Mental health in the youth justice system

1. Mental health of children and young people in the youth justice systemDerbyshire Mental Health Summit Wednesday 25th June 2014

2. ‘Lifestyles and habits established during childhood, adolescence and young adulthood influence a person’s health throughout their life.’ • (Healthy Child Programme, DH 2009) • Half of life time mental illness starts by 14 yrs of age. • More than 50% of 15-16 yr olds had consumed more than 5 alcoholic drinks in the past month. • More than 8 out of 10 adults who have ever smoked regularly start before 19 yrs of age. • 8 out of 10 obese teenagers go on to be obese adults. • (Children and Young People Health Outcomes Forum, 2012) ‘Children face a stepping-stone pattern of risk, where risks during infancy increase the chances of antisocial behaviour during childhood, which in turn amplify the likelihood of convictions during adolescence’. (CMO Report, 2013) …early identification and intervention is key to prevent behaviours becoming entrenched

3. Mental health in the youth justice system • Young people in the youth justice system have three times the prevalence of mental health needs compared to the general population. • YJB research (2005), involving 300 young people from six YOTs and six custodial units, found that 31% had mental health needs, which included: • 18% having problems with depression • 10% suffering from anxiety • 9% reporting a history of self-harm within the last month • 9% suffering from post-traumatic stress disorder • 7% having problems with hyperactivity • 5% reporting psychotic-like symptoms • 25% identified as having learning difficulties • Rates of suicide in boys aged 15–17 in custody in England and Wales may be as much as 18 times higher than the rate of suicide in boys aged 15–17 in the general population

4. On entering custody… • Snapshot data provided by Youth Offending Teams to the YJB at the time of placement (03 August 2012) reveals: This is a on. • Previous history of self-harm - 33% • Non-Acute mental health or psychological condition - 43% • Acute mental health or psychological condition - 6% • Substance misuse which is cause for concern - 52% • Detox for drug addiction - 5% • Non-Serious medical or health complaint - 36% • Taking any medication - 24% • Serious medical or health complaint - 4%

5. The health and well-being needs of children and young people tend to be particularly severe by the time they are at risk of receiving a community sentence and even more so when they receive a custodial sentence (1) • We know from the latest available evidence about children and young people in the YJS that: • Over 75% • have a history of temporary or permanent school exclusion (custody) • have serious difficulties with literacy and numeracy (custody) • Over 50% • have difficulties with speech, language and communication (custody) • have problems with peer and family relationships (community and custody) • of young people who commit an offence have been a victim of crime – twice the rate for non-offenders • Over 33% • have a diagnosed mental health disorder (custody) • of those accessing substance misuse services are from the YJS (community and custody) • have been looked after (custody) • have experienced homelessness (custody)

6. The health and well-being needs of children and young people tend to be particularly severe by the time they are at risk of receiving a community sentence and even more so when they receive a custodial sentence (2) • Over 25% • of young men in custody (and a third of young women) report a long-standing physical complaint • have a learning disability (community and custody) • A high proportion • of children from black and minority ethnic (BME) groups, compared with others, have post-traumatic stress disorder (community and custody) • have experienced bereavement and loss through death and family breakdown (community and custody) • Parental Offending • approximately 200,000 children had a parent in prison at some point in 2009 • with 90,000 at any one point • a ‘thicker soup’ - clustering of vulnerabilities and complexity

7. Examples of risk factors in childhood associated with offending and other adverse outcomes …the costs of failing to respond are high: the lifetime costs of crime amount to around £1.5 million for each prolific offender.

