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BackgroundBackground Researchhas revealedResearchhasrevealed
highlevels ofmental healthneedsinyounghigh levels of mentalhealth needsinyoung
offendersbut many studies have beenoffenders but many studies have been
sm a ll, focusi ng on speci fic popula tions.sm a ll, focusi ngon speci fic popula tions.
AimsAims To eval uat e the mentalhealth andTo evaluatethementalhealth and
psychosocialneeds of a nationallypsychosocialneeds of a nationally
representat i ve samp le of j uven ilerepresentat i ve samp le of j uven ile
offendersin England and Wales, includingoffenders in England and Wales, i ncl ud i ng
femaleoffendersandthosefrom Blackandfem a l e off enders andthose from B lackand
minorityethnicgroups.minorityethnicgroups.
MethodMethod Across-sectional survey ofAcross-sectionalsurvey of
301youngoffenders,151incustodyand1503 01youngoffenders,151incustodyand150
i nthe com m un ity, was cond u ct ed i n si xinthe com mun ity, was cond uct edi n s i x
geographicallyrepresentative area sgeographicallyrepresentative areas
across England and Wales.Eachyoungacross England and Wales.Eachyoung
personwasinterviewedto obtainpersonwasinterviewedto obtain
demographicinformation, mentalhealthdemographi c inf ormation, mental heal th
and socialneeds, andpsychometric data.and socialneeds, andpsychometricdata.
ResultsResults Young offenders were found toYoung offenders were found to
have highlevels ofneedsin a number ofhave h ig h levels of needs in a num ber of
different areasincluding mentalhealthdifferent areas including mental health
(3 1%), education /work (36%) and social(3 1%), educat ion/work (36%) and social
rela tionships (48%).Youn gof fe nde rsintherelationships (48%).Youngoffendersinthe
communityhadsignificantlymoreneedscommunityhadsignificantly more needs
thanthosein secure care andneedswerethanthosein secure care andneedswere
of ten unmet.One in five young offendersofte n un m e t.Onein five you n g offe nde rs
was also ident ified as having a learni ngwas also identified as hav ing a learning
disability (IQdisability (IQ5570).70).
ConclusionsConclusions Needs for youngNeeds for young
of fe nde rs wer e high butof ten u n me t.Th i sof fe nde rs we r e high butof ten un met.Thi s
emphasises theimportance of structuredemphasises the importance of structured
needs assessme nt with in cust ody andneeds assessment within custodyand
community settings in conjunction with acommunity settings in conjunction with a
care programme approachthatimprovescare programme approachthatimproves
continuityof care.continuity of care.
Declaration of interestDeclaration of interest None.None.
There is growing research literature onThere is growing research literature on
the mental health needs of adolescentsthe mental health needs of adolescents
in the youth justice system (Teplinin the youth justice system (Teplin etet
alal, 2002). However, many of the studies, 2002). However, many of the studies
conducted have been small, focusing onconducted have been small, focusing on
those in secure care, with few studies ofthose in secure care, with few studies of
female offenders or those from Black andfemale offenders or those from Black and
minority ethnic groups (Laderminority ethnic groups (Lader et alet al,,
2000; Kroll2000; Kroll et alet al, 2002). Over the past 5, 2002). Over the past 5
years there have also been significantyears there have also been significant
changes in youth justice service structure,changes in youth justice service structure,
culture and provision in England andculture and provision in England and
Wales. Services have expanded, sentencingWales. Services have expanded, sentencing
has changed and there is an emphasis onhas changed and there is an emphasis on
prevention and treatment (Youth Justiceprevention and treatment (Youth Justice
Board, 2004). However, there is noBoard, 2004). However, there is no
national needs assessment, using both cor-national needs assessment, using both cor-
porate and individual methods. Corporateporate and individual methods. Corporate
needs assessment is essential for serviceneeds assessment is essential for service
planning and estimating costs (Harringtonplanning and estimating costs (Harrington
et alet al, 1999). Individual needs assessment, 1999). Individual needs assessment
contributes to coordination of care andcontributes to coordination of care and
risk assessment (Kingdon, 1994).risk assessment (Kingdon, 1994).
This research was commissioned by theThis research was commissioned by the
Youth Justice Board to examine a nationalYouth Justice Board to examine a national
sample of young offenders using corporatesample of young offenders using corporate
and individual needs assessment methods.and individual needs assessment methods.
We report here on the individual needsWe report here on the individual needs
research. The aims were to measure ratesresearch. The aims were to measure rates
of mental health, social and educationalof mental health, social and educational
needs of juvenile offenders in secure facil-needs of juvenile offenders in secure facil-
ities and in the community and to exploreities and in the community and to explore
differences in needs dependent on setting,differences in needs dependent on setting,
gender and ethnicity.gender and ethnicity.
METHODMETHOD
Context and participantsContext and participants
This individual needs research was part of aThis individual needs research was part of a
larger study commissioned by the Youthlarger study commissioned by the Youth
Justice Board in 2002 to evaluate theJustice Board in 2002 to evaluate the
effectiveness of mental health provisioneffectiveness of mental health provision
for young offenders in custody and in thefor young offenders in custody and in the
community. This larger study included costcommunity. This larger study included cost
evaluation of youth crime (Barrettevaluation of youth crime (Barrett et alet al,,
2006), longitudinal follow-up of the secure2006), longitudinal follow-up of the secure
sample (Youth Justice Board, 2005) andsample (Youth Justice Board, 2005) and
qualitative aspects of service provisionqualitative aspects of service provision
(Youth Justice Board, 2005).(Youth Justice Board, 2005).
Six sites were chosen as geographicallySix sites were chosen as geographically
representative areas across England andrepresentative areas across England and
Wales. Each site comprised a secure facilityWales. Each site comprised a secure facility
and the local youth offending team. Theand the local youth offending team. The
secure facilities included four young offen-secure facilities included four young offen-
ders institutions and two local authorityders institutions and two local authority
secure children’s homes. Because of thesecure children’s homes. Because of the
small size of both secure children’s homessmall size of both secure children’s homes
and three of the six youth offending teams,and three of the six youth offending teams,
further sites were recruited (two localfurther sites were recruited (two local
authority secure children’s homes and threeauthority secure children’s homes and three
youth offending teams). These additionalyouth offending teams). These additional
sites were chosen for their geographicalsites were chosen for their geographical
proximity or service connection to theproximity or service connection to the
original site.original site.
Young people aged 13–18 years inclu-Young people aged 13–18 years inclu-
sive were recruited to the study. Thissive were recruited to the study. This
involved recruiting 25 individuals attendinginvolved recruiting 25 individuals attending
consecutively at each of the six youthconsecutively at each of the six youth
offending teams, while at the secure sites,offending teams, while at the secure sites,
the 25 young offenders recruited werethe 25 young offenders recruited were
equally divided between those just admittedequally divided between those just admitted
and those about to be released. Withinand those about to be released. Within
secure estates, both remanded (pre-trialsecure estates, both remanded (pre-trial
and post-trial) and sentenced young offen-and post-trial) and sentenced young offen-
ders were eligible for the study. Those inders were eligible for the study. Those in
the community included young offendersthe community included young offenders
on final warnings as well as those givenon final warnings as well as those given
community orders. We aimed to over-community orders. We aimed to over-
sample female young offenders and thosesample female young offenders and those
from Black and minority ethnic groups. Atfrom Black and minority ethnic groups. At
each of the youth offending teams andeach of the youth offending teams and
secure sites we attempted to recruit fivesecure sites we attempted to recruit five
young offenders from Black and minorityyoung offenders from Black and minority
ethnic groups and five female offendersethnic groups and five female offenders
with the aim of finally recruiting 60 femalewith the aim of finally recruiting 60 female
offenders and 60 offenders from Black andoffenders and 60 offenders from Black and
minority ethnic groups out of a total of 300minority ethnic groups out of a total of 300
young offenders (150 in custody and 150 inyoung offenders (150 in custody and 150 in
the community).the community).
