1. Mental Health Needs in the Children Detention Schools Siobhan Young (smyoung@justice.ie) 17 November 2010

2. Overview 1. Review of mental health needs -Tool -Team -Training 2. Example of proposed model for team

3. Policy, Legislative and Research Framework United Nations Convention on the Rights of the Child Agenda for Children’s Services National Youth Justice Strategy Legislation Research

4. Mental Health Service Provision within the CDS Oberstown Boys’ School (OBS) Oberstown Girls’ School (OGS) Trinity House School (THS) Review included the Finglas Child and Adolescent Centre (FCAC)

5. Questions Previous involvement with Child and Adolescent Mental Health Services (CAMHS) Screening/Non-Clinical Assessment Access to Specialist Mental Health Assessment and Intervention during Detention Linkages with CAMHS in Preparation for Discharge

6. Methodology File Review Staff Interviews Limitations

7. SchoolNumber of Files Reviewed OBS9 THS14 OGS5 FCAC3 Number of Files Reviewed

8. File Review: How Mental Health Needs are Addressed SchoolPrevious CAMHS Assessment on Admission Access to Specialist Assessment Access to Programmes (i.e. mental health) Linkages to CAMHS OBS55%0 00 THS42%0100%00 OGS80%20%60%00 FCAC100%66%100%066%

9. File Review: Other Themes SchoolPresence of Intellectual Disability Presence of Specific Learning Difficulties Experience of Substance Misuse Experience of Significant Loss OBS44%5566%77% THS27%064%35% OGS20% 60%100% FCAC33% 66%

10. Interviews Main Mental Health Problems How Mental Health Problems are Addressed Assessment on Admission (Non-Clinical) Access to Specialist Assessment Linkages to CAMHS Access to Programmes What Staff Think Should Happen

11. Interviews: Main Mental Health Problems ADHD Depression Schizophrenia Personality Disorders Conduct Disorders Psychosis

12. Interviews: How Mental Health Problems are Addressed Assessment on Admission (Non-Clinical) “To profile young offenders” “It doesn’t necessarily inform about mental health” Access to Specialist Assessment “We use the psychiatrist more but that’s usually for the court, it doesn’t feed into anything practical here” “We have two in at the moment who are not here for assessment but both have mental health difficulties. That’s where we’re running into difficulties – the only option is to call the GP” “The young person presenting to an external person coming in is very different to how they present to someone who is here the whole time. A lot of reports are that the young person presented very well. Well, he did for an hour”

13. Interviews: How Mental Health Problems are Addressed Linkages to CAMHS “They’re gone by the time the young person gets here” “A lot of time they are seen when they are younger but by the time they get here, all those bridges are burned” “A dumping ground for all the special care units” “The minute they enter juvenile justice the case is closed with the HSE. Everything else shuts down and off you go”

14. Interviews: How Mental Health Problems are Addressed Access to Intervention / Evidence Based Programmes “There are programmes but not specifically for mental health, they’re more generic” “We did have a drugs counsellor on campus, he was staff but he left. Now that would have to be bought in” “I mean surely when you get into that kind of important place with a young person that you would be able to offer a lot”

15. Interviews: What Staff Think Should Happen Onsite Mental Health Professionals “They don’t get the whole picture” “Gathering information” “Someone qualified on campus” “Gut Instinct” … “Winging it” “Very effective… with the right guidance” “Sometimes when it’s all mixed up behaviours, what you actually need is someone to give clarity so people can understand” “What’s going to change?”

16. Interviews: What Staff Think Should Happen Training “Incorporates some aspect of psychiatric training but it would be a small part” “Techniques on how to talk to children” “Some type of basic training would be valuable” “Everyone knows that unless you are properly informed or trained you can sometimes do more damage than good with these kids”

17. Recommendations 1. All young people should be screened for the presence of mental health problems on admission. 2. All young people identified as having mental health problems should have access to evidence based assessment and intervention with a clinical team. 3. All staff should have training in basic mental health awareness and positive mental health promotion.

18. Commission to Inquire into Child Abuse Report (2009) Office of the Minister for Children and Youth Affairs (2009) Action 12 of the Ryan Implementation Plan states that the HSE will develop a national specialist team for children in special care and detention in consultation with the Irish Youth Justice Service.

19. Example of Model Forensic CAMHS National Manager Oberstown Team St Patrick's Institution Dublin Team Limerick Team Cork Team. National Assessment, Consultation and Therapy Service