8. Why invest in youth justice? NHS England / Health and Wellbeing Boards / CCGs /PCCs Shared outcomes Youth Justice Services • Children and Young People's Health Benchmarking Tool • Followed recommendations of CYP Outcomes Forum Report 2012 • Developed by Chimat • Indicators from PH OF and NHS OF most relevant to the health and wellbeing of CYP in an easily accessible way to support local decision making • Includes First-time entrants to the youth justice system • As well as key triggers for offending inc: • School attainment, truancy and NEETs • Smoking • Teenage conceptions • Poverty • Public Health Outcomes Framework • • Violent crime (including sexual violence) • • First-time entrants to the youth justice system • Re-offending • • Statutory homelessness • • Hospital admission as a result of self-harm • • Successful completion of drug treatment • • Alcohol related admissions to hospital • NHS Outcomes Framework • Potential Years of Life Lost (PYLL) from causes amenable to healthcare for children and young people

9. If interventions to address a young person’s needs and vulnerabilities are delivered at an early stage, the potential benefit could be very significant. • The Case of James (Audit Commission (2004) : A review of the Reformed Youth Justice System) illustrates the financial cost of not intervening to support speech, language and other educational and social needs at an early age. • Actual interventions and costs were estimated at £153,687 (including 2 custodial terms in secure units before the age of 16). • The cost of providing speech and language support and an educational psychologist from the age of five to 15 was £42,243. • Assuming that the “crime route” was avoided, a saving of £111,444 in criminal justice costs is made through early diagnosis of learning difficulties and intervention to address them. • The scale of the sums involved suggest that services would need only to divert a small number of young people into appropriate services and away from a “criminal career” in order to be cost effective.

10. Specialist Service: Youth Justice Services Seriousness and Repeated offending Asset Custody Pre and Post Court Resettlement Prevention Support Enforcement and Punishment Onset Youth Justice Prevention Targeted Youth Support Early identification of risk CAF Universal Services Young Person’s Life Journey

12. CHAT and Assetplus • Comprehensive Health Assessment Tool (CHAT) • Developed by YJB and Dept. of Health • Evidence based tool specifically for under 18s in the YJS • Both community and custody versions • Covers Physical health, mental health, substance misuse, neurodisability and TBI • CHAT will ease and improve the collection and aggregation of information about health needs in the YJS • Critical that care pathways are established to refer into for specialist assessment and intervention / treatment • Assetplus • Mandatory youth justice assessment • Screening questions in Assetplus link to CHAT

13. Considerations for commissioners • To counter risks, it is important to take a life course approach and to strengthen the protective factors in children themselves and their surrounding environment. Many opportunities exist to change the trajectories of children’s lives. • Earlier intervention and closer links with an array of local health and social services and smarter commissioning are necessary to ensure that service models and funding streams better match the pronounced needs of these young people. • Better access to continuity of care through the offender journey, and integrated delivery of services, can help reduce offending and re-offending, benefiting the health and wellbeing of the wider local community. • Young people with mild-to-moderate needs may not meet the threshold for support from specialist services. Therefore, effective ‘lower tier’ interventions need to be able to be delivered by non-specialist services (but with support available via training and consultancy from local networks of specialist practitioners). • Essential to ensure key transition points are bridged to avoid gaps (‘the cliff edge’), especially youth to adult transitions and resettlement from custody • Engaging voluntary sector services offering wraparound support can provide important support to help young people make progress towards healthy adult lives, but these must be evidence based.

14. For those who have not benefitted from early intervention, YOTs offer an opportunity to turn around the lives of children with multiple and complex needs. • Priority should be placed on developing and resourcing more robust pathways to a range of engaging specialist services. • Children and young people in the YJS often have poor records of engaging with largely clinic-based community health services. Traditional service models are not designed to meet their multiplicity of need; nor are funding streams which create gaps during critical transition points during the teenage years. • Youth justice agencies and professionals often have detailed insight into the individual health and social care needs of people in contact with the YJS. • Utilise the knowledge that youth justice agencies have of evidence-based interventions that produce the most effective and cost-effective health and wellbeing outcomes at the local population level. • Consider that youth justice services have highly trained and experienced staff actively involved in a wide range of physical and mental health, substance misuse and social care work. • Build on relationships that already exist at a local level between health and youth justice services, including shared membership of Community Safety Partnerships and of local criminal justice boards.

15. Thank youHoward Jasper (Senior Development Adviser – Health)Howard.Jasper@yjb.gsi.gov.uk