Eligible young people willing to partici-Eligible young people willing to partici-
pate in the study were referred by staffpate in the study were referred by staff
at the secure and community sites to theat the secure and community sites to the
research assistants. The young person wasresearch assistants. The young person was
then informed about the study and consentthen informed about the study and consent
was obtained by one of three researchwas obtained by one of three research
interviewers. Where young people wereinterviewers. Where young people were
judged to be not competent to give writtenjudged to be not competent to give written
consent, consent was obtained from theirconsent, consent was obtained from their
parent or legal guardian. Ethical approvalparent or legal guardian. Ethical approval
was obtained from the North West Multi-was obtained from the North West Multi-
centre Research Ethics Committee.centre Research Ethics Committee.
MeasuresMeasures
Although previous studies of juvenile offen-Although previous studies of juvenile offen-
ders have often used psychiatric diagnosisders have often used psychiatric diagnosis
as a measure of mental health problems,as a measure of mental health problems,
534534
BRITISH JOURNAL OF PSYCHIATRYBRITISH JOURNAL OF PSYCHIATRY (2006), 188, 534^54 0(2006), 188, 534^ 540
Mental health needs of y o ung offe nders in cus todyMental health needs of y o ung offe nde rs in custody
and i n the com munityand i n the commun i ty
PR ATHIB A CHIT SABESAN, LE O KROLL, SUE B AILE Y,PRAT HIB A CHIT S ABE S AN, LE O KROLL , SUE B AILE Y,
CASSANDRA KENNING, STEPHAN IE SNEIDER, WENDY MacDONAL DCASSANDRA KENNING, STEPHAN IE SNEIDER, WENDY MacDONAL D
and LOUISE THEODOSIOUand LOUISE THEODOSIOU
MENTAL HEALTH NEEDS OF YOUNG OFFENDERSMENTAL HEALTH NEEDS OF YOUNG OFFENDERS
this method has certain limitations: forthis method has certain limitations: for
example, the prevalence of a disorder doesexample, the prevalence of a disorder does
not necessarily equate to the level ofnot necessarily equate to the level of
services required (Harringtonservices required (Harrington et alet al, 1999)., 1999).
The latter is influenced by a number ofThe latter is influenced by a number of
factors including the availability of anfactors including the availability of an
effective intervention and a willingnesseffective intervention and a willingness
to accept the intervention. Increasingly,to accept the intervention. Increasingly,
therefore, needs assessment is seen as atherefore, needs assessment is seen as a
more useful measure of health problemsmore useful measure of health problems
in children and adults, including juvenilein children and adults, including juvenile
offenders. The Salford Needs Assessmentoffenders. The Salford Needs Assessment
Schedule for Adolescents (SNASA; KrollSchedule for Adolescents (SNASA; Kroll etet
alal, 1999) is a semi-structured interview, 1999) is a semi-structured interview
specifically designed for research on adoles-specifically designed for research on adoles-
cents and has good psychometric propertiescents and has good psychometric properties
(Kroll(Kroll et alet al, 1999). In addition to psychi-, 1999). In addition to psychi-
atric symptoms, the SNASA covers severalatric symptoms, the SNASA covers several
other needs, including education and socialother needs, including education and social
needs. For each domain, the interviewerneeds. For each domain, the interviewer
gathers information on symptom severitygathers information on symptom severity
(on a five-point scale), client cooperation(on a five-point scale), client cooperation
(three-point scale), client perception of the(three-point scale), client perception of the
problem (three-point scale) and keyworkerproblem (three-point scale) and keyworker
stress (four-point scale). This instrumentstress (four-point scale). This instrument
also allows researchers to obtain infor-also allows researchers to obtain infor-
mation about interventions that have beenmation about interventions that have been
offered recently or not offered. From thisoffered recently or not offered. From this
information, the SNASA identifies needs.information, the SNASA identifies needs.
A need is defined as a significant problemA need is defined as a significant problem
requiring some form of intervention and isrequiring some form of intervention and is
automatically identified by the program ifautomatically identified by the program if
a threshold is crossed either in one area (se-a threshold is crossed either in one area (se-
verity criteria) or in a combination of areas.verity criteria) or in a combination of areas.
Within the final stage of the SNASA,Within the final stage of the SNASA,
experienced clinicians (child psychiatrists)experienced clinicians (child psychiatrists)
are required to make judgements aboutare required to make judgements about
interventions offered based on availableinterventions offered based on available
information about the young personinformation about the young person
obtained from both the individual and aobtained from both the individual and a
carer. A final needs status is generated,carer. A final needs status is generated,
rated as ‘no need’, ‘unmet need’ (in needrated as ‘no need’, ‘unmet need’ (in need
of an intervention that has not been given),of an intervention that has not been given),
‘suspended need’ (an intervention has been‘suspended need’ (an intervention has been
offered recently, but it is too soon to assessoffered recently, but it is too soon to assess
whether it has been beneficial) or ‘need thatwhether it has been beneficial) or ‘need that
persists despite intervention’.persists despite intervention’.
The different needs domains areThe different needs domains are
described within the results section. Fordescribed within the results section. For
both the research interviewers’ and theboth the research interviewers’ and the
clinicians’ needs ratings, reliability of theclinicians’ needs ratings, reliability of the
ratings was ensured by frequent meetingsratings was ensured by frequent meetings
between the research interviewers and clin-between the research interviewers and clin-
icians to agree on scoring. There was alsoicians to agree on scoring. There was also
assessment of the percentage of pairwiseassessment of the percentage of pairwise
agreement between research interviewersagreement between research interviewers
(81–87%) and clinicians (85–91%) on(81–87%) and clinicians (85–91%) on
individual cases.individual cases.
Details of offending behaviour wereDetails of offending behaviour were
obtained from self-reports from theobtained from self-reports from the
young person. Psychometric assessmentsyoung person. Psychometric assessments
used included the Weschler Abbreviatedused included the Weschler Abbreviated
Schedule Interview (WASI; PsychologicalSchedule Interview (WASI; Psychological
Corporation, 1999) and the WeschlerCorporation, 1999) and the Weschler
Objective Reading Dimension (WORD;Objective Reading Dimension (WORD;
Psychological Corporation, 1992). YouthPsychological Corporation, 1992). Youth
offending workers and either keyworkersoffending workers and either keyworkers
or personal officers who knew the youngor personal officers who knew the young
people were also interviewed for carerpeople were also interviewed for carer
information.information.
