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University Department of Child and Adolescent Psychiatry, Manchester
Central Manchester and Manchester Children’s University Hospital, Manchester
University of Central Lancashire, Preston
University Department of Child and Adolescent Psychiatry, Manchester
University Department of Primary Mental Health, Manchester
Central Manchester and Manchester Children’s University Hospitals, Manchester, UK
Correspondence: Dr P. Chitsabesan, Research Room, Gardner Unit, Bolton, Trafford and Salford Mental Health Trust, Bury New Road, Manchester M25 3BL, UK. Tel: +44 (0)161 773 9121; e-mail: pchitsabesan{at}yahoo.com
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Aims To evaluate the mental health and psychosocial needs of a nationally representative sample of juvenile offenders in England and Wales, including female offenders and those from Black and minority ethnic groups.
Method A cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, was conducted in six geographically representative areas across England and Wales. Each young person was interviewed to obtain demographic information, mental health and social needs, and psychometric data.
Results Young offenders were found to have high levels of needs in a number of different areas including mental health (31%), education/work (36%) and social relationships (48%). Young offenders in the community had significantly more needs than those in secure care and needs were often unmet. One in five young offenders was also identified as having a learning disability (IQ<70).
Conclusions Needs for young offenders were high but often unmet. This emphasises the importance of structured needs assessment within custody and community settings in conjunction with a care programme approach that improves continuity of care.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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This research was commissioned by the Youth Justice Board to examine a national sample of young offenders using corporate and individual needs assessment methods. We report here on the individual needs research. The aims were to measure rates of mental health, social and educational needs of juvenile offenders in secure facilities and in the community and to explore differences in needs dependent on setting, gender and ethnicity.
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METHOD |
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Six sites were chosen as geographically representative areas across England and Wales. Each site comprised a secure facility and the local youth offending team. The secure facilities included four young offenders institutions and two local authority secure children’s homes. Because of the small size of both secure children’s homes and three of the six youth offending teams, further sites were recruited (two local authority secure children’s homes and three youth offending teams). These additional sites were chosen for their geographical proximity or service connection to the original site.
Young people aged 13–18 years inclusive were recruited to the study. This involved recruiting 25 individuals attending consecutively at each of the six youth offending teams, while at the secure sites, the 25 young offenders recruited were equally divided between those just admitted and those about to be released. Within secure estates, both remanded (pre-trial and post-trial) and sentenced young offenders were eligible for the study. Those in the community included young offenders on final warnings as well as those given community orders. We aimed to oversample female young offenders and those from Black and minority ethnic groups. At each of the youth offending teams and secure sites we attempted to recruit five young offenders from Black and minority ethnic groups and five female offenders with the aim of finally recruiting 60 female offenders and 60 offenders from Black and minority ethnic groups out of a total of 300 young offenders (150 in custody and 150 in the community).
Eligible young people willing to participate in the study were referred by staff at the secure and community sites to the research assistants. The young person was then informed about the study and consent was obtained by one of three research interviewers. Where young people were judged to be not competent to give written consent, consent was obtained from their parent or legal guardian. Ethical approval was obtained from the North West Multicentre Research Ethics Committee.
Measures
Although previous studies of juvenile offenders have often used psychiatric
diagnosis as a measure of mental health problems, this method has certain
limitations: for example, the prevalence of a disorder does not necessarily
equate to the level of services required
(Harrington et al,
1999). The latter is influenced by a number of factors including
the availability of an effective intervention and a willingness to accept the
intervention. Increasingly, therefore, needs assessment is seen as a more
useful measure of health problems in children and adults, including juvenile
offenders. The Salford Needs Assessment Schedule for Adolescents (SNASA;
Kroll et al, 1999) is
a semi-structured interview specifically designed for research on adolescents
and has good psychometric properties
(Kroll et al, 1999).
In addition to psychiatric symptoms, the SNASA covers several other needs,
including education and social needs. For each domain, the interviewer gathers
information on symptom severity (on a five-point scale), client cooperation
(three-point scale), client perception of the problem (three-point scale) and
keyworker stress (four-point scale). This instrument also allows researchers
to obtain information about interventions that have been offered recently or
not offered. From this information, the SNASA identifies needs. A need is
defined as a significant problem requiring some form of intervention and is
automatically identified by the program if a threshold is crossed either in
one area (severity criteria) or in a combination of areas.
Within the final stage of the SNASA, experienced clinicians (child psychiatrists) are required to make judgements about interventions offered based on available information about the young person obtained from both the individual and a carer. A final needs status is generated, rated as ‘no need’, ‘unmet need’ (in need of an intervention that has not been given), ‘suspended need’ (an intervention has been offered recently, but it is too soon to assess whether it has been beneficial) or ‘need that persists despite intervention’.
