, Safer Communities Strategic focus on children at risk of both offending and re offending Leadership and accountability Commissioning responsibilities Improving standards Aligning Inspection frameworks Improving attention to health across the YJS pathway Diversion Police custody YOTs Courts Assessment, continuity, resettlement, data, workforce and training Diversion 8 pilots Police custody identifying health needs early in system YOTs ensuring good links with health system Courts Assessment, continuity, resettlement, data, workforce and training Diversion 8 pilots Police custody identifying health needs early in system YOTs ensuring good links with health system Courts Assessment, continuity, resettlement, data, workforce and training

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7. 7 Offending children are bad children��?

8. 8 �Health� needs Physical health: Dental Drugs and substance misuse Diet and nutrition Sexual health Emotional well being, mental health and mental illness Background treatment, attachment, neurological impact on development Learning difficulties Speech language and communication difficulties

9. 9   Behavioural and mental health problems 1 in 5 sentenced males and 2 in 3 of sentenced females have symptoms of anxiety, depression, and fatigue and/or concentration problems, compared with 1 in 10 of young people in the general population. 1 in 10 young men remanded in custody have considered suicide within the last week and 1 in 5 have attempted suicide some time in the past Drugs and alcohol Over half of young people in custody reported dependence on a drug in the year before being in prison. Of these, 1 in 4 sentenced females and 1 in 7 males were dependent on opiates such as heroin. Over half of female prisoners and two-thirds of males had a hazardous drinking habit before entering custody.

10. 10 Low educational attainment 50% have literacy and numeracy levels below those of the average 11 year old. 25% had the equivalent levels to those of the average 7 year old or younger. 30% had no education and training available to them before custody. Disrupted family backgrounds More than 50% have a history of being in care or social services involvement. 2 out of 5 females reported having suffered violence at home. 1 in 5 males reported having suffered violence at home. 1 in 3 females reported sexual abuse when younger 1 in 20 males reported sexual abuse when younger. Source Social Exclusion Unit Report 2002

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12. 12 Systemic conflicts and difficulties Police Sanction Detection Targets Community expectations Sentencers options Therapeutic vs punitive Children�s services/YOT structures Commissioning: CAMHS/child health/LA/MH/prison Multiple assessments Information sharing Communication Continuity and transitions: secure to community/Tier 4/adult YOT health workers: isolated, unrealistic range of skills required, varying ability to access health services (Healthcare Commission reports 2006 & 2009) Structural complexity The Home Office method of performance review that measures the percentage of crimes for which someone is charged or receives another formal sanction. The Home Office method of performance review that measures the percentage of crimes for which someone is charged or receives another formal sanction.

13. 13 Structures Regional Local YOT within a Children's Services Authority AND OR YOT within Safer Communities Partnership

14. 14 Regional Structures Government Office Director of Children and Learners Children�s Services Advisers Department of Health Directors of Public Health Home Office CYP leads Strategic Health Authorities Directors of Public Health Children�s Leads Safeguarding Leads Regional Development Workers for CAMHS National Treatment Agency DAATs YJB Regional teams (only work with local YOTs not secure settings) Regional Children�s Health Boards Regional Improvement & Efficiency Partnerships

15. 15 PSAs are levers 9 Halve the number of children in poverty 11 Raise educational achievement and narrow gap in achievement between children from disadvantaged backgrounds and their peers 12 Improve the health and well being of children and young people 13 Improve children and young people�s safety 14 Increase the number of children and young people on the path to success 15 Address disadvantage experienced because of gender, disability, race, age, sexual orientation, religion or belief 16 Increase the proportion of socially excluded adults in settled accommodation and employment, education and training 23 Make communities safer 24 Deliver a more effective, transparent and responsive criminal justice system for victims and the public 25 Reduce the harm caused by alcohol and drugs

16. 16 Local Structures Local Authorities Children�s Services Authorities Primary Care Trusts (commissioners) Primary Care Trusts (providers) Police Probation Housing Local Strategic Partnerships Crime and Disorder Partnerships YOT Management Board Local Children�s Safeguarding Board Children�s Trusts Drug Action Teams

17. 17 Thank you Caroline Healy Department of Health Wellington House 133-155 Waterloo Road London SE1 8UG 07767 426 107 caroline.healy@dh.gsi.gov.uk