Statistical analysisStatistical analysis
The software Statistical Package for theThe software Statistical Package for the
Social Sciences version 10 for WindowsSocial Sciences version 10 for Windows
was used to analyse the data. Total levelswas used to analyse the data. Total levels
of needs and cardinal problems wereof needs and cardinal problems were
parametric in their distribution and subse-parametric in their distribution and subse-
quently two-tailedquently two-tailed tt-tests and analysis of-tests and analysis of
variance were used to assess the correla-variance were used to assess the correla-
tion of different variables with them.tion of different variables with them.
The presence or absence of cardinalThe presence or absence of cardinal
problems in both major domains andproblems in both major domains and
individual areas were categorical variablesindividual areas were categorical variables
and subsequently chi-squared analysis wasand subsequently chi-squared analysis was
used to assess the correlation with otherused to assess the correlation with other
variables.variables.
It was calculated that with 150 partici-It was calculated that with 150 partici-
pants the study would have an 80% chancepants the study would have an 80% chance
of detecting an effect size of 0.3 betweenof detecting an effect size of 0.3 between
custody and community groups usingcustody and community groups using
the SNASA. To be able to detect an effectthe SNASA. To be able to detect an effect
size of 0.5 between juvenile offenders ofsize of 0.5 between juvenile offenders of
different genders (maledifferent genders (male vv. female) and. female) and
different ethnic groups (White Britishdifferent ethnic groups (White British vv..
Black and minority ethnic) we estimatedBlack and minority ethnic) we estimated
that we would need to recruit a sample ofthat we would need to recruit a sample of
64 female offenders and 64 young offenders64 female offenders and 64 young offenders
from Black and minority ethnic groupsfrom Black and minority ethnic groups
(Machin & Campbell, 1987). The signifi-(Machin & Campbell, 1987). The signifi-
cance of differences was calculated usingcance of differences was calculated using
a 95% confidence interval (Gardner &a 95% confidence interval (Gardner &
Altman, 1989).Altman, 1989).
RESULTSRESULTS
Study sampleStudy sample
At the secure sites, 162 young people wereAt the secure sites, 162 young people were
eligible for the study. Consent was obtainedeligible for the study. Consent was obtained
from 151 of these young people. Thefrom 151 of these young people. The
remaining 11 refused toremaining 11 refused to participate in theparticipate in the
study. Within communitystudy. Within community sites, 173 youngsites, 173 young
people were referred and 150 were inter-people were referred and 150 were inter-
viewed. The remaining 23 young peopleviewed. The remaining 23 young people
either refused or consistently failed toeither refused or consistently failed to
attend their interview appointments. Thus,attend their interview appointments. Thus,
301 young offenders were interviewed301 young offenders were interviewed
using the demographic pro-forma andusing the demographic pro-forma and
SNASA accompanied by 174 SNASA carerSNASA accompanied by 174 SNASA carer
interviews. Missing carer interviews wereinterviews. Missing carer interviews were
owing to the youth offending team memberowing to the youth offending team member
or personal officer being unavailable. Theor personal officer being unavailable. The
WASI and WORD assessments wereWASI and WORD assessments were
completed by 257 and 259 young peoplecompleted by 257 and 259 young people
respectively.respectively.
Demographic characteristicsDemographic characteristics
The characteristics of participants in theThe characteristics of participants in the
study are given in Table 1. The meanstudy are given in Table 1. The mean
age of the sample recruited was 15.7age of the sample recruited was 15.7
years (s.d.years (s.d.¼1.3, range 13–18). Over three-1.3, range 13–18). Over three-
quarters of the sample were male (77%).quarters of the sample were male (77%).
The majority of young offenders clas-The majority of young offenders clas-
sified themselves as White British (83%).sified themselves as White British (83%).
Although the study specifically oversampledAlthough the study specifically oversampled
young offenders from Black and minorityyoung offenders from Black and minority
ethnic groups, these figures were similarethnic groups, these figures were similar
to those found within the youth justiceto those found within the youth justice
system (Youth Justice Board Conference,system (Youth Justice Board Conference,
2004). Three-quarters (74%) of young of-2004). Three-quarters (74%) of young of-
fenders were from families where the familyfenders were from families where the family
structure had broken down, with only 36%structure had broken down, with only 36%
of biological parents still married or coha-of biological parents still married or coha-
biting. A third of young offenders (37%)biting. A third of young offenders (37%)
had been in care at some time, and 77%had been in care at some time, and 77%
had parents in manual employment. Ofhad parents in manual employment. Of
those under 16 years who should have beenthose under 16 years who should have been
535535
Ta b l e 1Ta b l e 1 Characteristics of partici pantsCharacte risti cs of partici pants
nn (%)(%)
Gender (Gender (nn¼ 301)301)
MaleMale 232 (77)232 (77)
FemaleFemale 69 (23)69 (23)
Ethnic origin (Ethnic origin (nn¼301)30 1)
White BritishWhite British 250 (83)250 (83)
African^CaribbeanAfrican^Caribbean 26 (9)26 (9)
AsianAsian 7 (2)7 (2)
Mixed raceMixed race 15 (5)15 (5)
OtherOther 3 (3(551)1)
IQ (IQ (nn¼301 )301)
5570 (extremely low)70 (extremely low) 60 (20)60 (20)
70^79 (borderl ine)70^79 (bord e rline) 93 (31)93 (3 1 )
80^119 (average)80^1 1 9 (average) 103 (34)103 (34)
55120 (superior)120 (superior) 1 (1(551)1)
MissingMissing 44 (15)44 (15)
Placeme nt for child re n under 16 yearsPlaceme nt for childre n under 16 years
old (old (nn¼209)209)
NoneNone 23 ( 11)23 (11)
Mainstream schoolMainstream school 32 (1 5)32 (1 5)
CustodyCustody 112 (54)112 (54)
CollegeCollege 1 2 (6)12 (6)
Community trainingCommunity training 1 1 (5)11 (5)
PupilreferralunitPupil referral unit 13 (6)13 (6)
Home tuiti onHome tuit i on 3 (1)3(1)
MissingMissing 3 (1)3(1)
CHITS ABES AN E T ALCHITSABESAN ET AL
in statutory education (in statutory education (nn¼209), 89% were209), 89% were
obtaining some form of educational provi-obtaining some form of educational provi-
sion, although only 16% of young peoplesion, although only 16% of young people
werewere in mainstream school. One in fivein mainstream school. One in five
young offenders had an IQ below 70young offenders had an IQ below 70
((nn¼60) and therefore met the criteria for60) and therefore met the criteria for
learning disability, and almost one in threelearning disability, and almost one in three
((nn¼93) was assessed as having borderline93) was assessed as having borderline
learning disability (Table 1). The meanlearning disability (Table 1). The mean
full-scale IQ of the sample was found tofull-scale IQ of the sample was found to
be 78.8 (s.d.be 78.8 (s.d.¼ 12.7, range 53–123), with12.7, range 53–123), with
a mean verbal score of 74.8 and mean per-a mean verbal score of 74.8 and mean per-
formance score of 87.4. The mean readingformance score of 87.4. The mean reading
age was 11.3 years (s.d.age was 11.3 years (s.d.¼3.3, range3.3, range
6–17). This is significantly lower6–17). This is significantly lower
((PP¼0.015) than the mean chronological0.015) than the mean chronological
age (15.7 years).age (15.7 years).
