Background

The prevalence of mental health needs amongst children within the youth justice system has been found to be higher than within the general population of adolescents. Of those children sentenced in the year ending March 2020 with a completed AssetPlus assessment, there were concerns in relation to mental health in 72 per cent of cases.

There are a number of risk factors that increase the chances of children getting involved in offending, and many of these are similar to the risk factors for mental health problems. For example:

• a higher likelihood of having been subject to trauma or severe neglect
• high levels of social disadvantage
• multi-layered, unmet, and complex needs
• not accessing services in a timely manner in the first place, despite high levels of need.

Mental health problems often appear differently in younger age groups than they do in adults, manifesting as behavioural problems, self-destructive or high-risk behaviour or social withdrawal, all of which can mask underlying problems. Mental health needs can be misinterpreted as bad behaviour or dismissed as normal adolescent acting out

Despite the high levels of need, justice-involved children face challenges in gaining access to relevant services. In addition to the long waiting lists and high thresholds experienced by the general adolescent population, there is the potential for discrimination from being seen as ‘offenders’ first and children with mental health needs second. Support may only be accessed once a crisis point has been reached.

Summary of the evidence

Causes of mental ill health in justice-involved children

Research has found that justice-involved children have often experienced a number of life events and/or circumstances which can have an undermining impact on their mental health. A 2012 survey of children displaying prolific offending behaviour found that:

• 48 per cent had witnessed family violence
• 55 per cent had been abused or neglected
• 62 per cent had difficulty in coming to terms with past events or trauma
• 79 per cent had social services involvement
• 81 per cent were without qualifications
• 95 per cent had substance misuse issues.

It is important to note that the relationship between mental health difficulties and offending is complex and causality can go in either direction. For example, a child could be acting out as a result of underlying depression, or depression could result from involvement in criminal behaviour.

The case for early intervention

There is strong evidence that instead of waiting until mental health difficulties reach the point of crisis, those working with children should focus on the known risk factors for poor mental health and concentrate on promoting resilience in children to prevent mental ill health and other adverse outcomes. Lord Bradley’s 2009 review of people with mental health and learning disabilities in the criminal justice system emphasised the importance of identifying vulnerable children at the earliest possible stage.

At the point of arrest there is an opportunity to identify mental health needs, to link children and their families with the support they need, and to reduce the chance of people going in and out of the youth justice system. A 2012 evaluation of Youth Justice Liaison and Diversion (YJLD) services found significant reductions in overall need, levels of depression and levels of self-harm, and a significant association between improvements in these aspects and the amount of YJLD contact.

Youth Justice Board guidance has identified a number of aspects deemed key to successful delivery including:

• mental health screening available at every stage of the youth justice system, undertaken by skilled and experience staff
• a range of local services being available to address identified complex needs
• full needs assessment information shared with key stakeholders
• children’s mental health needs being made known to police and courts to allow informed decisions to be made in relation to charging and sentencing.

The same guidance also notes barriers to effective delivery of this service, including:

• poor communication between key stakeholders
• focussing only on prevention or out-of-court issues and ignoring those seen as complex and high-risk
• not having the suitable referral pathways into services in place to meet identified needs
• Clinical Commissioning Groups not being aware of their role in commissioning services for the ‘vulnerable group’ at risk of entering or actually being in the criminal justice system.

Engaging children

A 2021 study, which included interviews with children and staff from across the youth justice system, found that while different children found it easy/difficult to talk about different topics, they generally preferred being asked ‘factual’ questions about ‘tangible’ things rather than questions about emotions. Children also reported preferring to talk about positive relationships, things they were good at, and ‘things that were not a problem’ in their lives. They reported being less happy to talk about offending, substance misuse and mental health, and happier to talk about hobbies, plans, work, and family. The practitioners’ responses revealed agreement on the following AssetPlus topics being most difficult for a child to emotionally engage with during the interview: family, drinking, drugs, mental health, and offending behaviour.

Interventions

There is considerable evidence of effective psychological and pharmacological treatments with general population adolescent samples for a range of mental health problems that are common in children such as depression, anxiety problems, attention deficit hyperactivity disorder (ADHD) and psychotic-like symptoms.

While these conditions affect justice-involved children, robust studies which show positive outcomes for this population are much more limited. A 2010 systematic review and meta-analysis undertaken in relation to interventions for justice-involved young people with mood disorders, anxiety disorders, or self-harm, identified just ten studies which reached the quality threshold. Out of these, eight were with children in custody, despite the vast majority of children being supervised by youth offending teams (YOTs) in the community.

Individual trials have reported varying degrees of success in terms of the effectiveness of interventions in decreasing depression, anxiety or self-harm. Aggregated data from three studies which examined group-based CBT found this significantly reduced depressive symptoms compared to those receiving ‘usual care’ or ‘no treatment control’. More research is required in relation to the effectiveness of group-based as compared to individual CBT treatments, although studies with non-offending adolescent populations have shown no difference in effectiveness of CBT across different delivery formats.

Enablers to accessing mental health services

A 2013 report which explored experiences of justice-involved young people with mental health needs concluded that the provision of mental health services for those at risk of or engaged with offending behaviour remained inadequate. The report highlighted five critical issues in ensuring that young people gain access to services to meet their mental health needs:

1. consistency of relationships with young people; it takes time for mutual trust and empathy to develop, but this is the core requirement for positive developmental work taking place. Find out more about relationship-based practice

2. staff delivering services to this client group need greater knowledge and skills regarding the identification and awareness of mental health issues
3. better coordination or collaboration between services; young people reported how changing personnel and agencies, short-term treatments, unclear expectations, and different job roles undermined their progress
4. assertive health care pathway management is crucial for those young people whose life circumstances are changing rapidly; young people reported a chaotic mix of pathway management to the detriment of their mental health. An individual agency should take the lead, improving co-ordination and actively monitoring the individual’s pathway, holding other services to account, and ensuring that medical case reviews happen regularly, that medication is actively monitored, and that the child is actively engaged
5. easy access to accurate information for young people, families, advocates, and services is essential; confusion and uncertainty leading to a lack of confidence caused by ‘not knowing’ was consistently reported. Information about all services, referral processes, and confidentiality must be available which explains simply what can be expected and when.

The video below, produced by the National i-THRIVE Programme, highlights the importance of working together in supporting children’s health and wellbeing.

Disclaimer: an external platform has been used to host this video. Recommendations for further viewing may appear at the end of the video and are beyond our control.

Back to Specific areas of delivery Next: Adversity and trauma

Last updated: 10 March 2023