The different needs domains are described within the results section. For both the research interviewers’ and the clinicians’ needs ratings, reliability of the ratings was ensured by frequent meetings between the research interviewers and clinicians to agree on scoring. There was also assessment of the percentage of pairwise agreement between research interviewers (81–87%) and clinicians (85–91%) on individual cases.
Details of offending behaviour were obtained from self-reports from the young person. Psychometric assessments used included the Weschler Abbreviated Schedule Interview (WASI; Psychological Corporation, 1999) and the Weschler Objective Reading Dimension (WORD; Psychological Corporation, 1992). Youth offending workers and either keyworkers or personal officers who knew the young people were also interviewed for carer information.
Statistical analysis
The software Statistical Package for the Social Sciences version 10 for
Windows was used to analyse the data. Total levels of needs and cardinal
problems were parametric in their distribution and subsequently two-tailed
t-tests and analysis of variance were used to assess the correlation
of different variables with them. The presence or absence of cardinal problems
in both major domains and individual areas were categorical variables and
subsequently chi-squared analysis was used to assess the correlation with
other variables.
It was calculated that with 150 participants the study would have an 80% chance of detecting an effect size of 0.3 between custody and community groups using the SNASA. To be able to detect an effect size of 0.5 between juvenile offenders of different genders (male v. female) and different ethnic groups (White British v. Black and minority ethnic) we estimated that we would need to recruit a sample of 64 female offenders and 64 young offenders from Black and minority ethnic groups (Machin & Campbell, 1987). The significance of differences was calculated using a 95% confidence interval (Gardner & Altman, 1989).
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Demographic characteristics
The characteristics of participants in the study are given in
Table 1. The mean age of the
sample recruited was 15.7 years (s.d.=1.3, range 13–18). Over
three-quarters of the sample were male (77%). The majority of young offenders
classified themselves as White British (83%). Although the study specifically
oversampled young offenders from Black and minority ethnic groups, these
figures were similar to those found within the youth justice system
(Youth Justice Board Conference,
2004). Three-quarters (74%) of young offenders were from families
where the family structure had broken down, with only 36% of biological
parents still married or cohabiting. A third of young offenders (37%) had been
in care at some time, and 77% had parents in manual employment. Of those under
16 years who should have been in statutory education (n=209), 89%
were obtaining some form of educational provision, although only 16% of young
people were in mainstream school. One in five young offenders had an IQ below
70 (n=60) and therefore met the criteria for learning disability, and
almost one in three (n=93) was assessed as having borderline learning
disability (Table 1). The mean
full-scale IQ of the sample was found to be 78.8 (s.d.=12.7, range
53–123), with a mean verbal score of 74.8 and mean performance score of
87.4. The mean reading age was 11.3 years (s.d.=3.3, range 6–17). This
is significantly lower (P=0.015) than the mean chronological age
(15.7 years).
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Those in custody had on average spent 3.9 months in custody (s.d.=3.6, range 0.03–18.0). With regard to previous sentences, 26% of young offenders had a previous custodial sentence, whereas 39% had a previous community order. The mean number of offences committed by these young people was 41.7 (s.d.=93.1, range 1–578); this included both convictions and non-convictions. A few offenders were responsible for the majority of the crimes committed (mean 42, median 9).
Table 2 explores the differences between the custody and community samples. Those in custody were significantly more likely to have a history of previous custodial sentences and community orders. There was also a significantly higher proportion of young offenders from Black and minority ethnic groups in custody. This finding has been documented previously (Home Office, 1992).
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Needs
Figure 1 shows the
percentage of young offenders in custody and the community with needs in five
different domains: mental health (depression, anxiety, post-traumatic stress,
psychosis, self-harm and hyperactivity); education (education attendance,
educational performance and weekday occupation for young people aged over 16
years); risky behaviour (inappropriate sexual behaviour, drug and alcohol
misuse); violent behaviour (violence to people and property); and
relationships (relationships with peers and family members). Almost a third of
young offenders had a mental health need (31%), whereas 29% had a need because
of some form of risky behaviour. About one in three young people had
educational or work needs (36%) or needs in relation to violence to people and
property (35%). Significant needs with peer and family relationships were
found in almost half of the study sample (48%).
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Risky and violent behaviour
In terms of risky and violent behaviour, 11% of young offenders had alcohol
problems and 20% had drug problems. Problems with aggressive behaviour towards
people and property were found in about one in four and one in five young
people respectively.
Education and relationships
Significant social difficulties were also found, with 29% of young
offenders experiencing difficulties with family relationships and 35% with
peers. Educational needs, with poor school attendance and performance
difficulties, were found (for those under 16 years old) in 17% and 19% of
young offenders respectively. Those over 16 years old fared only slightly
better, with education or work needs found in one in ten young people
interviewed.