Those in custody had on average spentThose in custody had on average spent
3.9 months in custody (s.d.3.9 months in custody (s.d.¼ 3.6, range3.6, range
0.03–18.0). With regard to previous sen-0.03–18.0). With regard to previous sen-
tences, 26% of young offenders had atences, 26% of young offenders had a
previous custodial sentence, whereas 39%previous custodial sentence, whereas 39%
had a previous community order. The meanhad a previous community order. The mean
number of offences committed by thesenumber of offences committed by these
young people was 41.7 (s.d.young people was 41.7 (s.d.¼ 93.1, range93.1, range
1–578); this included both convictions and1–578); this included both convictions and
non-convictions. A few offenders werenon-convictions. A few offenders were
responsible for the majority of the crimesresponsible for the majority of the crimes
committed (mean 42, median 9).committed (mean 42, median 9).
Table 2 explores the differences be-Table 2 explores the differences be-
tween the custody and community samples.tween the custody and community samples.
Those in custody were significantly moreThose in custody were significantly more
likely to have a history of previous custo-likely to have a history of previous custo-
dial sentences and community orders.dial sentences and community orders.
There was also a significantly higher pro-There was also a significantly higher pro-
portion of young offenders from Blackportion of young offenders from Black
and minority ethnic groups in custody. Thisand minority ethnic groups in custody. This
finding has been documented previouslyfinding has been documented previously
(Home Office, 1992).(Home Office, 1992).
NeedsNeeds
Figure 1 shows the percentage of youngFigure 1 shows the percentage of young
offenders in custody and the communityoffenders in custody and the community
with needs in five different domains: mentalwith needs in five different domains: mental
health (depression, anxiety, post-traumatichealth (depression, anxiety, post-traumatic
stress, psychosis, self-harm and hyper-stress, psychosis, self-harm and hyper-
activity); education (education attendance,activity); education (education attendance,
educational performance and weekdayeducational performance and weekday
occupation for young people aged over 16occupation for young people aged over 16
years); risky behaviour (inappropriate sex-years); risky behaviour (inappropriate sex-
ual behaviour, drug and alcohol misuse);ual behaviour, drug and alcohol misuse);
violent behaviour (violence to people andviolent behaviour (violence to people and
property); and relationships (relationshipsproperty); and relationships (relationships
with peers and family members). Almost awith peers and family members). Almost a
third of young offenders had a mentalthird of young offenders had a mental
health need (31%), whereas 29% had ahealth need (31%), whereas 29% had a
need because of some form of risky behav-need because of some form of risky behav-
iour. About one in three young people hadiour. About one in three young people had
educational or work needs (36%) or needseducational or work needs (36%) or needs
in relation to violence to people and prop-in relation to violence to people and prop-
erty (35%). Significant needs with peererty (35%). Significant needs with peer
and family relationships were found inand family relationships were found in
almost half of the study sample (48%).almost half of the study sample (48%).
Mental healthMental health
Table 3 shows the different types of needsTable 3 shows the different types of needs
(unmet, suspended or persistent despite(unmet, suspended or persistent despite
intervention) of the sample. Within theintervention) of the sample. Within the
mental health domain, almost one in fivemental health domain, almost one in five
young people had significant depressiveyoung people had significant depressive
symptoms, and one in ten reported anxietysymptoms, and one in ten reported anxiety
or post-traumatic stress symptoms. Self-or post-traumatic stress symptoms. Self-
harm within the past month was reportedharm within the past month was reported
by almost one in ten young offenders.by almost one in ten young offenders.
Risky and violent behaviourRisky and violent behaviour
In terms of risky and violent behaviour,In terms of risky and violent behaviour,
11% of young offenders had alcohol11% of young offenders had alcohol
problems and 20% had drug problems.problems and 20% had drug problems.
Problems with aggressive behaviour to-Problems with aggressive behaviour to-
wards people and property were found inwards people and property were found in
about one in four and one in five youngabout one in four and one in five young
people respectively.people respectively.
Education and relationshipsEducation and relationships
Significant social difficulties were alsoSignificant social difficulties were also
found, with 29% of young offendersfound, with 29% of young offenders
experiencing difficulties with family rela-experiencing difficulties with family rela-
tionships and 35% with peers. Educationaltionships and 35% with peers. Educational
needs, with poor school attendance andneeds, with poor school attendance and
performance difficulties, were found (forperformance difficulties, were found (for
those under 16 years old) in 17% andthose under 16 years old) in 17% and
19% of young offenders respectively. Those19% of young offenders respectively. Those
over 16 years old fared only slightly better,over 16 years old fared only slightly better,
with education or work needs found in onewith education or work needs found in one
in ten young people interviewed.in ten young people interviewed.
Unmet need and recommendedUnmet need and recommended
interventionsinterventions
Table 3 shows the level of unmet need inTable 3 shows the level of unmet need in
individual domains of the SNASA. Fewindividual domains of the SNASA. Few
young people had had any type of inter-young people had had any type of inter-
vention for their needs. Within somevention for their needs. Within some
domains, such as inappropriate sexualdomains, such as inappropriate sexual
behaviour, none of the young people identi-behaviour, none of the young people identi-
fied with needs was receiving any form offied with needs was receiving any form of
intervention. Therefore rates of unmet needintervention. Therefore rates of unmet need
were very high. The intervention mostwere very high. The intervention most
commonly recommended from the SNASAcommonly recommended from the SNASA
was the need for assessment (penultimatewas the need for assessment (penultimate
536536
Ta b l e 2Ta b l e 2 Differences between custody and community g roupsDifferences between custody and community groups
Custody groupCustody group
((nn¼151)151)
Community groupCom mun it y group
((nn¼150)150)
95% Confidence intervals for95% Confidence intervals for
percentage differencepercentage difference
PP
Age, years: meanAge, years: mean 1 5 .715.7 15.715.7 0.6730.673
11
Gender,Gender , nn (%)(%)
FemaleFemale 33 (22)33 (22) 36 (24)36 (24) NSNS 0.6580.658
22
MaleMale 118 (78)118 (78) 114 (76)114 (76) NSNS
Ethnicity,Ethnicity, nn (%)(%)
WhiteWhite 112 (74)112 (74) 138 (92)138 (92) 9.8 to 269.8 to 26 550.00010.0001
22
Black and ethni c minorityBlack and ethni c mino rit y 39 (26)39 (26) 12 (8)12 (8) 9.8 to 269.8 to 26
Num ber of offences: medianNumber of offences: median 18.018.0 6.06.0 550.00010.0001
33
Age at first offen ce, yearsAge at first offen ce, years 1 2.012.0 12.512.5 0.0540.054
11
Previous custodial sentence,Previous custodial sente nce, nn (%)(%) 49 (33)49 (33) 28 (19)28 (19) 4.2 to 23.84.2 to 23.8 0.0060.006
22
Pre vi ous commun ity order,Pre vious community orde r, nn (%)(%) 106 (72)106 ( 72) 41 (28)41 (28) 20.4 to 41.620.4 to 41.6 550.00010.0001
22
Previous care history ,Previous care history, nn (%)(%) 65 (43)65 (43) 49 (33)49 (33) 771to20.91to 20.9 0.0630.063
22
History of school expulsion/suspens ion,History of school expulsi on/suspension, nn (%)(%) 116 (78)116 (78) 111 (33)111 (33) NSNS 0.5590.559
22
1. Two -tailed1. Two-tailed tt-test.-test.
2. Chi-squared test.2. Chi-squared test.
3. Mann^Whitney test.3. Mann^Whitney test.
MENTAL HEALTH NEEDS OF YOUNG OFFENDERSMENTAL HEALTH NEEDS OF YOUNG OFFENDERS
column in Table 3). Assessment is the firstcolumn in Table 3). Assessment is the first
intervention to offer for most needs areas. Ifintervention to offer for most needs areas. If
completed, other interventions are thencompleted, other interventions are then
chosen from a menu of interventions bychosen from a menu of interventions by
clinicians. The second most commonlyclinicians. The second most commonly
recommended intervention (final column)recommended intervention (final column)
was either an educational approach orwas either an educational approach or
cognitive–behavioural therapy.cognitive–behavioural therapy.
