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Martin Smith is a clinical nurse specialist in child and adolescent mental health who has been working for five years in youth offending teams.  He currently works for the North East London Mental Health NHS Trust and is seconded to Havering youth offending team.

 

Regular audits of young people coming through the youth justice system show that the reasons for offending behaviour are lifestyle, abuse, poor parenting and social exclusion. These are similar to the reasons for mental health and drugs problems among young people. So addressing young people’s mental health problems could help address their offending behaviour.

 

Research shows that one-third of 16 to 18 year olds sentenced by courts have a primary mental disorder.(1) It also reveals that half of males on remand and about one-third of sentenced young men have a diagnosable disorder. Frequent drug use is recognised as a problem in all these categories with 6 per cent of young people experiencing psychotic symptoms. (2)

 

Waltham Forest youth offending team (Yot) in east London carried out research that showed young people’s health needs were not being met. (3) Many of these young people also had learning difficulties, which made it difficult for them to access health services while exacerbating problems of social exclusion and alienation.

 

The question was: what resources could be brought in to help these young people now that their mental and physical health needs were identified?

 

I was seconded by the North East London Mental Health NHS Trust as the clinical nurse specialist to Waltham Forest’s Yot so that targets set by the Youth Justice Board could be met; namely, acute mental health referrals should be seen within five days and non-acute referrals within 15 days by a tier three service (specialised multi-disciplinary teams).

 

The role meant that young people could be offered tier three mental health assessments and referred on as appropriate, or have interventions with a combination of clinical supervision and structured clinical meetings within the child and adolescent mental health services (Camhs).

 

But the enormity of the problem meant that not all young people would receive mental health assessments. To address this, an educational programme was carried out to develop skills within the Yot so that more staff could perform basic screening. I could then focus on fast-tracking the young people who needed help most.

 

The educational programme was extended to other local agencies in contact with young people including magistrates, primary care trust school nurses and the fire brigade. The latter was keen to learn about identifying and working with children with mental health problems who might start fires. The programme resulted in earlier detection of mental illness, which in turn would be better for long-term prognosis.

 

A monthly interagency meeting was set up with Camhs to discuss the young people who could not be sectioned under the Mental Health Act 1983, yet were deemed to have severe mental health and drug problems, and who did not want to be referred to Camhs.

 

These meetings gave psychiatrists the chance to talk about managing mental health problems and allowed Yot staff to share useful information on court process with Camhs, as well as reporting on some of their young people who may be offending.

 

My reports supported courts handing down community-based sentences rather than custodial ones to young people with mental health problems. And the work we were doing meant that more specialised psychiatric reports could be obtained if custody was imminent and mental health was a significant issue. Importantly this could support an admission to a psychiatric facility either in custody or the community.

 

General health assessments showed that many young people had never seen a GP or a dentist and that many had missed out on vaccinations. Measures were put in place to tackle the problem, including registering with GPs which led on to them obtaining other health services; talking to GPs about holding clinics at Yot premises; developing links with local dentists; working with primary care trust school nurses to set up clinics so that young people could be brought to have vaccinations on Yot premises; nurses also gave advice on contraception, diet, general hygiene and health.

 

Addressing physical health problems acted as a catalyst to making further progress in addressing young people’s mental health problems, drug use and offending behaviours. It also conveyed the message to clients that Yot staff were genuinely concerned about them and the focus was not just on the offending aspect of their lives.

 

Many young people and their families are not always motivated in their desire to deal with their problems so identifying opportunities to build therapeutic relationships and instigate change are vital. To identify these, good communication with colleagues is paramount to offer consultation, clinical supervision and then take action with young offenders at the point of need. These include: initial arrest; before attending court; when a custodial sentence has been imposed; before release from custody; when the young person has been a victim of crime themselves; crisis in the family, for example parental separation or parental mental illness.

 

Mental health assessments often show that other family members also have severe mental health problems but are not known to local services. I make the initial referrals for these individuals to the appropriate service. Parenting and family work also helps to address some of these problems.

 

When a young person has shown dangerous behaviour such as carrying out arson or sexual abuse, it is difficult to find specialised services and ones that are used can drain financially the referring service.Pooling money and staff from Camhs and developing a forensic mental health service for young people in North East London Mental Health Trust is being looked at to resolve this problem.

 

As well as addressing youth justice work, the model is an excellent example of partnership working that could be tailored to other agencies such as social services, education, and counselling services. This also gives the Camhs tiers fluidity and a framework for disseminating expertise through advice and education. The benefits are accurate referrals to Camhs tier three.

 

 

Training and learning

The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

 

Abstract

The article explains how the mental and physical health needs of young clients are being addressed in a pioneering scheme in the Waltham Forest youth offending team.

 

References

(1) Youth Offending and Health: The role of Yots, Nacro, June 1999 Briefings

(2) Deboarah Lader, Nicola Singleton, Howard Meltzer, Psychiatric Morbidity among Youg Offenders in England and Wales, Office for National Statistics, 2000

(3) M Smith, “An immunization programme”, Primary Care, September, 13 (71): 22-23, 2003