Psychological Effects of Imprisonment on Young Offenders

The aim of this dissertation is to examine the claim of authors such as Harrington and Bailey (2005) that a substantial proportion of young offenders in the UK suffer from severe mental illness. In accepting this claim, the secondary aim of this paper is to glean a greater understanding of why this is the case; do these offenders acquire mental illness as a result of the modern prison regime and regardless, why is the modern youth justice system so ineffective in dealing with this seemingly widespread problem?

The researcher of this paper shall argue that the current youth justice system needs, if it to achieve one of its primary aims, namely to rehabilitate youth offenders and prevent them from becoming recidivists, to focus their research and practice more heavily on the psychological processes which cause a young person to offend, so that such offenders, who are clearly suffering from mental problems, can be more easily identified and, where possible, positively helped to resolve these issues whilst they are serving their custodial sentences so that upon release these individuals are more likely to desist from criminality.

The principle methodology of this paper will be a literature review, a review of both primary and secondary sources from the subject fields of forensic psychology, criminology and penology.

Introduction

The primary issue which will be raised and explored throughout this dissertation is the contention that the current youth justice system, and in particular the youth prison system, is failing to adequately address the psychological needs (or as they are described by many criminologists: ‘criminogenic needs’) of youth offenders in the UK. Such an argument necessarily involves a simultaneous examination not only of the statistics which are available regarding the prevalence of mental illness in youth prisons and the rates of recidivism of those youths who have been previously sentenced to immediate custody, but also an examination of the latest psychological research in prisons, the current (and, to a lesser extent, historical) policies and practices pertaining to the ‘treatment’ of those imprisoned offenders who have been diagnosed with mental illness and also the writings of expert researchers in these relevant fields who provide original interpretative insights into the problems associated with mental illness in youth offenders and potential approaches to minimise this apparent epidemic.

The structure of this review shall take the following form: This dissertation will commence with a brief overview of past and present systems of caring for children serving custodial sentences and how their mental health needs were and are now met, including an examination of the changing definition of ‘needs’ in this context. The researcher, using research from government enquires, literature and reports concerned with this issue will then seek to identify those youth justice policies and practices which are apparently ineffective and/or inappropriate in reducing this problem and, in conclusion, make recommendations for future necessary/ effective reforms and also future research which should be conducted to assist in our understanding of the psychological causes of crime and to assist in the formulation of such reforms.

The researcher of this paper is greatly interested in the subject of this paper: After reading in Society Guardian articles about our young prison population the researcher was surprised to learn that there are over 11,000 young people between 15-20 in jail in England and Wales with a diagnosable mental disorder, that 10% will suffer a severe psychotic disorder in comparison with 0.2% of the general population and that the UK has the highest number of prisoners under 21, in comparison with the rest of Europe, 3000 of them being held in youth offenders institutes. Similar surprise ensued from discover of research conducted by the UK Office for National Statistics which found that nine out of ten youth offenders in the UK suffer from a mental disorder. The researcher feels strongly that more research needs to be conducted into these issues so that these worrying findings can be diluted; it is primarily for this reason that the researcher has chosen to conduct this research on that topic. Intending to pursue a career in the youth justice system working with young offenders in the UK, the researcher also feels strongly that a deeper substantive knowledge in this area will aid not merely his professional development but also his ability to help reduce the incidence of mental disorder in the UK youth justice system.

The researcher concedes that the objectives of this research did change direction at various points of the review: Initially, the aim was to identify the current practical failings of the youth justice system and to convincingly demonstrate that these failings directly or indirectly contribute to the problematic prevalence of mental illness in youth offenders and to likewise suggest practical reforms which should be employed to reduce this phenomenon; latterly, the researcher understood that rather than suggesting changes in practical reform that he should attempt to identify the failings in the current research and the strategies employed by the justice system, and to suggest alternative strategies and ideas for future research which will then in turn result in more effective justice practice.

The structure of this paper, as described in paragraph two of this introduction, has been carefully constructed to complement its arguments: the historical analysis of trends in UK penal policy and practice (pertaining to youth offenders) over the past fifty years,with which this paper will commence, provides ample support for the later contention that the current approach employed by the youth justice system in the UK to reduce the incidence of mental illness in its prisons is inadequate and also for those policy reforms which will be recommended by the researcher in this paper’s conclusions.