Between-group differencesBetween-group differences
GenderGender
Table 4 shows that although female offen-Table 4 shows that although female offen-
ders had more needs than males, this wasders had more needs than males, this was
not significantly different. The only domainnot significantly different. The only domain
that showed a significant difference wasthat showed a significant difference was
mental health, in the areas of depression,mental health, in the areas of depression,
self-harm and post-traumatic stress (seeself-harm and post-traumatic stress (see
Table 6). Similar results have been foundTable 6). Similar results have been found
in other studies (Timmons-Mitchellin other studies (Timmons-Mitchell et alet al,,
1997).1997).
EthnicityEthnic i ty
White British juvenile offenders had moreWhite British juvenile offenders had more
needs than those from Black and minorityneeds than those from Black and minority
ethnic groups, although this was not signif-ethnic groups, although this was not signif-
icant (Table 4). Because of their smallicant (Table 4). Because of their small
numbers, Black and minority ethnic groupsnumbers, Black and minority ethnic groups
were grouped for statistical analysis. Therewere grouped for statistical analysis. There
was a significant difference between thewas a significant difference between the
two groups in education needs, as Whitetwo groups in education needs, as White
British young offenders had significantlyBritish young offenders had significantly
more needs (Table 5). The reasons for thismore needs (Table 5). The reasons for this
are unclear and may be related to differ-are unclear and may be related to differ-
ences in cultural attitudes and socio-ences in cultural attitudes and socio-
economic characteristics. Significant differ-economic characteristics. Significant differ-
ences were found in the level of riskyences were found in the level of risky
behaviour between the two groupsbehaviour between the two groups
(Table 5). However, low numbers within(Table 5). However, low numbers within
the Black and minority ethnic group pre-the Black and minority ethnic group pre-
cluded further analysis. We also found thatcluded further analysis. We also found that
young offenders from Black and minorityyoung offenders from Black and minority
ethnic groups had significantly more post-ethnic groups had significantly more post-
traumatic stress symptoms than those whotraumatic stress symptoms than those who
were White British (Table 6). This may bewere White British (Table 6). This may be
secondary to a higher number of refugeessecondary to a higher number of refugees
or asylum seekers from Black and minorityor asylum seekers from Black and minority
ethnic groups. As the study did not collectethnic groups. As the study did not collect
this information, we are unable to verifythis information, we are unable to verify
this hypothesis.this hypothesis.
LocationLocation
Young offenders in the community had sig-Young offenders in the community had sig-
nificantly more needs than those in custodynificantly more needs than those in custody
(see Table 4) in relation to education, risky(see Table 4) in relation to education, risky
behaviour and relationships (see Table 5).behaviour and relationships (see Table 5).
There was no significant difference betweenThere was no significant difference between
young offenders in custody and thoseyoung offenders in custody and those
in the community in terms of mentalin the community in terms of mental
health. However, young offenders in thehealth. However, young offenders in the
community were found to have signifi-community were found to have signifi-
cantly more alcohol and drug misuse needscantly more alcohol and drug misuse needs
537537
Fig. 1Fig. 1 Needs of juvenile offenders in different domains: unmet needs, suspended needs and persistent needsNeeds of juvenile offenders in different domains: unmet needs, suspended needs and persistent needs
despite intervention (PDI).despite intervention (PDI).
Ta b l e 3Ta b l e 3 Needs and recommended interventions from the Salford Needs Assessment Schedule for AdolescentsNeeds andrecommended interventions from the Salford Needs Assessment Schedule for Adolescents
Un met need (Unmet need (nn¼ 301)301 )
nn (%)(%)
Suspended need (Suspended need (nn¼301)301)
nn (%)(%)
PDI (PDI (nn¼301)301)
nn (%)(%)
Most commonly recommend edMost commonly recommended
interventionintervention
Second most commonlySecond most commonl y
recommended interventionrecommend ed intervent i on
Depressi onDepression 55 (18)55 (18) 16 (5)16 (5) 2 (1)2(1) AssessmentAssessment Medicati onMedication
Self-harmSelf-har m 27 (9)27 (9) 10 (3)10 (3) 1 (1(551)1) AssessmentAssessm e nt A dvic eAdvice
AnxietyAnxiety 31 (10)31 (10) 7 (2)7 (2) 0 (0)0 (0) AssessmentAssessm e nt C BTCBT
PTSDPTSD 26 (9)26 (9) 7 (2)7 (2) 0 (0)0 (0) AssessmentAssessme nt CBTCBT
Psychotic symptomsPsychotic symptoms 16 (5)16 (5) 2 (1)2 (1) 0 (0)0 (0) AssessmentAssessment Med i cationMedication
HyperactivityHyperactivity 20 (7)20 (7) 3 (1)3(1) 2 (1)2(1) AssessmentAssess ment CBTCBT
Alcohol misuseAl cohol misuse 33 (11)33 (11) 14 (5)14 (5) 1 (1(551)1) AssessmentAssessment EducationEducation
Drug misuseDrug misuse 59 (20)59 (20) 16 (5)16 (5) 3 (1)3(1) AssessmentAssessment EducationEducation
Sexual behav iourSexual behavi our 19 (6)19 (6) 0 (0)0 (0) 1 (1(551)1) AssessmentAssessment EducationEducation
Violence to peopleViolence to people 76 (25)76 (25) 19 (6)19 (6) 11 (4)11 (4) AssessmentAsse ss me n t C BTCBT
Vi olen ce to propertyViolence to property 61 (20)61 (20) 12 (4)12 (4) 6 (2)6 (2) AssessmentAssessme nt C BTCBT
Social relati onsSocial relations 106 (35)106 (35) 1 5 (5)15 (5) 12 (4)12 (4) CBT approachCBTapproach Social skillsSocial skills
Family relationsFamily relations 86 (29)86 (29) 14 (5)14 (5) 14 (5)14 (5) CBT approachCBTapproach Fami ly adviceFami ly advice
School attendanceSchool attendance 56 (1 9)56 (19) 22 (7)22 (7) 5 (2)5 (2) Target settingTarget setting Monitor by staffMonito r by staff
School performanceSchool performance 52 (17)52 (1 7) 16 (5)16 (5) 5 (2)5 (2) Target settingTarget setting Monitor by staffMonito r by staff
Wee k day occupati onWeekday occupation 3 1 (10)31 (10) 15 (5)15 (5) 5 (2)5 (2) AdviceAdvice Paid workPaid work
Accommodati onAccom modati on 33 (11)33 (11) 0 (0)0 (0) 0 (0)0 (0) Supportive lodgingsSupportive lodgings
CBT, cognitive^behavioural therapy; PDI, persistent need despite intervention; PTSD, post-traumatic stress disorder.CBT, cognitive^behavioural therapy; PDI, persistent need despite intervention; PTSD, post-traumatic stress disorder.
