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Shutting the stable door (on World Mental Health Day)

A 2011 study by the Children’s Commissioner for England raised concerns about both the quality and variation in standards of care for young offenders with mental health issues, writes Kim Evans.

World Mental Health Day raises public awareness about mental health issues. The day promotes open discussion of mental disorders, and investments in prevention, promotion and treatment services.

More than 6,000 under-18s pass through the youth justice system each year and at any one time there are about 1,800 in custody – the highest per head in Europe. The Children’s Commissioner’s report (I think I must have been born bad PDF) found that too much focus was placed on restraining difficult offenders rather than tackling the reasons for their behaviour and that youths in the justice system have higher levels of difficulties on virtually every measure of the mental health and wellbeing scale – a massive 85% have personality disorders – eight times higher than the general population. Half of youngsters in custody have learning difficulties, whilst cases of depression, anxiety, psychosis and self-harm are also higher than average.

The report concluded that young people in custody are some of the most vulnerable in society and that good access to health and mental health services is key to breaking the cycle of offending.

The Ministry of Justice reckon that the mental health of young people who offend is a critical issue in their involvement with the youth justice system, there are known to be very high levels of mental health problems among young offenders, increasing the risks of both offending and reoffending.

The situation is no better amongst the adult prison population – according to the Prison Reform Trust 72% of male and 70% of female sentenced prisoners suffer from two or more mental health disorders, with many having had a previous psychiatric admission before going into prison.

A strategy to promote the health and well being of children and young people in contact with the youth justice system was published by the Department of Health in December 2009. The strategy responded to the recommendations made in Lord Bradley’s review of people with mental health problems and learning disabilities in the criminal justice system. It looked at health and wellbeing at all stages of the youth justice system and made a commitment to improve the provision of primary and specialist healthcare services for young offenders in the community and to support and promote health and well-being in the secure estate. It also recognised that there are health inequalities encountered by children and young people at risk of anti-social and offending behaviour.

So, what do we know from all this?

We know that there are terribly high levels of mental health problems among children and young people who end up in custody. We know that those offenders probably go on to become adult offenders. We know that there are inequalities in healthcare available to treat those young offenders. So the obvious answer would be to spend more money on health care, and education as a preventative measure. Wouldn’t it?

Grossly disproportionate
The new justice secretary Chris Grayling made his inaugural speech at the Conservative party conference. He made ‘no bones about his intention to be a tough Justice Secretary’. He also said that the justice system has to recognise that our prisons are full of people who face huge challenges, and has to be designed to ensure that those people do not return to a life of crime when they are released.

Grayling then neatly sidestepped quite how he intends to achieve that and moved to sound-bite about how, to prove that the Conservative party are ‘on our side’, he will bring forward a change to the law that allows householders to use whatever force they see fit to fight back at burglars. Unless of course their response is ‘grossly disproportionate’.

Well I hope he’s going to run classes for householders to better inform them as to what exactly he means by ‘grossly disproportionate’, because by the time the Sun and the Daily Mail have finished educating them, all the average householder will take away with them is that they can kill anyone stupid and criminal enough to cross their castle threshold.

Grayling says he will not compromise on punishing offenders, half of whom are reconvicted within a year of leaving prison. He then quotes the statistics; a quarter of prisoners were in care as a child. A quarter? How much care did they receive whilst ‘in care’? Half have no qualifications, none at all and he agrees that nearly three quarters have either mental health illness or substance addiction or both. I would say that amongst the young and adult clients I represented at the police station, probably nearer 90% had either a personality disorder, mental health problems or an addiction. Depression amongst young adult males was particularly prevalent.

Grayling said that he was proud of his Government’s reforms to welfare and education. Well, I’m happy he’s happy, but I think he’s maybe seeing only what he wants to see, because whilst there have been improvements in adult services, by contrast child and adolescent mental health services have long waiting lists and a ‘patchy’ provision of services, with campaigners warning that deep cuts to children’s services will only make it worse.

Cuts to sure start centres, school-based counselling support and voluntary sector projects won’t help.

There have been swingeing cuts to Child and Adolescent Mental Health Services (CAMHS), of the 55 areas who responded to a freedom of information request, 29 said that their budgets for children and young people’s mental health services had been cut for 2011/2012. Some councils reported cuts of up to 30%, leaving essential early intervention services at risk. Sarah Brennan, Chief Executive of  YoungMinds, a charity committed to improving the emotional wellbeing and mental health of children and young people said:

‘Draining money from early intervention services is short-sighted, and just stores up problems for the future as young people are left without access to early help, meaning mental health problems become more serious and entrenched.’

In my experience, the young male adults – 17 and 18 year olds who were the most at risk of their problems becoming entrenched were the ones who fell into the gap between children’s and adult services.

Transition to adult services is a notoriously difficult area, with these young adults frequently without any adult support and living alone being unable to access help. YoungMinds says that the way mental health services are commissioned makes it very difficult for young people who are offending to get the support they need. For example, young people who are diagnosed with disorders like ADHD, mild learning difficulties, autism spectrum disorders and personality disorder, even if seen by CAMHS services, will not be taken on by adult services.

So, this is why I despair of the Government’s plans to shut the stable door after the horse has bolted. It’s all very well adjusting a law that actually needs no adjustment in order to pander to the electorate over burglars, but what of the long term?

Until sufficient funding is guaranteed, and available for children’s and young people’s mental health services, the problems are never going to go away – the statistics prove that’s the case. I’d also argue that we need to start even further back, with emotional well being classes in schools. Educate children as to the signs and symptoms of mental well being. Provide them with the coping mechanisms that will assist in avoiding preventable mental health issues. Teach educators how to provide children with an holistic education to promote self esteem and confidence, to assist in making today’s children tomorrow’s better parents.

But you won’t do that will you Government? Because it doesn’t fit into a soundbite.

 

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