The Structure of the Literature Review

As noted previously in the introduction, above, the literature review of this paper will not confine itself to any one particular discipline; after all, the subjects of criminology, forensic psychology, social work and, to some extent, penology are have dedicated varying proportions of their research on the issues with which this paper is concerned; namely the prevalence of mental illness in young offenders in the UK Youth Justice system, in particular those offenders currently serving custodial sentences in young offenders institutes, and practical methods for reducing this problematic phenomenon. A clear concern to any researcher conducting amulti-disciplinary literature review of this kind is that the order of the analysis is prone to be confusing; a researcher could choose to perform a separate review of the literature from each respective subject area or, alternatively, a researcher might choose to make no such division but rather separate the review into the relevant questions and under each separate heading utilize the literature from any relevant discipline in no particular order. The researcher of this paper has chosen to adopt the latter of these two approaches; he feels that to divide the review analysis according to topic area is wholly artificial, especially in light of the fact that any research or literature which will be discussed will be wholly relevant to the same issues pertaining to young offenders.

With this methodological approach in mind, the questions which this literature review will seek to discuss and, where possible, answer, areas follows:

1] What is defined as ‘mental illness’ and how has this definition changed over the past 60 years?

2] How prevalent is mental illness in young offenders who arecurrently serving custodial sentences in young offenders’ institutes inthe UK?

3] To what extent is this a recent phenomenon? And to what extent isthis a phenomenon which is particular to young offenders serving asentence in a secure institution rather than to those young offenders who are serving non-custodial sentences or those young persons who have not been involved in the Youth Justice system at all?

4] Historically, how has the UK Youth Justice System responded to the problem of mental illness in young offenders who are currently serving custodial sentences in young offenders’ institutes?

5] Is there convincing evidence which suggests that there is link between this prevalence of mental illness and the high rates of recidivism in young offenders serving custodial sentences?

6] What is the approach which is currently employed by the UK Youth Justice System to tackle this problem?

7] To what extent is the current policy approach of the UK Youth Justice System appropriate in achieving its objectives in this regard?

8] How is this policy approach being implemented by the UK Youth Justice System?

9] Are these practical reforms appropriate in light of the policy approach adopted to reduce the incidence of mental illness in youth offenders in the UK?

10] What changes should be made to the current policy and practice of the UK Youth Justice System to effect a more successful reduction of this problem?

11] What further academic research is needed to assist in the formulation of these new policies and practices?

1] What is defined as ‘mental illness’ or ‘mental health’ and how has this definition changed over the past 60 years?

Any literature review on the prevalence of ‘mental illness’ in a particular population, in this case young offenders serving custodial sentences, would be incomplete without a preliminary discussion pertaining to the definition of ‘mental illness’ or ‘mental health’ in that context.

Within the context of young offenders, it is interesting to note that there is very little consistency in the definition of ‘mental health’: In fact, ‘a review of over 60 national and local education, health and social care documents (policy, strategy and guidance) revealed little consistency within, as well as, across agencies. There were 10 different terms or phrases used to label the positive end of the mental health continuum and 15 to describe the negative’ [Joint Commissioning Strategy for Child and Adolescent Mental Health Services in Kent, Draft Report, 15th January 2007, p6].

This having been said, it does not seem that the definition of ‘mental health’ in this context is particularly contentious. The Kent and Medway Multi Agency CAMHS Strategy Group have provided a working definition which incorporates each of the individual definitions found during their literature review of relevant policy documents: ‘Mentalhealth can be defined as: The ability to develop psychologically,emotionally, intellectually and spiritually, to initiate, develop and sustain mutually satisfying personal relationships, including the ability to become aware of others and to empathise with them, and the ability to use psychological distress as a developmental process, so that it does not hinder or impair further development’ [Joint Commissioning Strategy for Child and Adolescent Mental Health Services in Kent, Draft Report, 15th January 2007, p6]. 

However, to find a comprehensive definition of ‘mental illness’ in this context is not so straightforward: It would seem that practitioners in the field of forensic psychology have divided mental ill-health into three separate categories separated on the basis of severity of symptoms; namely, ‘mental health problems’, ‘mental health disorders’and ‘mental illness’.

Mental health problems, the least serious form of mental ill-health,‘may be reflected in difficulties and/or disabilities in the realms of personal relationships, psychological development, the capacity for play and learning and in distress and maladaptive behaviour. They are relatively common, and may or may not be persistent’ [Joint Commissioning Strategy for Child and Adolescent Mental Health Services in Kent, Draft Report, 15th January 2007, p6].

Mental health disorder is the term subscribed to those persons who are suffering from persistent mental health problems which affect theirfunctioning on a day-to-day basis. Whilst most young people will atsome stage in their development suffer from mental health problems, itis not normal to expect such persons to suffer from mental healthdisorders. As noted by the Kent and Medway Multi Agency CAMHS StrategyGroup, mental health disorder, as a term, ‘[implies] a marked deviation from normality, a clinically recognised set of symptoms or behaviour associated in most cases with considerable distress and substantial interference with personal functions or development’ [Joint Commissioning Strategy for Child and Adolescent Mental Health Servicesin Kent, Draft Report, 15th January 2007, p6].

