“Well I can understand people hanging themselves, but when
people cut their wrists that’s just nasty. It was just coming out
of his arm…”
“When I was in one YOI about three people tried hanging
“Everyone used to be at their doors laughing. But it ain’t
funny, they’re mad.”
“If you see for yourself mate, you get a shock.”
“When you hang yourself all your problems are solved”.
Listening to these young men – all aged under 18 – talking in
prison about hanging, raises questions about why we go on locking
up our most vulnerable and volatile youngsters in places that are
likely to make them worse not better. How much damage is done by
putting children and young people with mental illness in prison?
How much harm is caused by exposing troubled young people to the
distress of others, particularly when hard-pressed prison staff
cannot offer the care and support that so many desperately
Currently, there are more than 11,500 young people aged 15 to 20
in jail in England and Wales. Of these, a staggering 90 per cent
have a diagnosable mental illness, or substance abuse problem, or
both, and many also have personality disorders.1 Around two-thirds
of all young prisoners are suffering from anxiety and depression.
Ten per cent will be suffering from a severe psychotic illness such
as schizophrenia or manic depression compared with 0.2 per cent of
the general population. One in five young men and 40 per cent of
young women will have tried to kill themselves prior to
Young prisoners are clearly one of the most needy and most
excluded groups in our society. They are 13 times more likely than
other children to have been looked after by their local authority,
and 20 times more likely to have been excluded from school. On
every measure they are in need and at risk. But from the time when
they start offending these children’s chances of social care,
mental health or drug treatment in the community seem to fall away.
Once they enter the criminal justice system, few courts will have
mental health diversion schemes open to them, few youth offending
teams have been able to involve the NHS in their work and
psychiatric hospitals will continue to use diagnosis to screen out
challenging patients. In the absence of more appropriate services,
magistrates and judges will pass a custodial sentence at an early
stage. Far too often prison gets used as a dumping ground for young
people who have been failed by other public services.
For the majority of vulnerable young people, imprisonment will
compound, rather than resolve, their difficulties. Within two years
of release, three-quarters will have been reconvicted and almost
half – 47 per cent – will be back in jail.3 Not
surprising perhaps when you consider the health of these young
offender institutions themselves. The Prison Service annual report
2001-2 reveals that the service has not been able to meet its own
targets for increasing levels of purposeful activity or for
reducing numbers of assaults in institutions. The best had 28
hours’ purposeful activity a week – the worst just 17.4 hours a
Assaults on staff, prisoners and others are calculated as a
proportion of the average prison population. The average level of
assaults in institutions for under-18s ran at 60.5 per cent –
against a target of 9 per cent. Vulnerable young people are locked
in their cells for up to 20 hours a day, subject to bullying and
the risk of self-harm with little or no opportunity to seek help
from staff or to make plans for resettlement. Surely young
offenders deserve better treatment and guidance rather than
punishment and neglect?
It is difficult to see how things could get any worse but they
have. During the past few months, rising prison numbers, together
with the need to create some capacity in local prisons for those
travelling to and from the courts, have led to severe overcrowding
and extraordinary levels of movement and disruption across the
prison system. In a phenomenon referred to by officials as “the
churn”, transfers and prisoner movements, at little or no notice,
have wrecked any prospects of training or rehabilitation and
severed links between prisoners and their families.
Vulnerable adolescents find themselves in a system where they
can rely only on uncertainty. Instead of providing the stability
and planned care they need, prison replicates the inconsistency and
neglect many will have experienced in their earlier lives. Children
and young people are being moved from prison to prison at such a
rate that at our largest young offender institution, Glen Parva in
Leicestershire, only 40 per cent of the 800 young prisoners have
been there for more than one month. Another institution, Onley in
Warwickshire, recently criticised by the chief inspector of
prisons, has had six governors in charge in the past five years. If
this were a school no one would tolerate such unstable leadership.
Do magistrates and judges fully realise that they can expect no
more than containment from a system in crisis?
It does not have to be like this. Over the years report after
report has drawn attention to the unmet mental health needs of
young people in prison. In the past few months the Youth Justice
Board, the Prisons Ombudsman and the Prison Health Policy Unit have
all acknowledged the need for change and improvement. In its report
on preventing reoffending, the government’s social exclusion unit
has challenged public services, including health, education and
housing, to shoulder their responsibilities for responding to the
vulnerable and so also for reducing crime. Prison is no place for
mentally ill people. The current system does further harm to
already damaged adolescents. There is no need for more research or
analysis of the problem. The time has come for radical reform.
A clear agenda for change, linked to a timescale and underpinned
by adequate funding, must cover early intervention through to
improved mental health services for young adults. It should
- Increased support for vulnerable young families and an enhanced
role for Sure Start in promoting mental health and preventing
- Comprehensive child and adolescent mental health provision
ranging from support in schools and improved primary care for this
age group through to the development of specialist services across
- The NHS to make its full contribution to the work of youth
offending teams as required under the Crime and Disorder Act
- Better assessment of mental health problems at every stage
including point of entry to the criminal justice system and as part
of prison reception procedures.
- Greater geographical spread of court diversion schemes and the
development of mental health link worker schemes with the police
such as those introduced by the mental health and criminal justice
charity the Revolving Doors Agency.
- An extension of restorative justice measures retaining their
emphasis on personal responsibility but involving mental health
professionals and voluntary agencies.
- A reduction in the use of custodial remand and a drive to offer
intensive supervision, family support and specialist
- The development of small secure health settings for those young
offenders who require in-patient care.
Improved prison regimes for young adults with mental health
provision of at least equivalent standard to that available to
young people in the community.
It is a crime that it has taken so long for us to see youth
offending for what it is – a public health issue.
Juliet Lyon is director of the Prison Reform Trust.
1 J Lyon, C Dennison, A Wilson, Tell Them
So They Listen. Messages from Young People in
Custody, Home Office Research Study 201, 2000
2 F Farrant, Troubled Inside: Responding
to the Mental Health Needs of Children and Young People in
Prison, Prison Reform Trust, 2001
3 Social Exclusion Unit, Reducing
Re-offending by Ex-offenders, SEU, 2002
4 Prison Service, Annual Report
2001-2, The Stationery Office, July 2002