Young offenders (those under the age of 18) are more likely to have complex health needs than the wider population (Lader et al., 2000). They are also more likely than non-offenders to engage in risky health behaviours, including smoking, alcohol and substance misuse (Chitsabesan et al., 2006). The 2012 Chief Medical Officer’s report highlighted that, in England and Wales:
- The rate of suicide in boys aged 15–17, who have been sentenced and remanded in custody, may be as much as 18 times higher than the rate in non-offenders;
- Some 18% of 13–18 year olds in custody have depression, 10% have anxiety, 9% have post-traumatic stress disorder and 5% have psychotic symptoms;
- Of children and young people on community orders, 43% have emotional and mental health needs;
- Over a quarter of children and young people in the youth justice system have a learning disability. Some 60% of boys in custody have specific difficulties in relation to speech, language or communication;
- Children who are Looked After make up 30% of boys and 44% of girls in custody;
- One in 10 girls in custody have been paid for sex;
- Around 39% of children and young people in custody have been on the child protection register or experienced neglect or abuse;
- One in eight children and young people in custody have experienced the death of a parent or sibling;
- Some 40% of children and young people in custody have previously been homeless;
- Over half of children and young people who offend, have themselves been victims of crime (Department of Health, 2012).
Education, employment and training (EET) are protective factors against involvement in anti-social and offending behaviour. Young people not in education, employment or training (NEET) are five times more likely than their peers to become involved in the youth justice system and three times more likely to suffer depression, leading to longer term health problems and costs to society (Audit Commission, 2010: Against the odds). In addition a young person aged 16 and over returning to the community from custody is four times more likely to be NEET (Youth Justice Board, National Indicator 45: Education Training and Employment data, 2010).
The local picture
There is a high level of emotional health and wellbeing need identified within the Calderdale Youth Offending Team (YOT) cohort, with many young people referred to the Health Practitioner. Some require immediate referral to Children and Adolescent Mental Health Services (CAMHS) or professional discussion and advice with CAMHS in multi agency CAMHS consultation. Others have emotional / mental health needs but do not feel ready to engage with specialist services, or have had past involvement with CAMHS but do not want to re-engage and are therefore offered emotional support via appointments with the health practitioner until they are ready to be referred or until they no longer need support.
Locally, there is no recent history of suicide in young people engaged with the Youth Offending Team, though a number of young people have made serious suicide attempts and have been supported by the YOT and other agencies.
As at December 2015, there were 136 young people actively engaged with the Youth Offending Team. These were split evenly between those of school age and those above school leaving age. This is unusual, as the trend has previously been that as the number of pre-court decisions has increased so has the number of younger young people of school age.
The average number of Children Looked After (CLA) on Calderdale YOT caseload is 21. However 30% of these CLA are young people placed in Calderdale from other areas by their home authority.
There are a significant number of young people involved with Calderdale YOT who have experienced or are currently experiencing neglect, and are currently or have been the subject of a Child Protection Plan or Child In Need Plan. These young people are amongst the most vulnerable young people in our community.
Anecdotal evidence identifies there are a significant number of young people on the caseload who have experienced the death of a parent or sibling.
There are no young people classified as homeless on the YOT caseload. However there are a number of young people supervised by the YOT who do not have permanent or stable accommodation, this creates challenges in supporting them to address offending behaviour and to access health care appropriately.
Anecdotal evidence from local YOT workers would support the statement “Over half of children and young people who offend have themselves been victims of crime”.
Calderdale YOT works with young offenders on statutory Court Orders and with young people at risk of offending on the YOT prevention team caseload, referred in through the Early Intervention Panels, the Police as out of court disposals, and Anti Social Behaviour Order panel.
- The YOT lead on the Parent and Children Together (PACT) project in Calderdale. This is a Domestic Violence programme taking referrals across Calderdale to tackle the violence and aggression of young people towards their parent/carer. Two courses are run side by side, a parents programme and a young people programme, covering the same exercises at the same time to address the concern, with eventually parent and child making a PACT to change;
- YOT staff work with Women Centre staff to deliver a rolling support and education group to some of the most highly vulnerable girls in Calderdale;
- YOT staff run a summer programme for a small group of young people which includes education and a residential experience;
- The YOT run a Knife Crime Prevention Programme (KCPP) taking referrals from professionals across Calderdale;
- All YOT staff promote healthy lifestyle opportunities and physical health supporting young people to access programmes to improve health and wellbeing including walking groups, football activities, boxing and the gym.
During 2014, clients of the YOT were asked their opinions on the health service provision. Young people who participated indicated that their health worries were:
- Wanted to gain weight / want to be fitter / generally healthier;
- Mental health issues;
- Stop smoking / stop smoking cannabis.
Young people said they wanted to contact the health service at YOT via appointments, drop in and Facebook / online. Young people said they wanted the service based at the YOT.
Young people felt that a YOT health service should offer young people advice on sexual health / contraception, general information on health, information on weight gain, information on food, have truthful answers to health questions, offer all types of advice and help instead of referrals to other places, help to register with a dentist and help with going to a gym.
The young people involved with YOT of school age are mostly educated in mainstream schools, with the greatest cluster in the Pupil Referral Unit (PRU). The levels of ability for the YOT cohort are 18% level 2 and above, with the remainder being below level 2. The opportunities for young people for those below level 2 are limited, being delivered by Project Challenge and some Calderdale College provision. Prior to 2015 there was more availability at level 2 but in 2015 this drastically reduced.
Recently a Pilot study of speech language and communication [PDF 415KB] needs of young people involved with the YOT revealed a significant level of unmet needs across a range of communication and learning areas. It was found that there is a gap in services to meet some of this identified need and this is currently being explored.