Finally, mental illness, the most serious of the three forms of mental ill-health, can be recognized in those young persons suffering from severe clinical psychosis or neurosis, e.g. those suffering from schizophrenia.

These definitions provide a clear and useful taxonomy from which we can begin to analyse the statistics on the prevalence of mental ill-health in young offenders in the UK. However, before we commence this analysis, it is first important to briefly examine the perceived historical relationship between mental ill-health and crime ; after all, it has often been the case in the past that societies across the world have attributed certain (if not all) aspects of criminality to symptoms of mental ill-health, in particular mental disorder and mental illness. For example, The USSR during the Cold War often incarcerated political ‘criminals’ on the basis that they must be mentally insane for holding such opinions and beliefs.

Whilst the above example would shock most people of today, this phenomenon is not that far removed from how the UK government has traditionally treated the mentally ill: ‘In the UK, mental health care was for decades provided only in large ‘asylums’ – keeping ‘mentally ill’ people out of society believing this to be for their own good and that of their communities. Beginning in the 1950s and accelerating at the end of the 1980s, government policy switched to providing more services in the community and in most cases limiting hospital treatment to when it is needed most acutely’ [All-Party Parliamentary Group on Prison Health, House of Commons, November 2006, p2].

In light of the fact that historically the mentally ill have been dealt with in the same way as convicted criminals, it is not too difficult to understand why there has developed a publicly perceived link between mental illness and criminality. This misconception has also been given weight by a small number of brutal homicide cases in which the perpetrator was schizophrenic; whilst social workers and psychiatrists of today realise that schizophrenia does not necessarily cause its owners to be criminally violent, public opinion is still not as understanding: ‘Our understanding of mental ill health has…developed [since] that time, though public debate on the topic has not always been in step… the popular assumption that mental ill health and criminality are inextricably linked needs to be broken and policy informed by a deeper understanding of the complex links between mental ill health and offending’ [All-Party Parliamentary Group on Prison Health, House of Commons, November 2006, p2]. Therefore, whilst there may be certain links between mental ill-health and criminality, there is no intuitive similarity between these two respective phenomena.

2] How prevalent is mental ill-health in young offenders who are currently serving custodial sentences in young offenders’ institutes in the UK?

N.B. At the outset of this section of the literature review it is important to remind ourselves that secondary reviews of primary data can often be misleading or, worse, erroneous. For example, to quote a section from the website of the government’s ‘Crime Reduction Toolkit‘ A recent report by the Office for National Statistics, Psychiatric Morbidity Among Young Offenders, found that 9 in 10 young offenders aged between 16-20 years old showed evidence of mental illness’. This statement would, using the taxonomy of mental ill-health discussed insection [1] above, appear to suggest that 90% of young offenders in UK Prisons are suffering from severe psychiatric illnesses such as schizophrenia: such a contention is clearly erroneous as if this were the case then 90% of young offenders in Prison should in fact not be in prison at all but rather in secure mental hospitals. What the statement should have said is: ‘A recent report by the Office for National Statistics, Psychiatric Morbidity Among Young Offenders, found that 9 in 10 young offenders aged between 16-20 years old showed evidence of mental ill-health’. Hopefully this example has shown how careful one must be when attempting to describe or analyse the data findings from primary research.

All of the literature and research supports the contention that mental ill-health among young offenders in UK Prisons is prevalent. A recent Report suggests that “Young people in prison have an even greater prevalence of poor mental health than adults, with 95% having at least one mental health problem and 80% having more than one. [Laderet al., 2000, cited by Sainsbury Centre for Mental Health, March 2006,p3]”. This same conclusion is reported by Singleton et al. (1998): ‘95 per cent of young prisoners aged 15 to 21 suffer from a mental disorder. 80 per cent suffer from at least two. Nearly 10 per cent of female sentenced young offenders reported already having been admitted to a mental hospital at some point.’

A more recent research study conducted by Professor Richard Harrington and Professor Sue Bailey on behalf of the Youth Justice Board, entitled ‘Mental Health Needs and Effectiveness of Provision for Young Offenders in Custody and in the Community’, found that approximately 33% of the young offenders sampled had at least one mental health need, approximately 20% suffered from clinical depression, approximately 10% of these young offenders had a history of self-harm  and approximately 10% suffered from post traumatic stress disorder and severe anxiety . This study also found that approximately 5% of the young offenders sampled had symptoms indicative of clinical psychosis and that 7% of the sample population seemed to suffer from hyperactivity. [Harrington and Bailey, 2005].

In conclusion, it seems indisputable that mental ill-health is prevalent among young offenders in the UK, in particular among those youths serving custodial sentences.

