Children in custody are facing a “significant shortfall” in mental health provision, with some given no access to psychology services and having to wait more than half a year for treatment.
Young offenders aged between 12 and 17, many of whom suffer with mental health problems, are being left with urgent needs unmet due to reduced services in secure training centres (STCs), according to recent Ofsted inspections.
STCs are for young offenders aged between 12 and 17 and house between 50 and 80 inmates. They are designed to house more vulnerable children than Young Offender Institutions (YOI), which can hold up to 400 offenders aged between 15 and 21.
One centre, Oakhill STC in Milton Keynes, run by security firm G4S, employs one psychiatrist who visits the institution for two hours each week to meet the needs of 75 children. At the time of the inspection, one young person in the centre had been waiting for seven months for a mental health intervention.
An Ofsted report last month revealed that psychological and psychiatric services at Oakhill STC had been “significantly reduced” since the previous inspection, with demand “considerably higher” than the services available to meet children’s urgent needs.
Campaigners and MPs have described the findings as "extremely troubling" and called on the Government to take "immediate action" to improve the mental health provision in STCs, which they urge is denying children the chance to rehabilitate.
Children and young people in custody are three times as likely as their peers to have unmet mental health need, with many having experienced multiple traumas during their young lives such as neglect, abuse and maltreatment.
Ofsted rated all three STCs in England as “needing improvement” for their healthcare services, but the mental health provision at Oakhill is considerably lower than Medway and Rainsbrook. Oakhill is the only STC still run by G4S, after the other two STCs were recently taken over after concerns were raised about the company's management.
Medway STC in Kent, which was taken over by the National Offender Management Service after a Panorama investigation exposed misconduct by G4S staff, has an “effective” child and adolescent mental health service, according to an Ofsted report published in June. The service is made up of five members of staff including a clinical psychologist, an assistant psychologist and a peer support worker.
But the report highlighted an issue with the fact that children are seen in the education unit for mental health and substance misuse interventions, which means there’s a lack of privacy which makes it more difficult for the clinicians to engage meaningfully with the young people.
Rainsbrook STC in Warwickshire, which holds 58 children, has an integrated mental health team, with a newly appointed psychologist, according to a report published in August. But concerns were raised over the fact that there were 50 per cent vacancies in primary care, and psychological assessments of children were rarely accessed by staff.
Meanwhile, in Oakhill STC — as well as long delays and the absence of any psychology service — self-harm and suicide risk assessments carried out by staff were reported to be "extremely variable in quality", with many failing to consider critical relevant information such as previous serious mental health concerns.
Ofsted inspectors said of Oakhill: "Compared to our last inspection, psychological and psychiatric services are significantly reduced. This means that there are delays in accessing assessments and treatments, with one young person waiting for an intervention since March 2017.
"The psychiatrist's time is limited to two hours a week, which is largely used to review medicines. The only individual interventions are being delivered by the registered mental health nurses for low level needs [...] Some key services have been reduced since the last inspection: the resettlement team of case workers is smaller and there are no psychology services."
In response to the findings, Shadow Secretary of State for Justice Richard Burgon told The Independent: “Our prisons system is suffering an epidemic of mental health problems, self-harm and suicide. Far too many people are being jailed when what they really need is proper mental health treatment.
“It is extremely troubling that hundreds of prisoners are not receiving their treatment for serious mental health problems in hospital and on time, but even more disturbing when vulnerable children are waiting up to six months for mental help treatment, as the recent damming inspection of Oakhill found.
“The Government needs to intervene and take immediate action to put an end to such cases. Everyone has a right to proper mental health treatment and cuts to already inadequate mental health treatment provision in STCs denies children a second chance and makes it harder to turn their lives around.”
Andy Bell, deputy chief executive of the Centre for Mental Health, told The Independent ready access to high-quality mental health support was “essential” for children and young people in custody, as these youngsters often have particularly high psychological needs.
“Children and young people in custody have very high levels of mental health difficulty. It is therefore vital that whenever possible vulnerable children are not placed in custody, which can exacerbate mental health problems. And for those who are detained, ready access to high-quality mental health support is essential," he said.
“We must ensure that all staff working in secure environments are trained and confident in supporting young people’s wellbeing and understanding trauma, backed up by specialist help for those who need it.”
Naomi Murphy, psychologist and clinical director of a mental health unit in an adult prison, achoed his concerns, saying the lack of therapeutic services meant children in custody stood very little chance of not reoffending.
“I find it appalling that we don’t have better therapeutic provision for children in custody. I’ve never in 20 years working with offenders met anyone who didn’t have therapeutic needs; their experiences are nearly always of neglect, abuse and trauma,” she said.
“Children who find themselves in those services are children who will be vulnerable and will need some repairing and healing. It’s unforgiveable that we don’t offer something therapeutic. It becomes a vicious circle and means children are more likely to reoffend.”
Frances Crook, chief executive of the Howard League for Penal Reform, said poor mental health provision was an indication that STCs were cutting costs, and urged that the institutions themselves cause children’s health to deteriorate.
“The lack of mental health services indicates these institutions are cutting costs. Psychiatrists don’t come cheap, whereas a barely trained warden with keys comes much cheaper,” she said.
“There’s a problem with mental support for children anyway in the community, which may well have contributed to getting them into the STCs in the first place. Then when they get there, the institution itself contributes towards deteriorating their mental health."
Oakhill STC's director, Lisette Saunders, urged that the company recognised that it needed to develop the secondary care provision in the centre in order to offer an more "all encompassing" mental health service for child inmates.
“The health and wellbeing of the young people in our care is always our priority. G4S provides the primary care provision at Oakhill, which includes registered mental health nurses, learning disability nurses and a psychiatrist who visits on a regular basis," she said.
"We recognise that we need to develop our secondary care provision to offer an all encompassing mental health service for the young people. The psychiatric provision is currently under review by the Director and G4S Health Services to ensure access to sufficient psychiatric and psychological services is provided to meet the needs of young people."
A Ministry of Justice spokesperson meanwhile said: “The safety and welfare of every young person in custody is our priority but we have been clear there is much more to do.
“We are strengthening the provision of mental health care with more psychologists and specialised units for the most vulnerable children – the first of which opened at Feltham in November.
“More widely across the estate, we are investing an additional £64m to improve youth custody, including boosting the number of frontline staff in public sector Young Offender Institutions by 20% - all of whom will be specially trained to work in the youth estate."
The spokesperson added that 140 existing officers are enrolled on a specialist youth custody worker foundation degree, which they said would improve the safety of both staff and children and increase access to education and other activities.
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