Is mental health the key issue?

Sixteen-year-old Joseph Scholes was nine days into his prison
sentence when he was found hanged at Stoke Heath Young Offenders
Institution last March. His distress was such that he had torn the
finger nails from his hands and scratched the word “mum” onto his
leg.

Joseph had been a victim of domestic violence and suffered serious
sexual abuse at the hands of a relative on his father’s side. After
his parents divorced, Joseph spent some time in care in a
children’s home. In his teenage years, he spiralled into
depression, began to self-harm – at one stage slashing his face 30
times with a knife – and attempted suicide.

It was against this backdrop that Joseph was sentenced to two
years’ imprisonment for playing a peripheral role in a street
robbery while in care. Joseph received the maximum penalty for his
age and crime – his only previous conviction was hitting an
ambulance worker who had intervened during a suicide attempt.

“Why did they sentence such a vulnerable child?” asks Joseph’s
mother, Yvonne. “Custody is supposed to be the last resort, but it
patently wasn’t.”

Rehabilitation agency Nacro and Inquest are calling for a public
inquiry into Joseph’s death. But Joseph’s case is far from unique.
Last year 12 under-21 year olds committed suicide in prisons and,
so far this year, 10 have taken their own lives.

However, when Office for National Statistics research shows that 95
per cent of young offenders aged between 16 and 20 exhibit signs of
mental health problems, the suicides come as no surprise. Indeed,
Mental Health Foundation research found that young offenders were
around three times more likely than the general population to
experience mental health problems.

The risk factors that led young people to offend, such as erratic
parenting or living in deprivation, also contributed to mental
health problems, it found. The risky behaviour of offending and
interactions with the criminal justice system also causes stress,
anxiety and depression, which can lead to mental distress.

“How much mental health lies behind offending needs to be looked at
as a whole,” says Fran Russell, Howard League for Penal Reform’s
assistant director.

Nasa Begum, policy officer at mental health charity Mind, says that
by the time many young people offend, their symptoms of mental
distress are quite severe. But there is a high threshold for
eligibility of children and adolescent mental health services
leading to children not being diagnosed.

According to Juliet Lyon, Prison Reform Trust director, the health
service often doesn’t want to get involved with challenging young
people. “It is more convenient for the health service to allow them
to go into the criminal justice system, as prisons have no choice
but to take them”.

When a child offends, mental health problems should be detected
through assessments with youth offending team workers prior to
court. If the offence requires detention, all 12 to 14-year-old
boys and 12 to 16-year-old girls should be placed in local
authority secure children’s homes (LASCH) or secure training
centres (STC)where there is a higher staff-children ratio and a
more child-centred approach than YOIs.

Boys aged 15 and 16 deemed “vulnerable” by YOT workers can also be
placed in LASCHs or STCs. But those placed in prisons are supposed
to receive more intensive monitoring.

Lyon explains that there are a small proportion of violent
offenders with severe mental health problems who need secure
psychiatric hospital placements. But insufficient beds and a
difficult, “messy” procedure to access hospitals means offenders
are often “left languishing in prisons”.

For most, with less severe problems, the choices are minimal. There
is a health care wing, but Russell warns: “The reality is that beds
are short so staff will put them on the wing if they possibly can.”
As a result, many children with mental health problems are in
detention and face numerous problems. Firstly, Begum says, the
philosophy is of “containment and control” rather than
treatment.

John Coughlan, the Association of Directors of Social Services’
lead on youth crime, adds that once a young person is in custody,
“there is a strong likelihood that they will be dislocated from
services they may have previously received in the community”.

Overcrowding in prisons means young people are moved around,
creating an unstable environment and Lyon warns that Prison Service
staff are “compromised professionally” because they want to do
their best but are inadequately trained to work with these young
people.

At the same time, Russell is increasingly concerned by the use of
segregation where the most “challenging” young people are sent if
they are disruptive. Although the experience should address the
behaviour that resulted in the child being sent to the segregation
unit, they often receive less of a regime there than they would on
the wing. However, her main concern is the existence of special
cells to deal with “the most difficult children”. Here, children
claim they are stripped of their clothes and placed in rooms with
no natural light, furniture or toilet. The only object evident is a
bucket, and the naked child is provided with just a jacket and a
blanket.

“It is clear to us that these rooms are being used for young men
who are mentally ill and it is totally inappropriate,” she states.
The rooms are allegedly intended to allow disruptive young people
who cannot be controlled in any other way to calm down for a few
hours. However, the charity fears children are being held there for
“several days at a time”.

This evidence shows that prisons are totally unsuitable for
children with mental health problems. Incarceration is likely to
exacerbate mental distress. Self-harming is common in such
circumstances. Russell describes the most horrendous self-harm
cases where young people place the insides of biro pens into their
veins. “If you ever needed evidence that these are damaged,
disturbed young people, you just have to look at what they do to
themselves.” Yvonne Scholes believes it is a miracle that more
children do not kill themselves in custody. She asks: “Why are
vulnerable children placed in such unsuitable accommodation?”

Her views are echoed by many who work in the sector. Coughlan says
the ADSS would like to see all school age offenders removed from
custody and placed in LASCHs or STCs. There have been no suicides
in these settings and he believes that they are able to provide a
safer environment for distressed young offenders.

However the Howard League feels STCs are unsuitable as they focus
on containment rather than the child’s welfare. “Secure children’s
homes have been established a lot longer and the ethos is about
taking care of young people, identifying problems and meeting
them,” Russell says.

The charity wants to see more LASCHs, but the Youth Justice Board
announced last month that it is seeking to reduce the number of
beds it commissions from LASCHs and increase STCs which provide
“better value for money” – a move condemned by Scholes as
“shockingly disgraceful”. But as Russell highlights: “A lot of
these children should not be in prison in the first place,” and
Lyon says she “can’t think of a less appropriate place” for this
group.

Russell calls for a total review of services for young people and
says “we need to look at the reasons why young people offend
instead of just putting them into prison”.

Better mental health services in the community would improve
matters for many young people dramatically, most agree. And if
secure settings are needed they should “be therapeutic rather than
punitive”, according to Russell. “This is the most pressing problem
facing the youth justice system – not antisocial behaviour as civil
servants seem to believe.”