3] To what extent is this a recent phenomenon? And to what extent is this a phenomenon which is particular to young offenders serving a sentence in a secure institution rather than to those young offenders who are serving non-custodial sentences or those young persons who have not been involved in the Youth Justice system at all?
Whilst there is evidence that even as far back as 200 years ago UK Prisons were occupied to some extent by persons who suffered from mental problems, disorders and illness [Thomas Holmes, 1900], it is difficult to ascertain whether this was due to the same reasons which cause the phenomenon today, or whether these offenders were simply put in prison because of their mental ill-health, a practice which, as discussed above, was common in the nineteenth century. Unfortunately, in regards to the historical position, this is not a problem which can ever be easily resolved, and it is a question which is still relevant to a discussion of the phenomenon of today: Is the prevalence of mental ill-health among young prisoners due to their treatment within the youth justice system or did these individuals suffer mental ill-health prior to their involvement with the justice system?

Hagell (2002) p37 suggests that mental ill-health is more prevalent in young offenders than in their law-abiding peers, but this still does not answer the question of whether the reason that these individuals broke the law in the first place was because of their mental problems, disorders or illness: “there is little doubt that young people caught up in the criminal justice system do have elevated rates of mental health problems when compared to other adolescents. A conservative estimate would suggest that the rates of mental illness in these young people is three times as high as that for their peers.”
Likewise, an article by Sir David Ramsbotham entitled ‘The Needs of Offending Children in Prison’, which was published in the Report from the Conference of the Michael Sieff Foundation entitled ‘The Needs of Offending Children’, at p19, that whilst 95% of young offenders in custody are suffering from mental ill-health, only 10% of the general population are suffering from such problems, disorders or illnesses.

This finding is supported in result, if not precise figures, by a research study which was conducted by the Mental Health Foundation entitled: The Mental Health of Young Offenders. Bright Futures: Working with Vulnerable Young People [Hagell, 2002]. This study stated: “Despite methodological hindrances, it is clear from this review of the literature that there is a consensus that young people who offend are likely to have much higher than usual levels of mental health problems.Estimates from research studies suggest that the rates of problems were approximately three times as high as for their peers in the general population. In general, the mental health needs of young offenders are the same as those of the general adolescent population but more acute.” [Hagell, 2002, p28].

Regarding whether the prison regime itself is responsible for this prevalence, or merely the fact of incarceration, a study by Nicol et al (2000) found that there was very little difference between the levels of mental needs in those young persons held in prison and those held in other forms of welfare establishment. This implies that the same mental problems, disorders and illnesses which lead a young person to be incarcerated in a welfare institution are also present in those young offenders who break the law and are subsequently sentences to imprisonment.

A study commissioned by the Youth Justice Board [Harrington andBailey, 2005, p8] seemed to suggest that the mental needs of young persons were reduced as a result of being sent to Prison: “Young offenders in the community were found to have significantly more needs than those in secure care…Needs increased for young offenders discharged from secure facilities back into the community, suggesting that needs are only temporarily reduced while in custody.

In conclusion, there is no doubt that the prevalence of mental ill-health amongst young incarcerated offenders is not a new phenomenon, although it is impossible to state with any certainty whether this phenomenon is worse now than it ever has been in history previously. Regarding whether this phenomenon is particular to youth offenders over their law-abiding peers, it would seem that it is certainly more pronounced with this former group, but also with those offenders serving community sentences and those young persons who are being held in welfare establishments.

4] Historically, how has the UK Youth Justice System responded to the problem of mental illness in young offenders who are currently serving custodial sentences in young offenders’ institutes?

As noted earlier, ‘In the UK, mental health care was for decades provided only in large ‘asylums’ – keeping ‘mentally ill’ people out of society believing this to be for their own good and that of their communities. Beginning in the 1950s and accelerating at the end of the1980s, government policy switched to providing more services in the community and in most cases limiting hospital treatment to when it is needed most acutely’ [All-Party Parliamentary Group on Prison Health, House of Commons, November 2006, p2].

During the 1950’s and 1960’s the link between mental ill-health and criminality had arguably never been stronger; all prisoners were regarded as patients who could be effectively ‘treated’ to prevent them from re-offending in the future and whilst little specific attention was paid to the individual mental needs of offenders, the types of treatment reforms which were offered by the Criminal Justice System at this time were very similar to the kinds of group treatment therapies being offered to those mentally disordered and mentally ill patients in the mental asylums and hospitals of the day. During the 1970’s this paradigm of offender treatment was abandoned primarily as a result of research studies conducted into the success of some of these treatment reforms: conclusions from several research studies into the effectiveness of these criminal treatments on reducing criminal behaviour strongly suggested that ‘nothing works’ (Thomas-Peter, 2006,p29). These embarrassing findings caused the pendulum to swing away from rehabilitation towards a firmer commitment to incapacitation and punishment through positive custody.

