1. Targeting: the evidence Lorraine Khan National Programme Manager Centre for Mental Health

2. Why target? Most first time entrants will not re-enter the system Small number on the edges of system will recycle have high unidentified needs are disengaged from/missed by support systems experience poor life chances including health prospects have a greater chance of recycling through system and sometimes causing harm to others Lead to greater costs to public purse Clarity about targeting helps all partners Become hypervigilant Work together to improve longer term outcomes for community

3. Evidence with children: prevent rather than fire fight NOT What does the alarm sound like?

4. So who do we need to prioritise? Mental health and developmental needs Behavioural problems below the age of 12 Bullying, ASB, school behavioural problems/school exclusions etc Anger/hostility/agitation Concerns about self harm/ suicide/past maltreatment? Something not quite right (can’t quite put your finger on it) Flatness in mood, withdrawal from family or friends, change in sleeping Change in behaviour reported by someone who knows the person well Inappropriate smiling, distractedness, poor concentration Unusual patterns of eye contact Lack of emotional response/lack of empathy Confused thinking Concentration

5. Flags for learning disability or communication needs Suspected learning disability, developmental difficulties or communication concerns Karen Bryan’s work Are the young person’s responses unusually limited? (yep, no, dunno, grunts, etc) Does the young person have difficulty understanding you? (check what’s been understood so far) Does the young person have a speech problem? How easily influenced is the young person? Importance (again) of behavioural problems Cohen 2000: behavioural problems often misdiagnosed as bad behaviour rather than speech and communication needs Those at risk of school exclusion and attainment again need attention

6. What’s going on around the young person? The YP has been Looked After/is on the child protection register The YP has a parent with a MH problem/ SM dependency or criminal record The young person is a young carer (Mowbray & Mowbray 2006) Behavioural problems (again) can be an indicator of maltreatment

7. Suspected safeguarding or victimisation concerns Sexual exploitation, bullying/DV etc. Is the young person regularly missing from home? Is the young person truanting? Is the young person homeless? The YP has been arrested for a sexual/ violent/ particularly worrying offence?

8. Other health  Young person is known to regularly misuse drugs or alcohol  Behavioural problems associated with history of trauma to head Lost consciousness for more than 10 minutes Lost consciousness on more than one occasion Nearly half young people in custody had history of untreated head trauma (affecting self and anger management) Risk of other health inequalities E.g. Teenage conception

9. None of this targeting is of any use unless you can Access young people Engage young people Listen to young people Focus on what they think will help them move forward (which may be things that would not be first on your list)

10. . Thank you lorraine.khan@centreformentalhealth.org.uk