Suffering inside: The welfare of children in custody
Joe Lepper
Tuesday, November 25, 2014
As many as one in five children in custody has attempted suicide, while many more self-harm. Joe Lepper explores what the youth secure estate and health services are doing to reduce risk and protect the welfare of this vulnerable group.
Thirza Smith, manager of secure children's home Clayfields House, in Nottingham, believes her service helps save children's lives every day.
"We had a girl here who was trying to kill herself through strangulation," she recalls. "There were 48 incidents in one month where she had tied a ligature around her neck until her eyes went bloodshot and her nose bled."
But through a combination of bespoke mental health support and relationship-building with staff, such incidents stopped.
It is this kind of individual support that children in custody so desperately need, explains Frances Crook, chief executive of the Howard League for Penal Reform. But the truth is, the majority are far less fortunate.
"Children's prisons will have perhaps 300 boys and two staff overnight. If you are crying, there's no one with a key and no one to give you a hug. It is evil," she asserts.
The Prisons and Probation Ombudsman (PPO) is another fierce critic of the support the majority of vulnerable young people in custody receive. Nigel Newcomen's August 2014 report into deaths of 18- to 24-year-olds in custody found a system beset with poor risk assessments and a failure to tackle bullying that can trigger self-harm and suicide.
A 2013 PPO report into the deaths of three under-18s in youth custody was similarly damning. It found all were "extremely vulnerable" and should not have been placed in settings with a large number of young offenders and low staff ratios. This looked at the suicides in young offender institutions (YOIs) of 17-year-old Ryan Clark in April 2011 at Wetherby, 15-year-old Alex Kelly at Cookham Wood in January 2012 and Jake Hardy at Hindley in the same month. The inquest into the death of Alex opened earlier this month.
In February this year, the Youth Justice Board, which oversees the youth justice system in England and Wales, vowed to improve the safety of young people in the secure estate and learn from the deaths of those such as Ryan, Alex and Jake, drawing on examples of good practice.
Clayfields House secure children's home, which is run by Nottinghamshire County Council and accommodates 18 children aged between 11 and 18, is one such example of good practice. It was rated "outstanding" by Ofsted in its most recent inspection report for keeping children safe, improving outcomes, and the quality of care and education.
Mental health support available includes cognitive behavioural therapy, one-to-one anxiety management, family and drama therapy, and specialist sexual behaviour programmes.
This is delivered by Clayfields' own staff, who have therapeutic training; Child and Adolescent Mental Health (CAMHS) workers, who are on site daily; and a clinical psychiatrist available weekly.
The high staff ratio, of one to every two young people, is key to building vital relationships with young people and reducing self-harm.
This is typified by the support offered on the first day of a young person's stay, when the risk of suicide or self-harm is at its peak.
"All young people are assessed within the first two hours and then checked every five minutes at night. The next day, a mental health screening takes place," says Linda Wright, Clayfields' head of education and intervention services.
"We also do a risk assessment before they get into the building, talking to the youth offending team and social workers about their history of self-harm. By the time they walk in, we have a detailed knowledge of the level of risk."
Other institutions, such as Hindley YOI, where Jake Hardy died, are still trying to find ways to support vulnerable boys with a history of self-harm like him. The YOI houses 161 boys, mostly aged 16 and 17, and three years on from Jake's death, prison inspectors found problems.
During their visit in March they criticised the "intimidating" conditions. They found fights or assaults took place daily and in the six months before the visit there were 167 self-harm incidents.
In this atmosphere, the YMCA is working to improve life for Hindley's young inmates.
Sammi McGlynn, YMCA project co-ordinator at the YOI, explains that work has included establishing a youth club and a peer mentoring scheme, where young offenders with a good level of behaviour support new arrivals "who don't know the system and are scared and intimidated".
Among McGlynn's concerns is the poor level of support available to young offenders when they leave custody, chiefly the fact that some "wait months" to see someone.
Neal Hazel is professor of criminology at the University of Salford and part of the Beyond Youth Custody research project to evaluate custody resettlement, involving crime prevention organisations such as the charity Nacro.
Increased risks
He says poor resettlement planning is commonplace, increasing the risk of self-harm and suicide, or a return to custody.
"Planning doesn't start early enough in custody and some are not even registered with a GP when they come out," he says. "Sentence planning for a detention order, where part of the sentence is served in the community, is too focused on the custody side of it. Planning for release often doesn't start until days before."
Peter, aged 17, is among the emotionally fragile young people with experience of custody involved in Beyond Youth Custody's research. "I was really scared when I came out," he says. "I walked around town and I thought everyone was just staring at me, but they weren't, it was just me."
Another, Sasha, also 17, adds: "I couldn't handle being out of prison. I just couldn't stop crying and felt depressed all the time."
Clayfields is aware of such risks and ensures its resettlement planning "starts the minute they come through our door", says Smith.
Staff draw up plans around young people's "emotional readiness" to leave and ensure they have independent living and financial skills. Resettlement work includes advocacy, to ensure the right support is available when they leave.
Reoffending rates give a good indicator of the success of this approach and, in turn, the collective failure of most other youth custody settings.
Ministry of Justice figures for October 2011 to September 2012 show 68.2 per cent of young offenders reoffended within a year of their release. In stark contrast, Clayfields' reoffending rate is just 18 per cent.
Another strategy YOIs have used to improve support for vulnerable young offenders is to accommodate them in smaller units.
John Drew, senior associate at the Prison Reform Trust, believes these are far safer environments for young people in custody.
"This enables them to be away from the main group and concentrate resources in terms of mental health specialists," he says. "There is a different ratio of staff, who are handpicked and have a particular commitment to supporting vulnerable young people."