During the 1980’s, the wave of ‘new public management’ was born (Thomas-Peter, 2006, p30). This movement focussed heavily upon the procedural roles of the Prison and Probation Services in reducingre-offending. The Prison service started to contract out some of their primary responsibilities in a quest to encourage more efficient service from both their private sub-contractors and also their remaining state Prisons who would have to meet their performance targets to avoid being privatised in the same way as so many other Institutions had been. Likewise, the Probation service was reorganised and reintegrated to encourage greater efficiency of performance: ‘[The Probation Service,rather than] a loosely co-ordinated collection of individual socialworkers [became a unified and managed service] with a clearer sense of direction and purpose, which was more able to engage on equal terms with other services and to contribute and give effect to national policies’ (Faulkner, 2007, p7).

During the 1990’s researchers revisited the studies conducted in the1970’s and found that rather than demonstrating that ‘nothing works’, rather they supported the contention that certain types of treatment initiatives were working with certain types of individuals: Whilst only10% of a group may have responded well to that treatment, if the similarities between those responding offenders could be identified then for this new group, the reform could be said to be very successful. This has lead researchers such as Harper and Chitty (2005) to argue that the new question should not be ‘what works?’ but ‘what works for whom, and why’? This paradigm shall be discussed in greater detail in section [6] of this literature review.

It is important to note that, except for the changes made to the Probation Services in the 1980’s, the above discussion summarizes the developments in the paradigm of Criminal Justice generally and does not specifically answer the question of how the Criminal Justice system has historically dealt with the problem of mental ill-health in young imprisoned offenders.

The fact is that even as late as 2002, there was no real unified system implemented to deal specifically with this particular problem. Research on this topic was sparse and focused rather than on national strategies, on local remedies such as the pioneering work done by the Adolescent Forensic Services in the Midlands. Generally, where Young Offenders Institutions were involving forensic psychiatrists or mental health social workers this was not being done with the aim of treatmentor rehabilitation but rather for the purposes of assessment. Also, rather than assessing each young offender, these processes tended to be used for those offenders who were clearly suffering from mental ill-health and those offenders who specifically asked for such assistance. A report published by the Mental Health Foundation in 2002, entitled ‘The Mental Health of Young Offenders. Bright Futures: Working with Vulnerable Young People’ [Hagell, 2002, p23] summarized the position at that time in the following way: “As far as the Mental Health Foundation is aware, there is no recent research data available on the provision of psychological and psychiatric services to young offenders across the criminal justice system. However, at the time of writing it is clear that, from existing fragmented information, there is no routine, standardised screening employed across the criminal justice system and that responses to problems are inadequate and fragmented.”

Whilst it is true that certain practical initiatives were introduced from the mid-nineties, such as Youth Offending Teams, Detention and Training Orders, Parenting Orders and Child Safety Orders, the discussion of the effects of these reforms shall be reserved for sections [6] and [9] of this literature review, in which we shall analyse the current policy and practical approach employed by the Youth Justice System in dealing with the problem of prevalent mental ill-health among young prisoners.

5] Is there convincing evidence which suggests that there is link between mental illness and the likelihood of being sentenced to immediate custody? Is there convincing evidence which suggests that there is link between mental illness and the prevalence of mental illness and the high rates of recidivism in young offenders serving custodial sentences?

One would be right to question the relevance of this enquiry to the main purposes of this research paper; after all the objective of this paper is to examine the current strategy in dealing with the problem of mental ill-health in young offenders institutes and to propose recommendations for future clinical research and immediate reform. However, the researcher of this paper has chosen to dedicate a section of its literature review to the issues raised in the title of this section because he feels that, if a convincing link between mental ill-health and criminality/criminal recidivism can be demonstrated then it would provide additional support for the importance of reform in this area. After all, the youth of today are the adults of the future, and if it can be shown that reducing the prevalence of mental ill-health in young offender institutions has a positive (reducing) effect on the rates of recidivism then the Criminal Justice System maybe compelled to dedicate extra time, money and resources on further research in this area and also on the implementation of reforms designed to reduce the prevalence of this problem.

The first point to note is that there is a body of research which suggests that young persons with mental disorders are more likely to be arrested, charged and convicted for their criminal behaviour than those young people in similar circumstances who do not have such severe mental problems [Teplin, 1984]. This is supported by the research study conducted by Singleton et al (1998) which found that the majority of prisoners who had been diagnosed as having mental illness had, prior to having contact with the Justice System, already had contact with the NHS and other welfare services.

