HC 1048-III Health CommitteeWritten evidence from the Youth Justice Board for England and Wales (PH 169)
Introduction
1. The Youth Justice Board for England and Wales (YJB) welcomes the opportunity to provide a submission to the inquiry on Public Health. This submission provides brief background on the role of the YJB and the youth justice system and the links between health and offending and antisocial behaviour, before outlining some key issues related to public health. The YJB would be pleased to provide any further information that would be of assistance to the inquiry if required.
2. At national level it is vital that the work of Public Health England takes into account the specific issues relating to health and criminal justice, and at a local level there is potential for building closer relationships between Directors of Public Health, Health and Well Being Boards and the youth justice system. This will not only help ensure that the specific health needs of the young offender population are met, but also more effective delivery of community safety and early intervention/prevention strategies. The YJB sees the new Public Health Service having a key role to play in the prevention of health problems through:
stronger linkages with preventative education;
issuing guidelines to Health and Well Being Boards/GP consortia that highlight what is expected in terms of providing support and interventions;
advising on commissioning and effective operation of population health services;
ensuring needs assessments relating to young offenders feature adequately in JSNAs in order that adequate resources can be directed into youth justice and prevention services; and
ensuring the provision of services for young offenders (as with all vulnerable/excluded groups) who often are not accessing health services.
Background: The YJB and Youth Justice System
3. The role of the YJB is to oversee the youth justice system in England and Wales. It works to prevent offending and reoffending by children and young people under the age of 18, and to ensure that custody is safe, secure, and addresses the causes of their offending behaviour. The statutory responsibilities of the YJB include:
advising Ministers on the operation of, and standards for, the youth justice system;
monitoring the performance of the youth justice system;
purchasing places for, and placing, children and young people remanded or sentenced to custody;
identifying and promoting effective practice;
making grants to local authorities and other bodies to support the development of effective practice; and
commissioning research and publishing information.
4. While the YJB is responsible for overseeing the performance of youth justice services, including multi-agency Youth Offending Teams (YOTs), it does not directly manage these services. YOTs are made up of five statutory partners including health and are accountable to the local authority Chief Executive.
5. The main role of the YOT is to assess criminogenic risk, plan, review and supervise the sentences young people are serving (whether served in custody or the community) and to ensure they have access to mainstream services in order to reduce the risk factors related to their offending patterns. On that basis, the YJB has taken a holistic approach to identification and treatment of health, mental health and substance misuse (SMU) needs, including alcohol and illicit drugs.
6. Research has shown health, mental health and substance misuse problems significantly increase the risk of children and young people offending and reoffending. When a young person enters the youth justice system, the relevant bodies which make up the local statutory YOT partnerships (including health) have a responsibility to ensure that their health needs are taken into consideration and addressed effectively.
7. The YJB’s approach to ensuring that adequate provision is made for young people in the youth justice system is based on the following underpinning principles:
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8. We support any changes which improve early assessment and interventions for high risk families where this will prevent children with emerging mental health, conduct disorder or learning disability/difficulty from becoming offenders.
9. There are specific considerations involved in the delivery of health services to young offenders. These have been well documented in the DofH strategy Healthy Children, Safer Communities published in 2009. It is vital that in the reconfiguration of health service commissioning and delivery systems the following considerations are taken into account:
The need for effective commissioning and delivery of a range of health services to young people in custody, potentially located far from their home area.
The importance of resourcing triage and diversion services to ensure that those young people with mental health and or learning disabilities who may come to the attention of youth justice services are diverted at the earliest opportunity into the relevant treatment as opposed to being processed through criminal justice.
The ability of health services to input into multi-agency intervention programmes triggered when a young person’s health needs are identified, perhaps for the first time, upon entry into the youth justice system.
10. Well informed commissioning is key to ensuring the appropriate services are delivered. Those commissioning services have a responsibility to know which programmes are having an impact on:
reducing criminality; and
substance misusers altering their lifestyles to such an extent that they gain employment or go back into education to improve their ability to improve the local economic climate.
The Extent of Health Needs in the Youth Justice System
11. This section outlines the extent of the problems faced by young people in the youth justice system in five main areas:
mental health;
substance misuse;
sexual health;
physical well-being; and
health and education.
Mental Health
12. Young people in the youth justice system have three times the prevalence of mental health needs as the general population. The Healthy Children, Safer Communities strategy highlights over a third of young people in custody are diagnosed with a mental health disorder. This includes young people:
experiencing problems with depression;
suffering from anxiety;
suffering from post-traumatic stress disorder (PTSD);
having problems with hyperactivity; and
displaying psychotic-like symptoms.
Additionally:
a high proportion from BME groups, compared with others have post-traumatic stress disorder (community and custody); and
a high proportion have experienced bereavement and loss through death and family breakdown (community and custody).