There is a high level of substance misuse by young people on the YOT caseload and a variety of substances being used, including Alcohol and Legal Highs. Young people however, do not want to access existing specialist substance misuse services. Many have previously accessed this type of support and felt that it was not suited to their needs. Currently YOT staff are in discussions with the specialist service, exploring ways to help promote re-engagement with the service. YOT staff are supporting young people meanwhile in house with appropriate health and safety messages and encouraging engagement with the specialist service.
Sexually inappropriate behaviour
A local service gap appears to be emerging in respect of children and young people who are exhibiting inappropriate sexual behaviour and need an intervention. Unlike Harmful Sexual Behaviour (HSB) when there are staff trained in the Local Authority to complete an AIMS2 Assessment and Intervention, it was noted at a multi agency Emotional wellbeing support group (EWB) led by CAMHS, that a number of cases of inappropriate sexual behaviour by children were being highlighted by school staff about very young children of primary school age, yet there did not exist an appropriate referral and intervention pathway.
Similarly, at a recent YOT CAMHS consultation it was felt that there are young people who do not meet the criteria for a CAMHS intervention, as they are not assessed as having mental ill health, but who need an intervention to address inappropriate sexual behaviour.
There is anecdotal evidence from professionals that there is an increase in young people who are struggling to understand their sexual identity and this is being expressed by some in presenting behaviours of concern and emotional/mental health difficulties.
There are high numbers of young people on the YOT caseload experiencing emotional / mental health difficulties, however due to other factors in their lives these young people do not want to be referred to external specialist agencies to meet their needs and are therefore requesting support in house from the YOT team and from the YOT health practitioner.
Projected future need
The introduction of a new assessment tool within the YOT will potentially have a significant impact in increasing the health workload. YOT Health and YOT Operational managers have started to plan the health response to these changes by meeting with Branching Out, CAMHS and Special Educational Needs and Disability (SEND) managers, to inform and be ready to react to the changes that will transform the way health needs are identified and responded to in the YOT.
Changes to school leaving age has meant that more of the YOT caseload are now accessing the local colleges and alternative education provision. Unmet health needs will need to be addressed in the college and this is identifying the need to develop closer links with the Special Educational Needs (SEN) team, and contributions to the Education Health Care Plan (EHCP), transition to adult services and clearer referral pathways will need to be established.
Key considerations linked to the known evidence base (what works?)
Health practitioners are uniquely placed to work in partnership with others and provide integrated and personalised care to disadvantaged and vulnerable populations. YOT health practitioners develop and deliver health interventions designed with a particular focus on the most marginalised and disadvantaged young people in our community. Young people under age of 18 years who offend have complex health and support needs, and the needs of this group are particularly apparent for those who receive a community order (Jacobson 2010). The link between young peoples’ health, inequalities and crime is well documented; health, mental health and substance misuse problems significantly increase the risk of children and young people offending and re-offending. The Government response to the independent review of CAMHS indicated that children and young people needed timely and seamless support from the right professionals when needed, provided by targeted services, who will identify and address the needs of vulnerable children and young people (Keeping Children and Young People in Mind, Department of Health (DH) and Department for Children, Schools and Families, 2010).
Healthy Children, Safer Communities clearly recognises that children and young people in or on the edge of the Youth justice system experience far more unmet health needs than their non-offending peers (HM Government, 2009). These include poor communication skills, mental health problems, learning difficulties, self-harm and risk of harm to others (YJB 2003).
Offending behaviour is damaging for not just offenders and their victims, but also their families and the wider community. It is closely linked with deprivation, drug and alcohol misuse, mental health, loss of accommodation and employment as well as affecting outcomes for families and children. Improving the health of offenders reduces the chance of their re-offending, which in turn reduces the future impact on both victims and the families of offenders (DH 2009a, DH 2009b).
References and further information
- Chitasbesan P, Kenning C. (2006): Mental health provision for young offenders: service use and cost, Br J Psychiatry. 188:541–546;
- Lader, D., Singleton, N. and Meltzer, H. (2000): Psychiatric Morbidity among Young Offenders in England and Wales, London: Office for National Statistics;
- Department of Health (2012): Annual Report of the Chief Medical Officer, Our Children Deserve Better: Prevention Pays, Chapter 122012;
- Department of Health 2009a: The Bradley report: Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system;
- Department of Health 2009b: Improving Health, Supporting Justice. The National Delivery Plan of the Health and Criminal Justice Programme Board;
- Jacobson, J ( 2010): Vulnerable Defendants in the Criminal Courts: A Review of Provision for Adults and Children for the Prison Reform Trust;
- Department of Health and Department for Children, Schools and Families, 2010: Keeping Children and Young People in Mind;
- HM Government, 2015: Working Together to Safeguard Children;
- Department for Education and Skills, 2007: Aiming High for Young People: A ten year strategy for positive activities;
- National Literacy Trust, 2008: The Bercow Report;
- Commission for Healthcare Audit and Inspection and HM Inspection of Probation, 2009: Actions Speak Louder;
- HM Government, 2009: Healthy Children, Safer Communities;
- Audit Commission, 2010: Against the odds.
More information on children and young people can be found in the Further resources .
More information on youth offending can be found in:
Liz Bunney, Health Practitioner, Youth Offending Team, Children and Young People's Service, Calderdale Council;
Donna Green, Programme Manager - Young People, Public Health, Calderdale Council;
Edited by Naomi Marquis, Public Health Intelligence Officer, Public Health, Calderdale Council.
31 December 2015.