These findings cannot be squared easily with the findings of other research studies which suggest that “further offending [is] not predicted by mental health needs or alcohol and drug abuse problems. [Harrington and Bailey, 2005, p8]” After all, if mental ill-health can predict first instance-offending in young persons, then it must also surely be a predictor of recidivism in these persons also. This researcher is therefore more inclined to rely upon other research studies which suggest that this is not the case: For example, the study conducted by the Mental Health Foundation [Hagell, 2002, p24] found that: The outcomes for young offenders in need of mental health services include: further offending and worsening mental health problems if the needs are not met. The two are interlinked. While the offending may have been a risk factor for mental health problems in the first place, it has long been understood that mental health problems in turn go on to be a risk factor for continued offending (Kandel, 1978;Rutter et al 1998). Early detection may reduce the likelihood that young offenders will persist into adulthood.”

6] What is the approach which is currently employed by the UK Youth Justice System to tackle this problem?

As discussed earlier, the current approach employed by the Youth Justice System to deal with this problem is very much one which relies on providing treatment programmes for those youths who are either deemed mentally disordered or ill or those who come forward and request such programmes. This approach can be seen underlying new projects which are being implemented to deal with this problem: For example, an article published on the 5th March 2007 by the Sainsbury Centre for Mental Health states: “The Youth Justice Board (YJB) and the Department of Health (DH) are to join forces with the Sainsbury Centre for Mental Health (SCMH) with a major new project to improve services for children and young people who offend and have mental health needs. The Youth Justice Service Development project will test out the most effective ways health and criminal justice services can meet the mental health needs of young people in custody or involved with youth offending teams in the community. The two-year project, which is joint funded by the DH, SCMH and YJB, will review the evidence of what work is most effective to address mental health needs. The results will be used to develop the most promising approaches locally.” This is great example of what Harper and Chitty (2005) describe as the ‘what works and for whom’ treatment paradigm.

7] To what extent is the current policy approach of the UK Youth Justice System appropriate in achieving its objectives in this regard?

The approach discussed above in section [6] of this literature review is, in the opinion of this researcher, a valid one. It relies heavily upon clinical research which indicates ‘what works’ in treating youth offenders with mental ill-health, and therefore the Justice System must ensure that such research is promoted (through finance) asa priority. As Professor Sue Bailey writes: “The recent evidence base in the field of child and adolescent forensic mental health and juvenile justice is starting to make a real difference to clinical practice, pointing to practice that can offer multiple interventions at multiple points across the childhood years, and on into adult forensic practice.” Bailey (2003) p1.

8] How is this policy approach being implemented by the UK Youth Justice System?

As mentioned previously, in 1997 multi-professional  Youth OffendingTeams [YOTs] were introduced across the Youth Justice System in Englandand Wales. Because of the multi-disciplinary makeup of each YOT, assessments made for each young offender who comes before them will be tailored to the specific needs of that individual, not merely the mental needs but also any other needs which are relevant to that offenders criminal behaviour and risk of re-offending.

Also, the introduction of a wider range of community sentences such as the recently implemented Detention and Training Orders, Parenting Orders and Child Safety Orders have been introduced not merely to provide the courts with an alternative to custodial sentences but also to reduce the length of custodial sentence of those individuals who are currently serving time in prison.

The other practical reforms which have been implemented to reduce the prevalence of mental ill-health in young offenders and the problems caused by this phenomenon will be discussed in greater detail in the following section of this literature review.

9] Are these practical reforms appropriate in light of the policy approach adopted to reduce the incidence of mental illness in youth offenders in the UK?

In this section of the literature review we shall examine the particulars of the current policies and practices and identify those areas which are most in need of reform.

One of the most comprehensive evaluations of the current approach to tacking mental ill-health in youth prisons is provided by Harrington and Bailey (2005). Their report identified, as we have argued earlier, that the current approach to the problem of mental ill-health in young prisoners is very much an ad hoc one; “Provision of mental health services in many secure estate institutions was provided on a sessional basis by mental health professionals who had a personal interest in the area. Continuous provision was subsequently vulnerable to changes in personnel and priorities and, unlike community child and adult mental health services, a multi-disciplinary approach was not common.[Harrington and Bailey, 2005, p5]” Clearly this is not in-line with the policies underlying the introduction of the YOTs which clearly intended assessments and prospective treatment programmes to be provided by a multi-disciplinary team.

Other findings of this research revealed that it was not routine practice to assess each offender on admission to young offender institutions, the National Offender Management Service (the newly integrated Prison and Probation Services) would rely on previous assessments, where infrequently available. The report also found that where assessments had been, appropriate intervention packages were often not available either due to under-resourced treatment programmes or the simple lack of any appropriate programmes.

