Tackling offender mental health

As part of his five-year police and crime plan, London Mayor Sadiq Khan has pledged to do more to divert young people with mental health problems away from the criminal justice system and towards suitable support.

It is increasingly recognised that excluded and vulnerable young people, including those in contact with the criminal justice system, experience multiple risk factors for poor mental health, but what is less clear is the best way of supporting hard-to-engage groups.

The Centre for Mental Health has evaluated three projects currently in operation in London developed by charity MAC-UK.

The projects use the "Integrate" approach to engage young people at risk of offending by getting them involved with co-designing and co-delivering projects.

The "Integrate" model was first developed in Camden in 2008 on the principle that services need to meet young people where they spend their time.

Three projects - two in Camden and one in Southwark - have now been completed. It seeks to wrap "holistic and responsive" support, including mental health and emotional wellbeing provision, around vulnerable young people.

Trusted relationships

Crucially, young people co-design and co-deliver projects alongside mental health professionals in their community.

This has resulted in innovative service features including a focus on building trusted relationships between young people and the staff team, with time proactively set aside for professionals and young people "hanging out" together.

Professionals use "community gatekeepers", such as detached youth workers to reach young people in the first instance, and spend time in and around housing estates, supported accommodation hostels and youth centres where they know young people will be.

As relationships build, it becomes possible to ask young people to design a project they want. At the same time, staff support young people through providing "street therapy" - the application of psychological theory to their everyday practice with young people.

The evaluation found all three projects were successful in engaging groups of marginalised young people at risk of offending.

Young people distinguished their experience of the projects from that of other services, describing staff as non-judgmental and accepting.

Reducing stigma

The projects were found to increase mental health awareness and reduce stigma. They were also successful in bringing young people into education, employment and training. In one case, this increased from 43 to 74 per cent.

Over the period of the evaluation, the three projects worked with around 360 young people. In one of the projects, a third of participants displayed a level of wellbeing that would warrant a referral to a mental health service.
 
The evaluation found that, across all sites, mental health awareness increased in young people and the stigma around it reduced.

Meanwhile, young people and staff across all three sites reported that young people's mental health improved through contact with them.

"Clinician-rated measures of mental wellbeing confirmed young people's reports, showing significant improvements in needs associated with mental wellbeing across all three projects over the course of young people's engagement," the evaluation says.


Expert view: Young people's offending behaviour is often linked to poor mental health

By Andy Bell, deputy chief executive, Centre for Mental Health

Children who end up in the youth justice system are three times more likely to have diagnosable mental health difficulties compared with those who do not.

Many also have histories characterised by trauma and poor attachment from early in life, as well as a range of other difficulties which further hamper their ability to achieve their potential.

Three-quarters have significant speech and communication impairments, and one in five has a learning disability. These difficulties all too often remain undiagnosed throughout school and even by the time they move into secure custodial settings. 

Three-quarters of young people in custody have lived with someone other than a parent at points in their lives, compared with 1.5 per cent of children in the general population. Meanwhile, 40 per cent of girls and young women and a quarter of boys in custody report suffering violence at home, while one-third of young women in custody report having been sexually abused.

Despite these high levels of need and vulnerability, too many young people who are at high risk of offending are not getting their mental health, learning and developmental needs identified or met.

The reasons underlying this lack of support are many and include poor awareness of early and emerging mental health problems (children's behaviour is often a litmus test for their emotional health); fear of being labelled or, conversely, of labelling young people; and poorly designed services that struggle to engage young people, don't provide help on young people's terms or which can engage only when clear-cut crises emerge.

It is therefore vital that all services working with children and families are alive to the signs of risk for poor mental health. They need to know how to link families with sources of effective help as quickly as possible before problems escalate into a later crisis.

See also - Special Report Research Evidence:
Service users as the key to service change? The development of an innovative intervention for excluded young people