CHITS ABES AN E T ALCHITSABESAN ET AL
than those in secure accommodation (seethan those in secure accommodation (see
Table 6). This may be secondary toTable 6). This may be secondary to
reduced access to these substances whilereduced access to these substances while
young people are in custody.young people are in custody.
DIS CUSSIONDIS CUSSION
There are a number of important findingsThere are a number of important findings
from this study. The first is the high levelfrom this study. The first is the high level
of mental health, educational and socialof mental health, educational and social
needs among this sample of young people.needs among this sample of young people.
This is in keeping with findings from otherThis is in keeping with findings from other
studies that have highlighted the psycho-studies that have highlighted the psycho-
social adversity within this group (Krollsocial adversity within this group (Kroll etet
alal, 2002; Teplin, 2002; Teplin et alet al, 2002). However,, 2002). However,
educational needs were lower than reportededucational needs were lower than reported
by previous studies (Krollby previous studies (Kroll et alet al, 2002)., 2002).
Second, young offenders in the communitySecond, young offenders in the community
had significantly more needs than those inhad significantly more needs than those in
custody in the areas of education, riskycustody in the areas of education, risky
behaviour and social relationships. Securebehaviour and social relationships. Secure
accommodation may meet some of theaccommodation may meet some of the
needs of young people by providing statu-needs of young people by providing statu-
tory education, particularly for those undertory education, particularly for those under
16 years of age, and reducing access to16 years of age, and reducing access to
alcohol and drugs. The intense supervisionalcohol and drugs. The intense supervision
provided may also reduce opportunitiesprovided may also reduce opportunities
for peer relationship difficulties. However,for peer relationship difficulties. However,
it is unclear how much of this reductionit is unclear how much of this reduction
in needs is sustained once young peoplein needs is sustained once young people
leave secure accommodation. We reportleave secure accommodation. We report
elsewhere on a longitudinal follow-up studyelsewhere on a longitudinal follow-up study
that explored how needs change for youngthat explored how needs change for young
offenders in custody over time (Youthoffenders in custody over time (Youth
Justice Board, 2005); it found that needsJustice Board, 2005); it found that needs
increased on discharge into the communityincreased on discharge into the community
in the areas of alcohol and drug misusein the areas of alcohol and drug misuse
and social (peer and family) relationships.and social (peer and family) relationships.
There was no change in mental healthThere was no change in mental health
needs. This suggests that needs are onlyneeds. This suggests that needs are only
temporarily lower while young offenderstemporarily lower while young offenders
are in custody and increase again onare in custody and increase again on
release. This finding is similar to that of arelease. This finding is similar to that of a
previous follow-up study (Harringtonprevious follow-up study (Harrington et alet al,,
2004).2004).
Third, for many problem areas needsThird, for many problem areas needs
were unmet, with few offenders havingwere unmet, with few offenders having
any form of intervention for their problems.any form of intervention for their problems.
This included not only mental health areasThis included not only mental health areas
but also education, social and aggressivebut also education, social and aggressive
needs. The most commonly recommendedneeds. The most commonly recommended
intervention across many areas of theintervention across many areas of the
SNASA was the need for assessment.SNASA was the need for assessment.
Finally, high levels of learning disabilityFinally, high levels of learning disability
were found in this study, as in previouswere found in this study, as in previous
studies (Henry & Moffitt, 1997; Krollstudies (Henry & Moffitt, 1997; Kroll etet
alal, 2002). This has a number of implica-, 2002). This has a number of implica-
tions for educational provision for thesetions for educational provision for these
young people.young people.
Limitations of the studyLimitations of the study
There are a number of limitations to thisThere are a number of limitations to this
study which need to be considered. First,study which need to be considered. First,
the SNASA includes both client and carerthe SNASA includes both client and carer
538538
Ta b l e 4Ta b l e 4 Correlates of total levels of needCorrelates of total levels of need
nn (%)(%) Num ber of needsNumber of needs PP
11
MeanMean 95% CI95% CI
GenderGender
MaleMale 234 (78)234 (78) 2.52.5 2.2 to 2.82.2 to 2.8 0.0920.092
FemaleFemale 67 (22)67 (22) 3.13.1 2.4 to 3.82.4 to 3.8
EthnicityEthnicity
White BritishWhite British 250 (83)250 (83) 2.82.8 2.5 to 3.12.5 to 3.1 0.1810.18 1
African^CaribbeanAfri can^Caribbean 26 (9)26 (9) 1.71.7 0.8 to 2.60.8 to 2.6
AsianAsian 7 (2)7 (2) 1.91.9 771.3 to 5.11.3 to 5.1
Mixed raceMixed race 15 (5)15 (5) 2.32.3 0.8 to 3.30.8 to 3.3
OtherOther 3 (1)3 (1) 0.50.5 775.9 to 6.95.9 to 6.9
LocationLocation
CustodyCustody 151 (50)151 (50) 1.91.9 1.6 to 2.31.6 to 2.3 550.0000.000 11
Communit yCommunity 150 (50)150 (50) 3.33.3 2.9 to 3.72.9 to 3.7
1. Two -tailed1. Two-tailed tt-test.-test.
Ta b l e 5Ta b l e 5 Correlates of needs in different domainsCorrelates of needs in different domains
Educati onEducation Risky behavi ou rRisky behaviour ViolenceVi olenc e Rel ations hi psRe lat i onshi ps Mental healthMental health
GenderGender
Male (Male (nn¼ 232), %232), % 3636 2828 3434 4747 2727
Female (Female (nn¼69), %69), % 3333 3030 3636 4848 4444
95% CI for percentage difference95% CI for percentage difference 77 9.7 to 15.79.7 to 15.7 7714.3 to 10.31 4.3 to 10.3 7714.9 to 10.914.9 to 10.9 7714.4 to 12.414.4 to 12.4 774.0 to4.0 to 7730.030.0
PP
11
0.6620.662 0.7490. 749 0.7380.738 0.9520.952 0.00.01010
EthnicityEthnicity
White British (White British (nn¼250), %250), % 3838 3232 3636 5050 3232
Ethnic minorities (Ethnic mino rities (nn¼51), %51), % 2222 1414 2626 3535 2626
95% CI for percentage difference95% CI for percentage difference 3.1 to 28.93.1 to 28.9 6.9 to 29.16.9 to 29.1 772.3 to 24.32.3 to 24.3 0.5 to 29 .50.5 to 29.5 777.4 to 19.47.4 to 19.4
PP
11
0.0220.022 0.0090.009
22
0. 1 350. 1 35 0.0550.055 0.3590.359
CustodyCustody
Custody (Custody (nn¼151), %151), % 2323 1717 3030 3535 3131
Communit y (Commun it y (nn¼150), %150), % 4848 4141 3939 6060 3131
95% CI for percentage difference95% CI for percentage difference 7714.6 to14.6 to 7735.435.4 7714.1 to14.1 to7733.933.9 7719.7 to 1.719.7 to 1.7 7714.1 to14.1 to 7735.935. 9 7710.4 to 10.410.4 to 10.4