Another research study, commissioned by the Healthcare Commission,found, similarly, that “Too many young offenders have insufficient access to healthcare, particularly the large proportion needing mental health services [HM Inspectorate of Prisons, 1st November 2006].” The report found that often YOTs were inappropriately staffed, many lacking a healthcare worker, although did find that generally the introduction of this reform was having positive effects in increasing the accessibility of mental health services to young offenders. What is clear is that accessibility is simply not enough; to use the old adage,you can lead a horse to water but you cant make him drink.
Regarding the introduction of the new range of community Order sentences, generally these are perceived as a good thing: “A Lack of Alternatives It is a common complaint of judges that they feel obliged to imprison offenders with mental health problems because they can find no alternative way of getting treatment for their condition.”[All-Party Parliamentary Group on Prison Health, House of Commons, November 2006, p6].

10] What changes should be made to the current policy and practice ofthe UK Youth Justice System to effect a more successful reduction of this problem?

In line with the ‘what works’ paradigm of modern Criminal Justice, one general improvement which should be made is a greater ability to disseminate examples of local best practice to the national level. This might be achieved by encouraging individual secure facilities to experiment with new forms of treatment programme and publish their findings on the Youth Justice website. As concluded by Harrington and Bailey (2005) p 6: “There needs to be further development of accredited, evidence-based interventions to reduce offending behaviour, with implementation by trained staff.”

A routine screening process needs to be effectively implemented to ensure that the needs of each young offender entering a youth prison are identified. Harrington and Bailey (2005) p6 recommend the following: “Structured and continuous assessment of the mental health needs of young offenders is required, using reliable and validated tools – e.g. the Mental Health Screening Interview for Adolescents(SIFA) and the Mental Health Screening Questionnaire Interview for Adolescents (SQIFA).”

On this point, this researcher agrees with the content of the current Youth Justice Board Screening Manual which states that: “To help identify mental illness and potential risk of such problems there should be a Closer link between the Youth Justice System and the Child and Adolescent Mental Health Services (CAMHS).” This screening policy will only be effective however if the CAMHS are appropriately staffed and resourced which, according to the Report of the Mental Health Foundation entitled: The Mental Health of Young Offenders. Bright Futures: Working with Vulnerable Young People [Hagell, 2002] p28: “are not sufficiently resourced, organised or varied enough in their approach to be able to respond quickly and appropriately.”

Once the needs of an offender have been appropriately identified by an appropriately staffed multi-disciplinary YOT, this team should formulate an appropriate treatment programme which should then be implemented as continuous support. Such co-ordination will only be possible if each local authority drafts a careful and considered strategy describing routine practice.

One might also argue that whilst the government has come a long way in appreciating the importance of treating both mental and physicalill-health in youth offenders, the public is some way behind. This researcher therefore proposes that the Youth Justice system implement a Mental Illness in youth offenders public awareness campaign. As stated by Hagell (2002) p28: “A shift in understanding by politicians, policymakers, practitioners and the general public about how important diagnosing and meeting young offenders mental health needs is to the longer-term success of current and new programmes to reduce youth offending behaviour is also required.”

Another reform which might be beneficial in the reduction of the prevalence of mental ill-health in young prisoners is an actual reform of the Mental Health Act. As was found by the research studycommissioned by the Sainsbury Centre for Mental Health (March 2006) p5:“One of the recurring problems during our prison visits was the fact that there is no statutory provision for the treatment of people with mental health problems. Prisoners cannot be treated for mental health problems without consent. The visit to Leeds Prison highlighted the problems of treating people with severe mental health problems, as prisons do not come under the auspices of the Mental Health Act.”

Also raised by this Report was the question of whether the Prison and Probation services were the appropriate bodies to deal with the treatment of the mentally disordered and ill young prisoners. It has been contended that ‘Many would be much more appropriately cared for in the National Health Service (NHS)’ (Coid 1988; Brooke et al, 1996).

On this point, this researcher agrees with the content of the current Youth Justice Board Screening Manual which states that: “To help identify mental illness and potential risk of such problems there should be a Closer link between the Youth Justice System and the Child and Adolescent Mental Health Services (CAMHS).” This screening policy will only be effective however if the CAMHS are appropriately staffed and resourced which, according to the Report of the Mental Health Foundation entitled: The Mental Health of Young Offenders. Bright Futures: Working with Vulnerable Young People [Hagell, 2002] p28: “are not sufficiently resourced, organised or varied enough in their approach to be able to respond quickly and appropriately.”

11] What further academic research is needed to assist in the formulation of these new policies and practices?

Further research needs to be conducted utilizing longitudinal methodologies to evaluate how individual offenders needs change overtime: These young people frequently move within the youth justice system between community and secure sites, but there have been few longitudinal studies describing how their needs change. Such studies –although difficult to conduct – are vital when considering what mental health resources are necessary to meet changing needs.” [Harrington andBailey, 2005, p4].