13. In a study of young women in young offender institutions (Female Health Needs in Young Offender Institutions, also available from the YJB website), 36% had self-harmed in the last month: the majority of these (92%) had cut themselves. The study also found that 71% of the young women surveyed had some level of psychiatric disturbance, which rose to 86% when factoring in longstanding disorders.
Substance Misuse
14. Research commissioned by the YJB shows that young people in the youth justice system are more likely to have used both legal and illegal drugs (including alcohol and tobacco). They are also more likely to suffer from substance misuse problems, even in comparison to other groups of vulnerable young people: for example, the use of Class A and Class B drugs is considerably higher among young people who offend than in other groups in the general population.
15. YJB research of young people in custody shows that:
90% of young people in custody had used an illegal drug at some point in their life.
72% used cannabis daily in the 12 months before their arrest.
74% of the sample drank alcohol more than once a week, with the majority regularly drinking more than six units each time.
51% used two or more drugs more than once a week.
37% said they would commit less crime if they stopped using drugs.
25% said they would commit less crime if they stopped using alcohol.
16. Young people who have offended and have problems with substance misuse are likely to have experienced difficult life events such as problems within the family, including bereavement and abuse. They are also likely to have low levels of psychological well-being, to have poor social skills and to experience difficulties with school.
17. Substance misuse can lead to additional problems – for instance, it is the second largest contributory factor to homelessness among young people who offend (after violence in the home). Unsurprisingly, these young people report using drugs and alcohol in order to cope – in one study, 69% of young people reported that they drank alcohol or used drugs in order to think less about their problems.
Sexual Health
18. The Health of Children and Young People report (available from www.statistics.gov.uk) showed that adolescent sexually-transmitted infections have worsened since 1990. In a study into the health of young women in young offender institutions (Female Health Needs in Young Offender Institutions, available from the YJB website), although 26% of those surveyed reported three or more sexual partners in the last year, only 15% had always used condoms, 23% had been diagnosed with a sexually transmitted infection and 10% had been paid for sex.
Physical Well-Being
19. Many young people have physical health needs that only come to light through contact with YOTs. As highlighted in Healthy Children Safer Communities over a quarter of young men (and a third of young women) in custody report a long standing physical complaint.
20. Appropriate healthcare while young should help to reduce problems in adult life, but a quarter of these young people have never been to their GP, and many of those who use conventional GP services say they do not find them helpful. It follows that if they are not engaged with mainstream health and education provision, many young people will not have the information they need to make choices about healthy living. When YOT and secure establishment health workers carry out physical health checks, multiple health needs are sometimes identified. Included in this would be dentistry and opticians.
Health and Education
21. Information gathered from YOT assessments of young people indicates that there are established links between health, educational inclusion and achievement and risk of offending and committing anti-social behaviour. The Healthy Children, Safer Communities report highlights that of young people in the youth justice system:
over 75% have serious difficulties with literacy and numeracy (custody);
over 75% have a history of temporary or permanent school exclusion (custody);
over 50% have difficulties with speech, language and communication (custody); and
over 25% have a learning disability (community and custody).
22. Furthermore, a study in the North East with the region’s YOTs showed that over 40% of young offenders also have an identifiable learning disability or difficulties (2006).
23. It is also necessary to consider emerging emotional, behavioural and conduct disorders known to contribute to some young people’s educational ability/achievement along with increasing their risk of committing anti-social behaviour and/or (re)offending. These “conditions” include:
Attention Deficit Hyperactivity Disorder (ADHD).
Autistic Spectrum Disorders.
Aspergers Syndrome.
Conduct Disorders.
Traumatic Brain Injury (TBI)/Acquired Brain Injury (ABI).
Key Points to Consider for the Youth Justice System
24. If we do not address the holistic health needs (including mental health and substance misuse needs) of young people who offend, there is a strong possibility they will be excluded from the opportunity of improving and maintaining good health, and so from the ability to achieve their full potential in life. It is also more likely they will continue to offend in the longer term with all the contingent costs to society.
25. The YJB believes that all work with vulnerable young people in the youth justice system should be sensitive to their health needs and their possible substance misuse. Services should work together to respond effectively to young people’s identified needs. It is critical that health provision in YOTs and the secure estate is fully supported by local health services, and that current effective practice in bringing health services to this group of vulnerable young people continues to improve.
26. Whilst the YOT client group is small in terms of numbers, it is this cohort that subsequently goes on to cost the “system” the most. YOTs are in a unique position to identify those individuals with complex health needs. Through early intervention it is possible to prevent, not only more expensive health related treatments being required in the future but also offending and reoffending, negative outcomes and the related costs to the state of being dependant on benefits (eg for long term unemployment).
27. As noted above, young people often present with multiple needs which taken individually may not be deemed problematic but when grouped together collectively result in complex needs leading to high risk of poor outcomes that require a collaborative, multi-agency response if they are to be resolved.
June 2011