PP
11
550.0000.00011 550.0000.000110.0820.082 550.0000.000110.9310.931
1. Chi-squared test.1. Chi-squared test.
2. Fisher’s exact test (two-sided).2. Fisher’s exact test (two-sided).
MENTAL HEALTH NEEDS OF YOUNG OFFENDERSMENTAL HEALTH NEEDS OF YOUNG OFFENDERS
information in its final rating, although itinformation in its final rating, although it
can be used without carer information. Incan be used without carer information. In
just under half of cases an informant (carer)just under half of cases an informant (carer)
was unavailable for interview. This maywas unavailable for interview. This may
have resulted in lower needs ratings owinghave resulted in lower needs ratings owing
to an underreporting of symptoms byto an underreporting of symptoms by
young people, particularly those relatingyoung people, particularly those relating
to alcohol and drug use. In addition, 15%to alcohol and drug use. In addition, 15%
of young people in our sample declined toof young people in our sample declined to
complete the psychometric assessment,complete the psychometric assessment,
often because of interview fatigue. Second,often because of interview fatigue. Second,
even though the study aimed to oversampleeven though the study aimed to oversample
Black and minority ethnic groups, numbersBlack and minority ethnic groups, numbers
were too small for independent analysis andwere too small for independent analysis and
aggregation of groups was necessary. Thisaggregation of groups was necessary. This
may potentially mask differences betweenmay potentially mask differences between
individual ethnic groups. Finally, as theindividual ethnic groups. Finally, as the
sample was restricted to young people fromsample was restricted to young people from
England and Wales, our findings do notEngland and Wales, our findings do not
necessarily reflect the needs of youngnecessarily reflect the needs of young
offenders in other countries.offenders in other countries.
Clinical implicationsClinical implications
The assessment of mental health and theThe assessment of mental health and the
promotion of mental well-being of youngpromotion of mental well-being of young
people within the youth justice system ispeople within the youth justice system is
integral to the delivery of effective youthintegral to the delivery of effective youth
justice services (Callaghanjustice services (Callaghan et alet al, 2003)., 2003).
Within the youth justice system, the mentalWithin the youth justice system, the mental
health screening programme was launchedhealth screening programme was launched
in England and Wales in November 2003,in England and Wales in November 2003,
at the end of this study. In practice theat the end of this study. In practice the
mental health screening programme hasmental health screening programme has
been launched within the youth offendingbeen launched within the youth offending
teams, but not within secure facilities.teams, but not within secure facilities.
However, lack of screening may not beHowever, lack of screening may not be
the only reason for high levels of unmetthe only reason for high levels of unmet
need. Other problems, identified in inter-need. Other problems, identified in inter-
views with carers, included poor access toviews with carers, included poor access to
services and difficulties engaging youngservices and difficulties engaging young
people in treatment. The perception ofpeople in treatment. The perception of
those interviewed was that provision ofthose interviewed was that provision of
mental health services across the countrymental health services across the country
was variable and often influenced by local fac-was variable and often influenced by local fac-
tors; reasons included lack of resources andtors; reasons included lack of resources and
funding as the primary obstacle to provision.funding as the primary obstacle to provision.
In terms of education, although thereIn terms of education, although there
appeared to be good provision of educa-appeared to be good provision of educa-
tional services for young offenders intional services for young offenders in
custody, services were less comprehensivecustody, services were less comprehensive
for those in the community, especially forfor those in the community, especially for
those under 16 years old for whom non-those under 16 years old for whom non-
mainstream alternatives were limited. Themainstream alternatives were limited. The
introduction of agencies such as Connex-introduction of agencies such as Connex-
ions (http://www.connexions.gov.uk) hasions (http://www.connexions.gov.uk) has
been a helpful resource for a number ofbeen a helpful resource for a number of
young people wanting training and appren-young people wanting training and appren-
ticeships rather than mainstream education.ticeships rather than mainstream education.
With the high level of learning disabilitiesWith the high level of learning disabilities
identified in this study and previous studies,identified in this study and previous studies,
there is a need to consider tailored educa-there is a need to consider tailored educa-
tional provision based on individual needstional provision based on individual needs
and ability, particularly for those underand ability, particularly for those under
16 years of age. It is important to address16 years of age. It is important to address
these issues of service provision for youngthese issues of service provision for young
offenders with learning disabilities, as theyoffenders with learning disabilities, as they
may be a particularly vulnerable group.may be a particularly vulnerable group.
This cross-sectional survey was part ofThis cross-sectional survey was part of
a larger study examining service provisiona larger study examining service provision
for young offenders within the youth justicefor young offenders within the youth justice
system and continuity of care as young of-system and continuity of care as young of-
fenders moved from secure to communityfenders moved from secure to community
sites (Youth Justice Board, 2005). Thissites (Youth Justice Board, 2005). This
study and previous studies (Little & Bul-study and previous studies (Little & Bul-
lock, 2004) have highlighted concernslock, 2004) have highlighted concerns
regarding the continuity of care for youngregarding the continuity of care for young
people within the criminal justice system.people within the criminal justice system.
This supports the recommendation toThis supports the recommendation to
implement a care programme approachimplement a care programme approach
for children and young people withfor children and young people with
complex needs (Youth Justice Board,complex needs (Youth Justice Board,
2005).2005).
In addition to their high levels of needs,In addition to their high levels of needs,
young offenders place a significant financialyoung offenders place a significant financial
burden on public services. However, theburden on public services. However, the
extent of the problem nationally to servicesextent of the problem nationally to services
is unknown. The second part of this studyis unknown. The second part of this study
estimates the cost of young offenders toestimates the cost of young offenders to
the criminal justice system and otherthe criminal justice system and other
services (health, social services and theservices (health, social services and the
voluntary sector) and also explores thevoluntary sector) and also explores the
relationship between needs, service userelationship between needs, service use
and cost (Barrettand cost (Barrett et alet al, 2006)., 2006).