Likewise, as recommended previously in section [12] of this literature review, further research needs to be conducted to test new types of treatment programmes the result of which can form the basis of future practical reform.

Conclusions

In light of the clearly divided structure of the literature review of this paper the conclusions of this research dissertation have already been made quite clear. In this concluding section of the paper let us summarize the contents of these conclusions:

First, the prevalence of mental ill-health among young offenders who are currently serving custodial sentences is worryingly high.

Second, there is clear evidence that the current practical approach which is being implemented by the Youth Justice System is not realising its full potential in reducing this worrying phenomenon; YOTs are generally under-resourced, under-supervised and under-staffed and the range of practical treatment packages available to them is currently inadequate; there is currently no effective screening system to ensure that the mental needs of each young offender are assessed on commencement of their custodial sentence, and; there are not enough local level YOT strategy plans to aid in the effective operation of their functions.

Third, the Mental Health Act 1983 needs to be amended to make treatment compulsory for all young offenders diagnosed with a mental disorder or illness.

Fourth, the current policy approach of the Youth Justice System is an appropriate one, but it relies heavily upon clinical based trials to design its practical reforms and as such extra government funding should be available for any researchers wishing to test a new type of treatment programme for mentally ill and/or disordered offenders.

References

Joint Commissioning Strategy for Child and Adolescent Mental Health Services in Kent, Draft Report, 15th January 2007. 

All-Party Parliamentary Group on Prison Health, House of Commons,November 2006. ‘The Mental Health Problem in UK HM Prisons’. HMSO:London.

Lader et al., 2000, cited by the Report of the Sainsbury Centre for Mental Health, March 2006.

Singleton et al. (1998). N Singleton, H Meltzer, R Gatwood, J Coid andD Deasy, Psychiatric Morbidity among Prisoners in England and Wales,ONS, 1998.

Harrington and Bailey, (2005). Report Commissioned by the YouthJustice Board entitled ‘Mental Health Needs and Effectiveness of Provision for Young Offenders in Custody and in the Community’. YJB.

Prison Reform Trust Troubled Inside: Responding to the Mental Health Needs of Children and Young People in Prison, 2001.

Sir David Ramsbotham (2001). ‘The Needs of Offending Children in Prison’. The Report from the Conference of the Michael Sieff Foundation: ‘The Needs of Offending Children’.

Hagell (2002). The Mental Health of Young Offenders. Bright Futures:Working with Vulnerable Young People. London: Mental Health Foundation.

Nicol et al (2000). Nicol, R., Stretch, D., Whitney, I., Jones, K.,Garfield, P., Turner, K., & Stanion, B. Mental health needs and services for severely troubled and troubling young people, including young offenders, in an NHS region. Journal of Adolescence, 23, 243-261.

Barrett, B., Byford, S., Chitsabesan, P. et al (2006). Mental health provision for young offenders: service use and cost. British Journal of Psychiatry, 188, 541-546.

Thomas-Peter, (2006). Modern Context of Psychology in Corrections. In ‘Psychological Research in Prisons, Towl, G. (2006) pp24-39.Blackwell Publishing.

Faulkner, D. (2007, forthcoming). Prospects for Progress in Penal Reform. To be published in Crime and Criminal Justice.

Harper, G and Chitty, C. (2005) The Impact of Corrections on Re-offending: A Review of What Works’, Home Office Research Study 291,London, Home  Office.

HM Inspectorate of Probation (2006) An Independent Review of a Serious Further Offence Case, Damien Hanson and Clifford White and Anthony Rice, an Independent Review of a Serious Further Offence Case, London, HM Inspectorate of Probation.

Teplin, L.A. (1984), "Criminalizing mental disorder: the comparative arrest rates of the mentally ill", American Psychologist, Vol. 29pp.794-803.

Kandel, D.B., Kessler, R.C. & Margulies, R.Z. (1978). Antecedents of adolescent initiation into stages of drug use: A developmental analysis. In Longitudinal Research in Drug Use: Empirical Findings and Methodological Issues. Edit. by Kandel, D.B. Washington, D.C:Hemisphere Publishing Corp.

Rutter, M. & the English and Romanian Adoptees (ERA) Study Team(1998) Developmental catch-up, and deficit, following adoption after severe early privation. Journal of Child Psychology and Psychiatry, 39,465-476.

Bailey, S. (2003). Young offenders and mental health. Current opinion in Psychiatry, 16, 581-591.

Coid(1988). Mentally abnormal prisoners on remand: I - Rejected or accepted by the NHS? BMJ, 296, 1779 -1782

Brooke et al, (1996). Point prevalence of mental disorder in unconvicted male prisoners in England and Wales. BMJ, 313, 1524 -1527.