Young offenders and mental health
Val Lake and Brian Hall describe how partnership working helped meet the mental health needs of young offenders in Hartlepool
The mental health needs of children and young people have become more widely recognised over the last 20 years, with moderate to severe problems affecting between 10 and 20 per cent. Young people within the criminal justice system are up to three times more likely to have mental health problems compared with their contemporaries in the general population.
Partnership work between Hartlepool youth offending service (YOS) and the child and adolescent mental health service (CAMHS) was an acknowledgement of the potential mental health vulnerability of young offenders. YOSs were formed as a result of the implementation of the Crime and Disorder Act (1998), with changes introduced that moved the emphasis from a system of punishment to one that encourages young offenders to acknowledge responsibility for their criminal behaviour and its effect on victims.
To ensure that young offenders' health needs are assessed and that they receive equitable access to health services, health advisers have been employed nationally within YOSs since their inception. The role of the health adviser is to work in collaboration with other services, acting as an advocate for young offenders and helping them to change their offending behaviour.
Youth crime in Hartlepool is higher than the national average but when the YOS was established there was limited evidence of the needs of young offenders. To help the YOS understand those needs, the health adviser undertook a comparative research study looking at the needs of 80 young offenders compared to those of 80 non-offending young people. The study showed that:
- half of the young offenders were unemployed
- less than a third attended school or training
- those in the young offenders group felt their lack of sound education hampered their future prospects
- the stigma of an impending criminal record affected their future options for employment
- mental health featured as an increasing problem for the young offenders as age increased
- issues of concern included drug and alcohol misuse, low self-esteem, and high levels of anger, aggression, loss and bereavement.
- there existed a profound lack of motivation in the offenders group by the time they reached 15
- male offenders recognised difficulties managing finances
- hopes for their future were limited, creating a living-for-today situation.
The Hartlepool health adviser also developed an holistic assessment of children and young people's health needs. This measured physical wellbeing as well as emotional and psychological needs. In the early stages of this assessment three main themes arose:
- the mental health needs of this vulnerable group
- substance misuse
- access to primary care services.
The health adviser began to seek out appropriate services that could provide support to meet the identified needs. To address mental health needs, liaison with the specialist CAMHS primary mental health worker began. Initial discussions led to a greater understanding of each other's roles and responsibilities and raised awareness of the young offenders' mental health vulnerability for both services. To formalise and further develop this work the YOS health adviser was invited to attend the multi-agency CAMHS sub-group, providing an opportunity to ensure the mental health needs of young offenders were considered within the CAMHS agenda.
Although this was a positive step, the CAMHS team co-ordinator and the YOS health adviser felt the bi-monthly sub-group meetings were too infrequent to gain a real understanding of the issues for young offenders. They were aware of new ways of working in partnership that were being introduced nationally and of initiatives that were being generously funded. Although funding for this type of venture was not available in Hartlepool, the two services were keen to work together, and discussions between the CAMHS team co-ordinator and the YOS health adviser led to the development of their own model that required good will, trust and determination to succeed.
After discussions with CAMHS, YOS management and the primary care trust (PCT), it was agreed that the health adviser would spend one day per week with the CAMHS team and attended the team's multi-disciplinary allocation meetings, which gave an opportunity to increase awareness of the CAMHS referral criteria and participate in group supervision. Possible referrals from the YOS were discussed in these meetings, which went on to create a more focused and efficient means of managing young offenders' mental health and immediately quickened the referral. It was also agreed that the health adviser would shadow members of the team and be involved in initial assessments and therapeutic interventions.
Factors that helped this model succeed were the flexibility and enthusiasm of each service and the awareness of the mental health vulnerability of young offenders.
Benefits
- CAMHS and YOS have developed an increased understanding of each other's roles and responsibilities of working with young people.
- The YOS is now making appropriate referrals to CAMHS.
- The health adviser has an increased understanding of working with young people with mental health issues.
- The political agenda continues to drive the YOS and CAMHS toward closer working strategies.
Recommendations
- Discussions with YOS managers are required to encourage the continued use of this model of partnership working.
- YOS health advisers to undertake appropriately recognised mental health training.
- The health adviser to continue as a CAMHS sub-group member to ensure the YOS client group continues to be included in the CAMHS planning agenda.
- Agreement between the YOS and CAMHS for mental health practice supervision for the health adviser.
- Discussions between YOS and CAMHS are essential to consider the financial implications.
Conclusion
This joint working by Hartlepool CAMHS and YOS has truly demonstrated a determination by both services to develop new ways of working with limited budgetary constraints. It is essential that serious thought is given to the impact and effectiveness that this model of working has begun to demonstrate for young offenders. Substantial improvements in service delivery can indeed be gained if realistic budgetary and service planning takes place and if this model is used as a foundation for further growth.
Val Lake is Team Co-ordinator, Hartlepool CAMHS, and Brian Hall is Health Adviser, Hartlepool Young Offenders Service
For more information email: