My practice

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