1. Removing Barriers. Achieving Change. Annual Youth Justice Convention Bournemouth 13-14 November 2007 Angela Greatley Chief Executive Sainsbury Centre for Mental Health

2. Removing Barriers. Achieving Change. Scope Why this is a key topic Scale of the problem What kind of outcomes How we can get there

3. Removing Barriers. Achieving Change. Young people’s mental health difficulties: not the same as adults Fewer fitting MHA criteria: More difficult to diagnose: emerging and complex difficulties Caution about premature labelling Greater legislative responsibility to protect welfare Result: Behaviour may be interpreted simply as ‘bad’ and punished rather than deemed worthy of mental health assurance Prison has become the default mental health provider for young people

4. Removing Barriers. Achieving Change. Scale of the problem Young men in custody: suicide 18 times more likely (Fazel et al 2005) YP in YJS: three times the prevalence of mental health needs as general population (Hagell, 2002) < 9/10 young people in custody have MH vulnerabilities (Lader et al 2000) < 8/10 have more than one MH vulnerability (Lader et al 2000) Learning disability (IQ < 75): 1 in 5 young people (Chitsabesan 2006) Borderline personality disorder: 84% + of young people, 16-20 years (Lader et al 2000) High rates of re-offending associated with MH/psychosocial problems (YJB effective practice reader: 2004)

5. Removing Barriers. Achieving Change. Young women: main issues Over 1 in 3 had self harmed (over 9/10 had cut themselves) Nearly ¾: some level of psychiatric disturbance Twice as likely to suffer from depression High rates of PTSD reported (Source: YJB 2006: female health needs in YOIs) A 1/3 of girls and 1 in 20 boys disclosed sexual abuse (SEU 2002)

6. Removing Barriers. Achieving Change. BME young people Access to MH services predominantly through CJ routes Are overrepresented as adults in higher intensity MH treatment

7. Removing Barriers. Achieving Change. What kind of outcomes Improved emotional wellbeing Early identification of difficulties More accessible, responsive services Community understanding and reduced fear Improved risk management

8. Removing Barriers. Achieving Change. Barriers Information sharing Identification of LD and of communication problems Joined-up working (continuity) Lack of family involvement in custody Lack of responsivity in programme design Poorly targeted programmes Inflexible services Services lacking cultural or gender sensitivity Differences in philosophy between health and CJS

9. Removing Barriers. Achieving Change. How can we get there (1) Promote health and wellbeing in schools and colleges Identify problems and intervene early Develop youth health services that are non- stigmatising Use assertive outreach and advocacy models of MH services for young people in CJS

10. Removing Barriers. Achieving Change. How we can get there (2) Work with strengths, tackle factors for exclusion Use evidence based approaches e.g. MST Involve young people in designing Involve families and carers Stop pushing young people from pillar to post

11. Removing Barriers. Achieving Change. Strategic shifts Partnership working Commissioning Evidence base for interventions Truly child/young people centred