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Recommendation 11 Lifestyle weight management programme staff: training

4.4.10 Young offenders

National picture

Young offenders are at risk of having higher than usual rates of mental health problems for three main reasons:

 Because the original risk factors that led to their offending also predict, in the general

population, to mental health problems. These factors include inconsistent or erratic parenting, over-harsh discipline, hyperactivity as a child, and various other types of stressors on families and neighbourhoods.

 Because various aspects of offending itself may cause mental health problems. The characteristically risky behaviour of young offenders may itself cause stresses.

 Because interactions with the criminal justice system are stressful and may on their own lead to anxiety and depression, particularly those associated with custody.

Research suggests that prevalence of mental health problems for young people in contact with the criminal justice system range from 25 to 81%, being highest for those in custody. Figures in the literature indicate the rates of mental health problems to be at least three times as high for those within the criminal justice system as within the general population.

The most common disorders for both the normal population and the population of young offenders are conduct disorders, emotional disorders and attention disorders. Substance misuse is also a particular problem53.

Local picture

The Surrey Youth Support Service (YSS) works with approximately 2000 children and young people aged 10 - 19 years.

The SCC Youth Justice Service Health needs assessment54 highlights that the majority of the young people in the current assessment have suffered significant loss or bereavement, fewer than 1 in 5 live with both birth parents, their childhoods have often been scarred by abuse or neglect, and a large minority have considered taking their own life or have attempted suicide. The young people's physical and emotional health is poor; they do not take good care of themselves and often engage in behaviour which risks further damaging their health. The children and young people who reach the top end of the criminal justice system are also those with the poorest physical and

mental health too often become looked after children or those who have had extensive involvement with children's social care.

The needs assessment describes the key findings from an audit of 100 randomly selected ASSET documents (YJS assessment tool). The results of the health needs assessment show that this group of young people experience high levels of health needs as well as deprivation and social problems.

 75% of young people were currently using or had used drugs in the past

 65% of drinkers were binge drinking at least monthly, and 11% were binging daily  Up to 84% of young people smoked, and at least half wanted to give up

 75% of young people’s daily functioning was ‘significantly affected by emotions or thoughts’  Over half the young people said they had lost someone special

 31% had suffered from abuse

 18% had thought about killing themselves

 18% of young people had deliberately harmed themselves, and 13% had attempted suicide in the past.

 80% of young people were not living with both parents, and 35% had lived with two or more different carers in the last 6 months

 30% were currently looked after children or had been in the past  89% had at least one family or relationship problem

 25% were living with known offenders

 66% were not in mainstream school or college and 57% had no qualifications.  26% were affected by emotional or psychological difficulties.

 13% had a formal mental health diagnosis and 46% had contact with or a referral to mental health services

Commissioning and Resources

The Surrey Youth Justice Service is now integrated with Surrey YSS (January 2012) with a broader remit around improved outcomes for vulnerable young people. Objectives to prevent and reduce offending are integrated with an overarching strategy to increase participation into

education, training and employment (16-19 years); to prevent homelessness and increase quality supported housing provision for young people up 18 years old; and to offer a CIN service for teenagers. The YSS delivery model is organised into 4 geographical areas (co-terminus with Surrey Children's Services NE, NW, SE and SW), 11 multi-disciplinary borough teams. Every young person and family referred to the YSS is allocated a case worker, receives a full assessment (including health) with an action plan to address need.

The service also undertook a change in strategy towards youth offending alongside Surrey Police with a commitment to work restoratively with young people, families and victims. In practice this means fewer young people enter a formal Youth Justice process and are dealt with out of court on

a Youth Restorative Intervention (YRI) to address offending through making amends within the community.

The Youth Justice strategy for Surrey for 2012 to 2015

 Use restorative approaches to prevent offending, address offending effectively, improve victim satisfaction, raise public confidence and where appropriate to divert young people from the criminal justice system (including young people who are looked after).

 Concentrate proportionately more resource on the smaller number of young people with more complex and higher risk issues where intensive support will reduce the risk of further offending and protect the public with particular attention to transitions to adult services for those with enduring needs

 Maintain low use of sentence and remand custody by providing credible bail support and community sentence options

 Continue to focus on reducing the over-representation of looked after children in the youth justice system

Tackle four major risk factors in offending behaviour by supporting and enabling young people at risk of offending or re-offending to:

 participate in purposeful activity including education, training and employment  live at home or find appropriate supportive alternative housing

 lead lives free of dependency on drugs or alcohol

 overcome the difficulties of emotional and mental health problems

The mental health needs of young people sentenced to a Court Order are scored 0-4 using the ASSET assessment and planning tool. Those with a higher 3 or 4 score triggers at the very least a consultation with a primary mental health worker (PMHW) or CAMHS to discuss level of need, referrals and/or a care plan that usefully starts to address the issue. Those scoring 1 or 2 are monitored, with a plan to prevent/de-escalate usually delivered by the case officer with support from Mental Health services if required.

Table 44 - Mental Health Core ASSSET scores Apr 2012 to Mar 2013

Count of Mental Health Mental Health assessment

scores (ASSET)

TOTAL Young People on Court Order TOTAL % 0 44 22% 1 64 32% 2 60 30% 3 28 14% 4 2 2% Grand Total 198

Source: SCC SYP Performance & Information

CAMHS (SABP) and YSS (SCC) jointly commission four specialist PMHWs posts at WTE Band 7 to improve emotional wellbeing and mental health outcomes. Each PMHW supports across the cohort with a consultation assessment, interventions and training model of delivery and are based within the YSS across the four areas.

‘No Labels’ is a unique partnership project between Surrey YSS and CAMHS designed to engage

13 -18 year olds with emotional and mental health issues. No Labels is for young people who have been referred to CAMHS but for whatever reason have problems attending appointments or are unsure about how CAMHS might be helpful. The YSS provide trained youth support officers, within

each of the 11 boroughs and districts in Surrey, referred to by CAMHS, to ensure teenagers with mental health problems are engaged in services.

Conduct disorders are a serious but frequently unrecognised mental health condition in children and young people. A new NICE guideline highlights the central role of parents and guardians in the management of conduct disorders and antisocial behaviour, recommending specific training

sessions to help support parents and carers.

Conduct disorders are characterised by repeated and persistent misbehaviour much worse than would normally be expected in a child of that age. This may include stealing, fighting, vandalism and harming people or animals. These disorders are the most common reason for children to be referred to mental health services, with around 5% of all children aged between 5 and 16 years diagnosed with the condition. Conduct disorders also often coexist with other mental health disorders, most commonly ADHD.

Parents in the judicial system

A child’s mother or father may be prison, not in Surrey and a percentage of children are likely to also go into the judicial system but these children are not always identified. Safeguarding training has been offered to prison officers.