Wetherby's specialist unit Keppel, which supports 48 15- to 18-year-olds, is seen as the best in England at providing this form of specialist support within a YOI. Earlier this year, prison inspectors described it as a "model of how a specialist unit should be". They noted swift staff intervention to halt incidents of self-harm and violence, and a strong focus on building relationships.
But Drew warns many more young people with emotional problems are unable to access such support, as their self-harm is not properly understood or reported. "The most blindingly obvious self-harm, such as cutting, are recorded, but punching walls or deliberately provoking a fight or restraint are not," he says.
Lorraine Khan, associate director for children and young people at the Centre for Mental Health, agrees that fighting as a form of self-harm, particularly among boys, needs to be better understood by those working in the secure estate.
"Boys have described to me how feeling pain made them feel better and how they picked fights to achieve that," she says.
Having a good knowledge of a young person's history of self-harm can help the secure estate establish whether violence is self-harm or an act of aggression. But Drew says such record keeping is "patchy", owing to factors such as young people with complex issues moving across council and health trust boundaries.
Social workers, who have responsibility for looked-after children entering care and young people on remand, can bridge that information gap and offer guidance based on their knowledge of children.
"Where the prison system may view a child as aggressive, we may have information to show they are vulnerable and suggest moving them to a specialist wing," explains London-based social worker Laura Eden, a representative of The College of Social Work.
But while the evidence emerging from Clayfields shows clear benefits to young offenders of small units offering intensive support, the government is instead looking to invest in large, secure colleges, the first of which will be piloted in 2017.
Crook believes these will fail to protect the most vulnerable and calls for a radical rethink of policy so that custody is used rarely and based on Clayfields' model of intensive care in a small setting. "We know from 100 years of research that locking children up is a disaster," she stresses. "Very small units run like a home are far more effective in keeping children safe."
Behind bars: Imprisoned children today
- Six children aged between 14 and 17 died in custody between 2003 and 2011. Of these, five hanged themselves. Two were on remand. All were boys.
- Among under-18s in custody, 27 per cent of boys and 55 per cent of girls have spent time in care.
- One in eight under-18s in custody has experienced a death of a parent or sibling.
- 22 per cent of boys under-18 in custody have depression and 17 per cent suffer from an anxiety disorder.
- One in five under-18s in custody has attempted suicide and two in five have harmed themselves.
Sources: Inquest, Prison Reform Trust
THE CASE AGAINST CUSTODY - WHY WE MUST STOP LOCKING UP CHILDREN BY DEBORAH COLES, CO-DIRECTOR, INQUEST
"Preventable deaths are the most extreme outcome of a system that fails some of society's most troubled children. Children in prison have backgrounds of multiple social disadvantage and experiences of substance misuse, self-harm, mental health difficulties, learning disabilities, abuse and trauma, underpinned by poverty and inequality. Their custodial experience exacerbates and compounds this vulnerability.
"Children are being remanded and sentenced to custody, sometimes at great distances from home, in institutions that do not have the culture, empathy resources, facilities or trained staff to keep them safe and deal with their complex needs.
"An array of critical prison inspectorate reports reveal a grim and violent prison culture where restraint, bullying, self-harm, segregation and violence are systemic and institutionalised.
"Inquest has worked with the families of most of the 33 children who have died in the youth justice system since 1990 and monitored the investigations and inquests into their deaths. Our evidence-based research reveals preventable deaths where systemic failings in treatment and care are repeated with alarming regularity and mechanisms to safeguard children from bullying, self-harm and suicide fail miserably.
"Our evidence also exposes a lack of accountability and management failures in response to deaths and harm.
"There is no consideration of the social harms done to children incarcerated in prisons which do little more than contain them.
"This containment is underpinned by an emphasis on punishment and control, rather than a child-centred approach to welfare and protection. Secure children's homes that are more child-focused have been drastically reduced. In the context of staff cuts, lack of resources, punitive and harsher regimes, and demoralised and under-trained staff, this has proved to be a system incapable of reform.
"Prison is an expensive and damaging intervention which far from offering solutions, fails, as illustrated by the high reconviction rate.
"The government is intent on ignoring the facts and warnings from the past with plans to build Europe's biggest children's prison, euphemistically called "the secure college". The authorisation of force "to ensure discipline" and a preoccupation with the "management of children", is a startling prospect as we remember the deaths of 15-year-old Gareth Myatt and 14-year-old Adam Rickwood, who were both subjected to violent and unlawful restraint for trivial acts of adolescent misbehaviour.
"Successive governments have refused to hold an inquiry into the deaths and abuses of children in prison. This wilful indifference and denial of what is done to some of society's most vulnerable children is also reflected in the increasing demonisation and criminalisation of children, and in the punitive political rhetoric favoured by the mass media and many politicians.
"So how do we best protect the hundreds of vulnerable children who end up in the criminal justice system? These deaths raise important social and public health issues that go beyond the prison walls as inquests frequently reveal multi-agency failings.
"There have been serious shortcomings in the protection and support available to children in conflict with the law, both inside and outside the criminal justice system. Inquest has called for radical change - the abolition of child imprisonment.
"The redistribution of resources towards child-centred community services and interventions run by child specialists, across a variety of welfare and health settings, could better achieve lasting change.
"Where children need to be detained for their own or public safety this should be in small, local, therapeutic settings with a focus on recovery and rehabilitation.
"This new, radical approach would signal that we as a society recognise all children are deserving of rights and protection. Anything less and deaths and harm will continue to devastate young lives and the lives of families."