Effectiveness Of Mental Health Provision for Young Offenders Mental Health Services of Salford and the University of Manchester Funded by the Youth Justice Board Research Team Dr.P.Chitsabesan, S.Sneider, G.Taylor, C.Kenning and W.Macdonald Principal Investigators Professor.R. Harrington, Professor.S.Bailey and Dr.L.Kroll

Overview Almost 2 million crimes are committed by young people each year Strong continuity of antisocial behaviour into adulthood Services patchy and lack of continuity of care Providing services requires an integrated approach from agencies involved in their care High levels of co-morbidity

Methods of Assessment Problems with Previous Studies – Small or in specific geographical locations – Unrepresentative of the juvenile offending population Males only Few from ethnic minorities Secure or community sites only – Mainly cross-sectional data – Psychiatric diagnosis only

Needs Assessment Definition – Capacity to benefit – Significant problem that can benefit from an intervention that is not being offered

Needs Assessment Standardised measures for needs assessments for adults well established – Includes: client and carers views, availability of effective interventions, client’s perception and motivation S.NASA (Salford Needs Assessment Schedule for Adolescents) – Reliability studies (Kroll et al., 1999)

S.NASA Covers 17 areas of need (mental health, educational and social) Interview gathers information on: symptom severity, client co-operation and key worker stress in addition to interventions offered S.NASA computer algorithm generates significant problems (problem requiring intervention) Significant problems rated by clinicians into: – Unmet need – Suspended Need (ongoing intervention) – Persistent needs despite interventions (PDI)

Effectiveness of Mental Health Provision to Young Offenders

Aims Question 1 What is the level of mental health need among young offenders in the community and in secure facilities Question 2 Do needs change for those discharged from secure facilities

Study Design Within each site a random sample of 25 consecutive attendees at a YOT team and 25 offenders in a Secure Estate were selected 6 paired sites across England and Wales-each site included a Youth Offending Team and Secure Estate

Study Design Cross-sectional Survey 300 Young Offenders (150 in custody and 150 in the community) Longitudinal Records Survey Records follow-up of all 300 offenders including mental health interventions and rates of re- offending Longitudinal Interview Survey 75 offenders discharged from secure estates into the community

Pre-liminary Findings

Results Subjects – Site: 151 – secure care and community – Sex: Male n=234 (78%): Female n=67 (23%) – Age: Mean age –15.7yrs (range 13-18yrs) – Ethnicity: White (83%) Afro-Caribbean (9%) Asian (2%) Other – Eastern European (1%) Mixed Race (5%)

Results Prevalence of Significant Problems

Mental Health Needs Rates of Mental Health Problems: – Depression- 18% – Anxiety- 10% – PTSD- 9% – Hyperactivity- 7% – Psychosis - 5% – Alcohol Abuse- 11% – Drug Abuse- 20% – Self-harm - 9%

Mental Health Needs At Follow-up Rates of Mental Health Problems: – Depression- 27% – Anxiety- 13% – PTSD- 13% – Hyperactivity- 8% – Psychosis - 5% – Alcohol Abuse- 23% – Drug Abuse- 24% – Self-harm - 7%

Correlates of Need Baseline – Sex (M>F but not significantly different) – Ethnicity (not significantly different) – Site (Community>secure –significantly different) Follow-up – Needs increased at follow-up

Reasons for Unmet Need Many of these needs were unmet: – 1) Problems with screening: Inadequate training Transfer without documents Static assessments on referral/admission – 2) Reasons for non-referral: Lack of services locally and long waiting lists Concerns about the imminent transfer of the young person disrupting an intervention – 3) Young person refused any intervention

Reasons for Unmet Need Example drug abuse and mental health Unmet need at baseline and reasons identified during follow- up– drug abuse (n=53) and mental health (n=73) Screening Problems: – Drug abuse -52% and mental health – 78% Service Problems: – Drug abuse – 12% and mental health – 10% Young Person Refuses/DNA: – Drug abuse – 32% and mental health – 7% Missing/lost to follow-up: – Drug abuse – 4% and mental health – 5%

Conclusions Young offenders have high levels of need, including mental health The most significant correlate of need is location – Young offenders in secure estates had lower levels of need compared with those in the community – Needs increased on discharge from secure estates Many of these needs were unmet