Kirsty Smedley’s research while affiliated with Greater Manchester West Mental Health NHS Foundation Trust and other places

Working as a practitioner psychologist with young people who self-harm, in both secure and community forensic settings, can be a psychologically demanding but rewarding job. It is essential for psychologists to have an understanding of self-harming behaviour and how to carry out comprehensive assessments (including an analysis of risk), devise formulations, deliver — or oversee the delivery of — interventions, and develop safety plans. Psychologists need to understand not only the young person’s individual and systemic strengths and difficulties, but, crucially, the context in which the self-harm takes place. Psychologists, as well as other forensic practitioners, must consider the function of the self-harm and think about how the function of self-harm may change over time and place. Indeed, young people who are in contact with forensic services may make transitions to and from different spaces. For example, they may move in and out of prison, or move wing within a prison, or move from a prison to a secure hospital setting. Other transitions may include being taken into care and moving to live in a children’s home, or being asked to leave home by a caregiver and moving into hostel accommodation, or, indeed, sleeping rough on the streets. Young people who are in contact with forensic services often have a combination of enduring and complex social and psychological needs and multiple temporary ‘transition’ experiences, where they have to adapt to different places at different times.

Many studies have identified high levels of mental health problems among adolescents in custody and there is increasing evidence that mental health problems in this population are associated with further offending and mental health problems into adulthood. Despite recent improvements in mental health provision within custodial settings there is little evidence of structured interventions being offered or of their effectiveness being evaluated. A cognitively based intervention was developed and offered to adolescents with a variety of mental health problems in different secure settings, and the outcomes compared with a control group. Although this small-scale study did not identify significant differences in outcomes for the two groups, both recruitment and retention in therapy were good, and potential candidates were not excluded on the basis of learning difficulties or co-morbidity. The study demonstrated the viability of a delivering cognitively based intervention for common mental health problems within secure settings.