Earlier screening and intervention
The common assessment framework provides an ideal opportunity for the early identification and support for people with mental health difficulties. But care must be taken to ensure that this process does not stigmatise people and deepen social exclusion.
Vulnerable young people on the periphery of, or entering, the youth justice system require better quality mental health screening. Reports from practitioners indicate that need is under identified, with youth offending teams (Yots) relying on limited funds and varying skills in the detection of mental health problems.
Often difficulties first come to light in schools. Some child and adolescent mental health service (Camhs) workers have relocated to schools to improve young people’s access to services and to support schools in their management of young people’s difficulties, but this work needs to be stepped up.
Shared management approach
Camhs, substance misuse services, social care and voluntary sector provision must integrate better.
Practitioners, young people and carers continue to talk about a “pass the parcel” approach to dealing with young people’s mental health needs, with agencies regularly in conflict over whether those with complex behaviour have a mental health, social care or substance-related need. Many of the problems experienced by this group of young people are complex, with unclear diagnoses. They require shared management rather than a fragmented approach.
Accessible, young people-friendly, non-stigmatising mental health services are vital for young people. These services should provide speedy access to other holistic services to assist young people with multiple recovery needs.
In some areas, a one-stop shop approach, where several holistic services are available under one roof, has helped improve provision.
The identification and management of learning disabilities and autistic spectrum disorders, both in custody and in the community, remains inconsistent. Most mental health workers in custody identify this as an area of work for development.
In the community, there are reports of limited resources being available to support young people with these conditions, particularly in the case of mild to moderate learning disabilities. This must be addressed.
Local systems should be developed to effectively identify young people with mental health vulnerabilities when they are in police custody. Young people should be diverted away from the youth justice system and information given to the court with the aim of providing more appropriate care packages.
In Northamptonshire and Hereford, Yot health practitioners work closely with community psychiatric teams whose role is to identify adults with mental health difficulties in police custody. Young people known to the Yot team or identified as having mental health vulnerabilities are picked up through this partnership. The Yot practitioner then assesses the young person, liaises with the court to offer advice where necessary, and negotiates with local mental health providers to facilitate a residential placement or the provision of a package of mental health care.
In-patient treatment assessments
Most young people in the youth justice system with severe mental health problems must enter custody before suitability for in-patient treatment is assessed. This assessment can take at least a month and often longer.
Although specialist mental health teams are now in place in most custodial units, they vary in terms of their resources and services. Furthermore, the skill base of primary health workers (who have the task of screening young people for mental health vulnerabilities on entry into custody) varies considerably in relation to mental health issues.
Ultimately, a prison is no place to address the needs of most young people with mental health difficulties, particularly given the high suicide rates. Some reports are still received of young people being held in former punishment blocks as their condition deteriorates.
Most young people should therefore not enter custody for assessment if mental health difficulties are suspected. Better identification pre-remand or before sentence is required, and those with complex difficulties should be assessed in secure adolescent psychiatric assessment centres if this level of containment and observation is required.
Community alternatives for those with mental health difficulties are not well promoted in courts. Yet there is emerging evidence about their ability to help young people improve their emotional well-being, behaviour and lifestyle.
For example, multisystemic therapy, which involves providing intensive support to enable families and young people to halt destructive and self-destructive behaviour, is being piloted and evaluated in the UK. It is already seen in the US as a best practice response for young people with mental health difficulties.
The Youth Justice Board’s substance misuse resettlement schemes (RAP), meanwhile, are available in 59 Yot areas. These voluntary programmes offer young people practical help with quitting their former lifestyles through focusing specifically on their needs, offering support and advocacy, and putting them in touch with services that can offer alternative leisure, training and employment opportunities.
Some health practitioners in Yots have also talked about the positive impact made by early intervention in psychosis (EIP) teams and forensic mental health services in helping to stabilise in the community young people with more severe mental health difficulties. And more accessible models of Camhs have been commissioned in some regions focusing on socially excluded young people.
Courts need to know about mental health care pathways in their area. Protocols could be developed about what services courts might expect from providers.
For those young people in custody with mental health needs, more intensive, needs-led, and supportive resettlement services are vital for when they leave custody. These services need to promote hopefulness about recovery, focus on self-generated goals for progress, and provide access to services including accommodation, training and employment services, as well as practical support and activities.
For more, go to www.scmh.org.uk