1. Working with Young People: Self-harm and Suicide A local, multi-disciplinary approach to supporting children and young people in Cheshire and Merseyside Join the conversation #STORMevent

2. Young people in the criminal justice system Evidence from the Bradley Commission 7 October 2015

3. Young people who offend Lifelong vulnerabilities that precede crime: Parental mental ill health Neglect, abuse and maltreatment Early starting behavioural problems School exclusion (52%) Sexual abuse & exploitation (29% young women) Looked After Children 15 times more likely to enter youth justice system

4. High rates of mental ill health and disability 95% of children in custody have a mental health problem At least half have conduct disorder High rates of: Acquired brain injury Language and communication difficulties (60%) 5% have symptoms of psychosis High risk of self-harm and suicide

5. Young people in gangs About 6% of young people Twice as likely as other youth justice entrants to have multiple vulnerabilities Girls have higher still levels of vulnerability and different reasons for joining gangs

6. The Bradley Report Published April 2009 Made 82 recommendations including: Criminal justice and mental health teams Training in mental health and learning disability for justice professionals 14 day waiting time for hospital transfer Key recommendations adopted by successive governments

7. The Bradley Commission Independent commission led by Lord Bradley Reviewed progress in implementation over five years Focused on areas needing more investigation: Black and minority ethnic communities Young adults in transition Personality disorder

8. Liaison and diversion National programme to put L&D services in all police stations and courts Currently 50% coverage using all-ages operating model All age approach needs to reflect specific needs of children and young adults

9. Specific issues for young adults Low levels of service access and help- seeking: stigma and fear of clinical services Multiple transitions: CAMHS to adult mental health Children’s services to adult social care Youth to adult justice system Disrupted relationships with professionals Account for 18% of self-harm incidents (9% custody population)

10. Examples of promising approaches The Integrate Movement: ‘streetherapy’ with young men in gangs YSS: intensive support for young adults with ‘sub-threshold’ needs St Giles Trust Project SOS: mentoring and practical support “They’ve been there themselves and what they’re offering is based on reality”

11. Key success factors for work with young adults Primary focus on wellbeing Consistent and continuous relationships Service user leadership and involvement Addressing multiple needs and transitions Interagency and collective working Being accessible and available when needed

12. Opportunities for earlier intervention Perinatal mental health care Interventions for early starting behavioural problems: Family Nurse Partnerships Group parenting programmes School awareness of risks and signs, with clear referral pathways Effective therapies for adolescents, eg multi- systemic therapy, functional family therapy

13. What next? Finish the job on liaison and diversion Intervene early for children at risk of offending and gang involvement Innovate and evaluate improved support for young adults Integrate with mainstream mental health care (child and adult) Listen to young people

14. Thank you For more information: Contact andy.bell@centreformentalhealth.org.uk follow us @CentreforMH @Andy__Bell__ visit: www.centreformentalhealth.org.uk

15. Working with Young People: Self-harm and Suicide A local, multi-disciplinary approach to supporting children and young people in Cheshire and Merseyside Join the conversation #STORMevent

16. Consent Considerations in Adolescent Self Harm Dr Laurie van Niekerk 7 October 2015

17. Aims Brief overview Legislation Local example

18. Overview What are the main factors to take into account? –Age of the child/young person (language) –Capacity/Competence –Young person’s view (empowering) –Parents/Carers views (inclusive) –Level of Risk (timely response)

19. What should be discussed? their condition(s) the purpose of investigations and treatments you propose and what that involves, including pain, anaesthetics and stays in hospital the chances of success and the risks of different treatment options, including not having treatment who will be mainly responsible for and involved in their care their right to change their minds or to ask for a second opinion.

20. Confidentiality Where a competent child ask you to keep their confidence, you must do so, unless you can justify disclosure on the grounds that you have reasonable cause to suspect that the child is suffering, or is likely to suffer, significant harm. You should however seek to persuade them to involve their family, unless you believe it is not in their best interest to do so.

21. Legislature for Health Staff *GMC guidance on Confidentiality/Consent 16 “Gillick Competence” Mental Capacity ACT * (components & Cases) Mental Health ACT [S136; S2; S3; S5(2)] Children’s ACT: Scope of Parental Consent If in doubt, speak to your senior – arrange consultation with Psychiatry, Legal/Court of Protection, Defense Union, IMCA, IMHA,

22. Health Passport/Care Plan Partners: Young people; CAMHS; A&E and Paediatric staff (nursing/medical) –information about me; health condition and confidentiality/consent statement; –how best to help me (non-judgemental; what works/has worked; other agencies already involved – key worker/contact); preference of male/female staff; preferred pain relief etc

23. Thank you

24. Working with Young People: Self-harm and Suicide A local, multi-disciplinary approach to supporting children and young people in Cheshire and Merseyside Join the conversation #STORMevent