Future researchFuture research
Future research is needed to improve under-Future research is needed to improve under-
standing of the needs of female offendersstanding of the needs of female offenders
and those from different Black and minor-and those from different Black and minor-
ity ethnic populations. Conducting researchity ethnic populations. Conducting research
in this area has been a challenge in view ofin this area has been a challenge in view of
the rapidly changing context of the criminalthe rapidly changing context of the criminal
justice and national health systems (Depart-justice and national health systems (Depart-
ment of Health, 2004). This pace of changement of Health, 2004). This pace of change
does not appear to be slowing, with newdoes not appear to be slowing, with new
539539
Ta b l e 6Ta b l e 6 Correlates of mental health needsCorrelates of mental health needs
Depressi onDepression Self-harmSelf-harm AnxietyAnxiety PTSDPTSD PsychoticPsychotic
symptomssym ptoms
DrugDrug
misusemisuse
AlcoholAlcohol
misusemisuse
HyperactivityHyperactivity
GenderGender
Male (Male (nn¼ 232), %232), % 1 313 771010 66442121 9988
Female (Female (nn¼69), %69), % 3535 1717 1313 1919 991616 1717 11
95% CI for percentage difference95% CI for percentage difference 7734. 1to34.1to 779.99.97719.5 to19.5 to 770.50.5 775.8 to 1 1 .85.8 to 11.8 7722.0 to22.0 to 773.33.3 7712.2 to 2.212.2 to 2.2 5.1 to 15.15. 1 to 15.1 7717 .6 to 1.617 .6 to 1.6 2.8 to 1 1 .22.8 to 11.2
PP 550.0000.00011 0.0050.005 0.3930.393 0.000.00110.1540.1 54 0.3830.383 0.0520.052 0.0540.054
11
EthnicityEthnicity
White British (Whi te British (nn¼250), %250), % 1818 1010 1 111 77662121 1414 77
Black and mino rit y (Black and mino rity (nn¼51), %51), % 1818 66881616 441212 8866
95% CI for percentage difference95% CI for percentage difference 7711.6 to 11.611.6 to 11.6 773.5 to 1 1.53.5 to 11 .5 775.4 to 1 1 .45.4 to 1 1 .4 7719.5 to 1.519.5 to1.5 774. 1 to 8. 14.1 to 8. 1 771.2 to 19.21.2 to 19.2 772.6 to 14. 62.6 to 14.6 776.2 to 8.26.2 to 8.2
PP 0.8990.899 0.5910.591
11
0.5270.527 0.0490.049 0.6260.626 0.1 220. 1 22 0.4340.434 1.001.00
11
CustodyCustody
Custody (Custody (nn¼151), %151), % 1919 1010 1 111 1111 551111 6666
Communit y (Community (nn¼150), %150), % 1818 881010 77662828 1616 77
95% CI for percentage difference95% CI for percentage difference 777.8 to 9.87.8 to 9.8 774.5 to 8.54.5 to 8.5 775.9 to 7 . 95.9 to 7 .9 772.4 to 10.42.4 to 10.4 776.2 to 4.96.2 to 4.9 7725.7 to25.7 to 778.38.3 773.0 to 17.03.0 to 17 .0 776.6 to 4.66.6 to 4.6
PP 0.9030.903 0.5570.557 0.8650.865 0.2250.225 0.5980.598 550.0000.000110.0050.005 0.6320.632
PTSD, post-traumatic stress disorder.PTSD, post-traumatic stress disorder.
1. Fisher’s exact test (two-sided).1. Fisher’s exact test (two-sided).
CHITS ABES AN E T ALCHITSABESAN ET AL
initiatives constantly being developed. It isinitiatives constantly being developed. It is
thus important for any future research inthus important for any future research in
this area to continue to keep up to datethis area to continue to keep up to date
with this rapidly changing environmentwith this rapidly changing environment
and understand the context in which theseand understand the context in which these
changes are occurring.changes are occurring.
ACKNOWLEDGEMENTSACKN OWLEDGEMENTS
We thank the you n g peopl e who g a ve up so much ofWe thank the youn g peop l e who ga v e up so much of
their ti me to take part in this study. We also thanktheir time to take part in this study. W e also thank
all the staff of the youth off endi n g teams, secu r eall the staff of the yout h offend i ng teams, secur e
establishments and providers of child and adolescentestablishments and providers of child and adolescent
mental health services for their patience, supportmental health services for their patience, support
and interest in the research. Finally, a special tributeandinterestintheresearch.Finally,aspecialtribute
to Professor Richard Harrington, who died in Mayto Professor Ri chard Harri ngton, who died in May
2004, and was the dr i v i ng force of thi s study. The2004, and was the dr ivi n g force of this study. The
legacy of his work, his enthusiasm and leadershiplegacy of his work, his enthusiasm and leadership
continue to inspire us all . He is greatly missed.continue to inspire us all. He is greatly m issed.
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540540
CLINICAL IMPLIC ATIONSCLINICAL IMPLICATIONS
&&
Needs of young offenders are high but often unmet; a structured assessmentNeeds of young offenders are high but often unmet; a structured assessment
programme across custody and community sites is recommended.programme across custody and community sites is recommended.
&&
A care programme approach is recommended to improve continuity of care forA care programme approach is recommended to improve continuity of care for
these young people with complex needs.these young people with complex needs.
&&
Review of the educational provision for youngoffenders isrequired, as a significantReview of the educational provision for youngoffenders is required, as a significant
nu mber have learning disabil it ies.n u m ber have learn i n g disab il ities.
LIMI TAT IONSLIMITAT IONS
&&
Data from carer interviews and psychometric a ssessments were incomplete.Data from c arer interviews andpsychometric assessments were incomplete.
&&
Aggregation of data from different Black and minority ethnic groups might haveAggregation of data from different Black and minority ethnic groups might have
missed differences between the groups.missed differences between the groups.
&&
The sample may not have been representative, with oversampling of femaleThe sample may not have been representative, with oversampling of female
offenders.offenders.
PRATHIBA CH ITSABESAN , M RCPs y ch,Universi ty Department of Child and Adolescent Psy ch ia t ry,PRATHIBA CHI TSABESAN , M R C Ps y ch,U n i ve rsity Department of Ch ild and Ado lescent Psych iat ry,
Manchester; LEOKROLL, MRCPsych,Central Manchester and Manchester Children’s University Hospital,Manchester; LEOKROLL, MRCPsych,Central Manchester and Manchester Children’s University Hospital,
Manchester; SUE BAILEY, FRCPsych,University of Central Lancashire, Preston; CASSANDRA KENNING,MSc,Manchester; SUE BAILEY, FRCPsych,University of Central Lancashire, Preston; CASSANDRAKENNING, MSc,
STEPHANIE SNEIDER, MSc,University Department of Child and Adolescent Psychiatry, Manchester;STEPHA NI E SNE IDE R, MSc,Un iversi ty Departmen t of Ch ild and Adolescen t Psy ch ia t ry, Manchester;
WENDY MacDONALD, PhD,University Department of Primary Mental Health, Manchester;WENDY MacDONALD, PhD,University Department of Primary Mental Health, Manchester;
LOUISE THEODOSIOU, MRCPsych,Central Manchester and Manchester Children’s University Hospitals,LOUISE THEODOSIOU, MRCPsych,Central Manchester and Manchester Children’s University Hospitals,
Manchester, U KManchester, UK
Correspondence: Dr P.Chitsabesan,Research Room,Gardner Unit,Bolton,Trafford and SalfordCorrespondence:Dr P.Chit sa b e sa n,Research Ro om, Gardner Unit,B olton,Tr afford and S alford
Mental HealthTrust,Bury New Road,Manchester M25 3BL ,UK.Tel: +44 (0)161773 9121; e-mail:Mental HealthTrust,Bury New Road,Manchester M25 3BL ,UK.Tel: +44 (0)161773 9121; e-mail:
pchitsab esanpchitsabesan @@yahoo.comyahoo.com
(First received 15 February 2005, final revision 23 September 2005, accepted 27 October 2005)(First received 15 February 2005, f inal revision 23 September 2 005, accepted 27 October 2005)
