Working therapeutically with young offenders requires a different approach from working with other young people. This is because of their characteristics and needs, which are likely to require the involvement of more than one agency, their often changing circumstances and the context of the youth justice system.

Mental health problems, predominantly of emotional nature (depression, anxiety, self-harm), can be masked by externalised behaviours and are difficult to recognise. Young people can be embarrassed to disclose such information or find it difficult to articulate their distress. In addition, mental health problems may not be easily disentangled from offending behaviours. Either can be the cause or effect of the other or, more often, both can be related to mediating factors such as family violence, parenting or relationships difficulties and drug use. These are compounded by the lack of education, structured activities and self-confidence.

Being clear on who seeks therapeutic help, and why, is always important. If this is initiated by the young person or their family, one needs to understand the motivation to change: is it to alleviate distress or hope for a more lenient sentence? Referral through the courts is likely to be identified as part of the judicial process and affect the young person's engagement. In all cases, such clarity will enable agencies to try to engage the young person, while being honest on the possible "cross-over" with offending work and court orders.

Involving and empowering the family from the outset is equally important, but often not easy. On my last visit to a youth court, the number of young people who were accompanied by their peers rather than their carers struck me.

Adolescents and young adults often find it difficult to engage with mental health services because of the perceived stigmatisation. Outreach work, flexible or joint appointments, sensitive listening style (for example, not asking lengthy questions on experiences that other professionals will have repeatedly asked before) and following their clues (what is important for them at the time) can facilitate the first contact and increase the chances of therapeutic engagement.

As for the intervention, potential overlap should first be distinguished from offending work (such as anger management) and other kinds of support (such as mentorship). Research indicates that more structured and problem-focused approaches (cognitive behavioural therapy) are more likely to engage the young person and lead to changes in emotional, behavioural and offending difficulties.

The integration of therapeutic principles and objectives in existing parts of the care plan and an initially low-key approach may have a better chance of success, gradually moving towards more formalised therapeutic work, depending on the young person's initial response.

Panos Vostanis is a consultant child and adolescent psychiatrist, and professor of child psychiatry at the University of Leicester