Elsevier

The Lancet

Volume 359, Issue 9322, 8 June 2002, Pages 1975-1979
The Lancet

Articles
Mental health needs of boys in secure care for serious or persistent offending: a prospective, longitudinal study

https://doi.org/10.1016/S0140-6736(02)08829-3Get rights and content

Summary

Background

The mental health needs of children and adolescents in secure care are a matter of concern, but little systematic research has been done. Our aim was to assess the mental health, social, and educational needs of these young people in a prospective, longitudinal study.

Methods

We enrolled 97 boys aged 12–17 years who had been admitted to secure care. We assessed their needs (n=97) at the time of admission and 3 months later (n=90) with standardised interviews and psychometric tests.

Results

26 (27%) boys had an intelligence quotient (IQ) of less than 70. The need for psychiatric help was high on admission to a secure unit, with the most frequent disorders being depression and anxiety. There were high rates of aggression, substance misuse, self harm, and social, family, and educational problems, and associated needs. The mean number of needs was 8·5 (SD 2·9) on admission and 2·9 (SD 2·4) after 3 months (mean difference 5·6, 95% CI 5·0–6·3). Areas in which needs were mostly met included education, substance misuse, self care, and diet. Areas where the frequency of need fell substantially, but remained high, were social and family problems, and aggressive behaviours. Psychological needs persisted, with new onsets of depression, anxiety problems, and post-traumatic-stress symptoms shortly after admission. The most frequently required interventions were psychological assessment and cognitive behavioural work.

Interpretation

Boys in secure care have many needs and a high rate of psychiatric morbidity. During the admission period, secure care units address some domains of need, but others remain unchanged or get worse. Psychological and psychiatric provision in secure units need to be improved.

Published online May 21, 2002. http://image.thelancet.com/extras/01art3150web.pdf

Introduction

Most young people who commit criminal offences remain in the community. A few, however, require some kind of secure provision. In the UK the type of secure provision for young offenders is changing, but at present involves four main kinds of facility. Young offender institutions are run by the prison service and places for children aged 15–17 years in 13 designated establishments are commissioned by the Youth Justice Board. Three secure training centres provide places for children aged 12–16 years and are run by the private sector, with places also commissioned by the Youth Justice Board. By contrast, the secure-care system is part of the child-care system, run by the Department of Health and managed by local authorities. Children and younger adolescents are admitted to these centres. Of the 450 places available in local authority secure-care units, about 300 are bought by the Youth Justice Board for youth justice placements. The remainder are purchased by local authorities for welfare placements under child-care legislation. A small number of children younger than 17 years require detention under the mental health legislation, and are detained or admitted either to National Health Service medium secure facilities or to one of the hospitals that provide specialist services within the private sector.1

The mental health needs of children and adolescents in secure care cause great public concern, not only because of the risk that these youngsters pose to other people but also because of the risk that they can pose to themselves through substance misuse or suicide.2, 3 The Youth Justice Board is responsible for setting and monitoring standards in secure accommodation for young offenders. Many of the young people admitted to these centres are at high risk of mental health problems. They often come from backgrounds that increase the risk of such problems—eg, broken homes—and their risk is further enhanced by other factors such as poor school attendance and learning difficulties.4

The results of research done on young adults in young offender institutions indicates a high rate of mental health problems5, but there has been little systematic research done on the needs of children and adolescents in secure care. Previous research in secure care has tended to be qualitative6, 7 or cross sectional.8, 9, 10 Since the needs of this vulnerable group are likely to change over time, studies should have a longitudinal component.

Our aim was to measure the needs and psychiatric morbidity of child and adolescent offenders before they entered secure care, and 3 months after their placement. Our main objectives were to assess how needs changed over time and what steps were taken by the units to assess and offer interventions for identified needs.

Section snippets

Methods

Psychosocial needs cannot be assessed over short periods. We therefore included only adolescents who were on long-term placements (>3 months). During the first assessment, which took place shortly after admission, we focused on the 3 months before admission. The second assessment was done 3 months later. All interviews were done by one investigator (JR). LK, DB, and PS did the clinical rating of needs, based on the results of the interviews. We randomly assigned the interview results to LK, DB,

Results

Four of the five secure units that we approached agreed to take part in our study. There were 101 eligible referrals to these units, 97 of whom agreed to be interviewed. 97 boys were, therefore, interviewed with K-SADS and SNASA at entry into the secure units. 87 key workers were interviewed with SNASA; the remaining information was obtained from files. 93 adolescents completed the WISC and 78 the WORD tests. 3 months after the first interview, 90 of the adolescents were reassessed; the

Discussion

Our results show that admission to secure care is followed by a great reduction in need. There was an especially large reduction in educational needs, a result that accords with those of previous studies.15 This finding is important in view of the high rates of low IQ and reading difficulties in this sample. Aggressive behaviours, substance dependence, social relationships, and self care also improved.

This reduction seems to be largely due to the process of being incarcerated and heavily

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