Unmet need and recommended interventions
Table 3 shows the level of
unmet need in individual domains of the SNASA. Few young people had had any
type of intervention for their needs. Within some domains, such as
inappropriate sexual behaviour, none of the young people identified with needs
was receiving any form of intervention. Therefore rates of unmet need were
very high. The intervention most commonly recommended from the SNASA was the
need for assessment (penultimate column in
Table 3). Assessment is the
first intervention to offer for most needs areas. If completed, other
interventions are then chosen from a menu of interventions by clinicians. The
second most commonly recommended intervention (final column) was either an
educational approach or cognitive–behavioural therapy.
Between-group differences
Gender
Table 4 shows that although
female offenders had more needs than males, this was not significantly
different. The only domain that showed a significant difference was mental
health, in the areas of depression, self-harm and post-traumatic stress (see
Table 6). Similar results have
been found in other studies
(Timmons-Mitchell et al,
1997).
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Ethnicity
White British juvenile offenders had more needs than those from Black and
minority ethnic groups, although this was not significant
(Table 4). Because of their
small numbers, Black and minority ethnic groups were grouped for statistical
analysis. There was a significant difference between the two groups in
education needs, as White British young offenders had significantly more needs
(Table 5). The reasons for this
are unclear and may be related to differences in cultural attitudes and
socio-economic characteristics. Significant differences were found in the
level of risky behaviour between the two groups
(Table 5). However, low numbers
within the Black and minority ethnic group precluded further analysis. We also
found that young offenders from Black and minority ethnic groups had
significantly more post-traumatic stress symptoms than those who were White
British (Table 6). This may be
secondary to a higher number of refugees or asylum seekers from Black and
minority ethnic groups. As the study did not collect this information, we are
unable to verify this hypothesis.
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Location
Young offenders in the community had significantly more needs than those in
custody (see Table 4) in
relation to education, risky behaviour and relationships (see
Table 5). There was no
significant difference between young offenders in custody and those in the
community in terms of mental health. However, young offenders in the community
were found to have significantly more alcohol and drug misuse needs than those
in secure accommodation (see Table
6). This may be secondary to reduced access to these substances
while young people are in custody.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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Third, for many problem areas needs were unmet, with few offenders having any form of intervention for their problems. This included not only mental health areas but also education, social and aggressive needs. The most commonly recommended intervention across many areas of the SNASA was the need for assessment. Finally, high levels of learning disability were found in this study, as in previous studies (Henry & Moffitt, 1997; Kroll et al, 2002). This has a number of implications for educational provision for these young people.
Limitations of the study
There are a number of limitations to this study which need to be
considered. First, the SNASA includes both client and carer information in its
final rating, although it can be used without carer information. In just under
half of cases an informant (carer) was unavailable for interview. This may
have resulted in lower needs ratings owing to an underreporting of symptoms by
young people, particularly those relating to alcohol and drug use. In
addition, 15% of young people in our sample declined to complete the
psychometric assessment, often because of interview fatigue. Second, even
though the study aimed to oversample Black and minority ethnic groups, numbers
were too small for independent analysis and aggregation of groups was
necessary. This may potentially mask differences between individual ethnic
groups. Finally, as the sample was restricted to young people from England and
Wales, our findings do not necessarily reflect the needs of young offenders in
other countries.
CLINICAL IMPLICATIONS
The assessment of mental health and the promotion of mental well-being of
young people within the youth justice system is integral to the delivery of
effective youth justice services (Callaghan
et al, 2003). Within the youth justice system, the mental
health screening programme was launched in England and Wales in November 2003,
at the end of this study. In practice the mental health screening programme
has been launched within the youth offending teams, but not within secure
facilities. However, lack of screening may not be the only reason for high
levels of unmet need. Other problems, identified in interviews with carers,
included poor access to services and difficulties engaging young people in
treatment. The perception of those interviewed was that provision of mental
health services across the country was variable and often influenced by local
factors; reasons included lack of resources and funding as the primary
obstacle to provision.
In terms of education, although there appeared to be good provision of educational services for young offenders in custody, services were less comprehensive for those in the community, especially for those under 16 years old for whom non-mainstream alternatives were limited. The introduction of agencies such as Connexions (http://www.connexions.gov.uk) has been a helpful resource for a number of young people wanting training and apprenticeships rather than mainstream education. With the high level of learning disabilities identified in this study and previous studies, there is a need to consider tailored educational provision based on individual needs and ability, particularly for those under 16 years of age. It is important to address these issues of service provision for young offenders with learning disabilities, as they may be a particularly vulnerable group.
This cross-sectional survey was part of a larger study examining service provision for young offenders within the youth justice system and continuity of care as young offenders moved from secure to community sites (Youth Justice Board, 2005). This study and previous studies (Little & Bullock, 2004) have highlighted concerns regarding the continuity of care for young people within the criminal justice system. This supports the recommendation to implement a care programme approach for children and young people with complex needs (Youth Justice Board, 2005).
