Effectiveness Of Mental Health Provision for
Young Offenders
Mental Health Services of Salford and the University of Manchester
Funded by the Youth Justice Board
Research Team
Dr.P.Chitsabesan, S.Sneider, G.Taylor, C.Kenning and
W.Macdonald
Principal Investigators
Professor.R. Harrington, Professor.S.Bailey and
Dr.L.Kroll
Overview
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Almost 2 million crimes are committed by young
people each year
Strong continuity of antisocial behaviour into
adulthood
Services patchy and lack of continuity of care
Providing services requires an integrated approach
from agencies involved in their care
High levels of co-morbidity
Methods of Assessment
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Problems with Previous Studies
– Small or in specific geographical locations
– Unrepresentative of the juvenile offending
population
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Males only
Few from ethnic minorities
Secure or community sites only
– Mainly cross-sectional data
– Psychiatric diagnosis only
Needs Assessment
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Definition
– Capacity to benefit
– Significant problem that can benefit from an
intervention that is not being offered
Needs Assessment
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Standardised measures for needs
assessments for adults well established
– Includes: client and carers views, availability
of effective interventions, client’s perception
and motivation
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S.NASA (Salford Needs Assessment
Schedule for Adolescents)
– Reliability studies (Kroll et al., 1999)
S.NASA
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Covers 17 areas of need (mental health, educational and
social)
Interview gathers information on: symptom severity, client
co-operation and key worker stress in addition to
interventions offered
S.NASA computer algorithm generates significant
problems (problem requiring intervention)
Significant problems rated by clinicians into:
– Unmet need
– Suspended Need (ongoing intervention)
– Persistent needs despite interventions (PDI)
Effectiveness of Mental Health
Provision to Young Offenders
Aims
Question 1
 What is the level of mental health need among
young offenders in the community and in secure
facilities
Question 2
 Do needs change for those discharged from
secure facilities
Study Design
6 paired sites across England and
Wales-each site included a Youth
Offending Team and Secure Estate
Within each site a random sample of
25 consecutive attendees at a YOT
team and 25 offenders in a Secure
Estate were selected
Study Design
Cross-sectional Survey
300 Young Offenders
(150 in custody and 150 in the
community)
Longitudinal Interview
Survey
Longitudinal Records
Survey
75 offenders discharged from
secure
estates into the community
Records follow-up of all 300
offenders including mental health
interventions and rates of reoffending
Pre-liminary
Findings
Results
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Subjects
– Site: 151 – secure care and 150 - community
– Sex: Male n=234 (78%): Female n=67 (23%)
– Age: Mean age –15.7yrs (range 13-18yrs)
– Ethnicity:
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White (83%)
Afro-Caribbean (9%)
Asian (2%)
Other – Eastern European (1%)
Mixed Race (5%)
Domains
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V
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R
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% of Young Offenders
Results
Prevalence of Significant Problems
60
50
40
30
20
10
0
Mental Health Needs
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Rates of Mental Health Problems:
–
–
–
–
–
–
–
–
Depression
- 18%
Anxiety - 10%
PTSD
- 9%
Hyperactivity - 7%
Psychosis
- 5%
Alcohol Abuse- 11%
Drug Abuse
- 20%
Self-harm
- 9%
Mental Health Needs At
Follow-up
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Rates of Mental Health Problems:
–
–
–
–
–
–
–
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Depression
- 27%
Anxiety - 13%
PTSD
- 13%
Hyperactivity - 8%
Psychosis
- 5%
Alcohol Abuse- 23%
Drug Abuse
- 24%
Self-harm
- 7%
Correlates of Need
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Baseline
– Sex (M>F but not significantly different)
– Ethnicity (not significantly different)
– Site (Community>secure –significantly
different)
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Follow-up
– Needs increased at follow-up
Reasons for Unmet Need
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Many of these needs were unmet:
– 1) Problems with screening:
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Inadequate training
Transfer without documents
Static assessments on referral/admission
– 2) Reasons for non-referral:
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Lack of services locally and long waiting lists
Concerns about the imminent transfer of the young person
disrupting an intervention
– 3) Young person refused any intervention
Reasons for Unmet Need
Example drug abuse and mental health
Unmet need at baseline and reasons identified during followup– drug abuse (n=53) and mental health (n=73)
 Screening Problems:
– Drug abuse -52% and mental health – 78%
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Service Problems:
– Drug abuse – 12% and mental health – 10%
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Young Person Refuses/DNA:
–
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Drug abuse – 32% and mental health – 7%
Missing/lost to follow-up:
– Drug abuse – 4% and mental health – 5%
Conclusions
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Young offenders have high levels of need,
including mental health
 The most significant correlate of need is
location
– Young offenders in secure estates had lower levels of
need compared with those in the community
– Needs increased on discharge from secure estates
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Many of these needs were unmet