In addition to their high levels of needs, young offenders place a significant financial burden on public services. However, the extent of the problem nationally to services is unknown. The second part of this study estimates the cost of young offenders to the criminal justice system and other services (health, social services and the voluntary sector) and also explores the relationship between needs, service use and cost (Barrett et al, 2006).
Future research
Future research is needed to improve understanding of the needs of female
offenders and those from different Black and minority ethnic populations.
Conducting research in this area has been a challenge in view of the rapidly
changing context of the criminal justice and national health systems
(Department of Health, 2004).
This pace of change does not appear to be slowing, with new initiatives
constantly being developed. It is thus important for any future research in
this area to continue to keep up to date with this rapidly changing
environment and understand the context in which these changes are
occurring.
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Clinical Implications and Limitations |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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LIMITATIONS
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ACKNOWLEDGMENTS |
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TOPABSTRACTINTRODUCTIONMETHODRESULTSDISCUSSIONClinical Implications and...ACKNOWLEDGMENTSREFERENCES |
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REFERENCES |
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Callaghan, J., Pace, F., Young, B., et al (2003) Primary mental health workers within youth offending teams: a new service model. Journal of Adolescence, 26, 185 –199.[CrossRef][Medline]
Department of Health (2004) Getting the Right Start: National Service Framework for Children. London: TSO (The Stationery Office).
Gardner, M. J. & Altman, D. A. (1989) Statistics with Confidence: Confidence Intervals and Statistical Guidelines. London: BMJ Books.
Harrington, R. C., Kerfoot, M. & Verduyn,C. (1999) Developing needs-led child and adolescent mental health services: issues and prospects. European Journal of Child Psychiatry, 8, 1 –10.
Harrington, R. C., Kroll, L., Rothwell, J., et al (2004) Psychosocial needs of boys in secure care for serious or persistent offending. Journal of Child Psychology and Psychiatry, 45, 1 –8.
Henry, B. & Moffitt, T. E. (1997) Neuropsychological and neuroimaging studies of juvenile delinquency and adult criminal behaviour. In Handbook of Antisocial Behaviour (eds D. Stoff, J. Breiling & J. D. Maser), pp. 280 –288. New York: Wiley.
Home Office (1992) Race and the Criminal Justice System. London: HMSO.
Kingdon, D. (1994) Making care programming work. Advances in Psychiatric Treatment, 1, 41 –46.[Medline]
Kroll, L.,Woodham, A., Rothwell, J., et al (1999) Reliability of the Salford Needs Assessment Schedule for Adolescents. Psychological Medicine, 29, 891 –902.[CrossRef][Medline]
Kroll, L., Rothwell, J., Bradley, D., et al (2002) Mental health needs of boys in secure care for serious or persistent offending: a prospective, longitudinal study. Lancet, 359, 1975 –1979.[Medline]
Lader, D., Singleton, N. & Meltzer, H. (2000) Psychiatric Morbidity among Young Offenders in England and Wales. London: Office for National Statistics.
Little, M. & Bullock, R. (2004) Administrative frameworks and services for very difficult adolescents in England. In Adolescent Forensic Psychiatry (eds S. Bailey & M. Dolan), pp. 336–344. London: Hodder/Arnold.
Machin, D. & Campbell, M. (1987) Statistical Tables for the Design of Clinical Trials. Oxford: Blackwell Scientific.
Psychological Corporation (1992) Wechsler Objective Reading Dimensions. London: Harvant & Bruce.
Psychological Corporation (1999) Wechsler Abbreviated Scale of Intelligence. London: Harvant & Bruce.
Teplin, L. A., Abram, K. M., McCelland, G. M., et al
(2002) Psychiatric disorders in youth in juvenile detention.
Archives of General Psychiatry,
59, 1133
–1143.
Timmons-Mitchell, J., Brown, C., Schulz, C., et al (1997) Comparing the mental health needs of female and male incarcerated juvenile delinquents. Behavioural Sciences and the Law, 15, 195 –202.
Youth Justice Board (2004) National Standards for Youth Justice Services. London: Youth Justice Board.
Youth Justice Board (2005) Effectiveness of Mental Health Provision for Young Offenders in Custody and the Community. London: Youth Justice Board.
Youth Justice Board Conference (2004) Young Offenders and Mental Health Needs. London: Youth Justice Board.
Received for publication February 15, 2005. Revision received September 23, 2005. Accepted for publication October 27, 2005.
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B. BARRETT, S. BYFORD, P. CHITSABESAN, and C. KENNING Mental health provision for young offenders: service use and cost The British Journal of Psychiatry, June 1, 2006; 188(6): 541 - 546. [Abstract] [Full Text] [PDF]
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Psychiatric Bulletin | Advances in Psychiatric Treatment | All RCPsych Journals |
