Mentally disordered young offenders in transition from child and adolescent to adult mental health services across England and Wales

Abstract

Purpose This paper provides an overview of transitions across forensic child and adolescent mental health services in England and Wales. The purpose of this paper is to delineate the national secure services system for young people in contact with the youth justice system. Design/methodology/approach This paper reviews findings from the existing literature of transitions across forensic child and adolescent mental health services, drawing attention to present facilitators and barriers to optimal transition. The authors examine the infrastructure of current services and highlight gaps between child and adult service continuity and evaluate the impact of poor transitions on young offenders’ mental health and wellbeing. Findings Young offenders experience a broad range of difficulties, from the multiple interfaces with the legal system, untreated mental health problems, and poor transition to adult services. Barriers such as long waiting lists, lack of coordination between services and lack of transition preparation impede significantly smooth transitions. Research limitations/implications The authors need to develop, test and evaluate models of transitional care that improve mental health and wellbeing of this group. Practical implications Mapping young offenders’ care pathway will help to understand their needs and also to impact current policy and practice. Key workers in forensic services should facilitate the transition process by developing sustainable relationships with the young person and creating a safe clinical environment. Originality/value Transition of care from forensic child and adolescent mental health services is a neglected area. This paper attempts to highlight the nature and magnitude of the problems at the transition interface in a forensic context.

Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in England

“…Community placements are often reluctant to take over young people presenting with high risk and high vulnerability, and this could explain transition delays. 12 A good example of multiple transitions and poor outcomes is illustrated in this sample with a young girl who experienced four transitions until she was admitted to an adult medium secure unit. The main reason for these transitions was that community and low secure services could not manage her symptoms and risk along with her young age.…”

“…Readiness is an extremely important component to facilitate transitions for challenging groups. 12 Currently, the care pathway of young people with ADHD and autism spectrum disorders (ASD) moving to adult services is not clear, and there is no robust information about long-term outcomes. 13,14 The Department of Health 15 encourages transitions that are tailored to the developmental needs of young people disregarding rigid and arbitrary age criteria.…”

A retrospective case note review of young people in transition from adolescent medium secure units to adult services

“…Incarcerated young people with milder symptoms may remain in youth justice settings where their symptoms are less likely to be understood, thus their needs may go unrecognised (Almond, 2012). Young people must present with both high-risk and a mental disorder to be liable for detention under the Mental Health Act in forensic hospitals (Livanou et al, 2017). Accordingly, the severity of the mental disorder seems to determine young people's care-pathway.…”

“…However, the lack of interface between CAMHS and adult services amplifies the problem. Emotional and developmental readiness to move to adult-oriented services and the lack of provision to prepare young people for this life-changing transition exacerbates their mental health symptoms (Livanou et al, 2017). Services rely on arbitrary national age criteria which often disregard ongoing developmental needs (Davis, 2003;McGorry et al, 2013).…”

Co‐producing a complex psychosocial intervention during COVID‐19 with young people transitioning from adolescent secure hospitals to adult services in England: Moving Forward intervention (MFi)

“…However, only 16% of young people receive mental health treatment in secure hospitals in England, despite increased rates of 46%–81% custody youth presenting with mental health problems (Hindley et al., 2017). Adolescents in secure hospitals (Tier 4) present with high‐risk, emerging personality disorders (Hill et al., 2014), complex mental health issues, developmental trauma (Mcara & Mcvie, 2010) and offending histories (Livanou, Furtado, & Singh, 2017), which are additional risk factors to poor mental health, high reoffending, and reinstitutionalisation rates (Hales, Holt, Delmage, & Lengua, 2019). Adolescent secure hospitals provide inpatient care, specifically tailored to these high‐risk youth, where treatment and nursing address acute needs which are otherwise not manageable in general adolescent inpatient hospitals (National Health Service; NHS, 2018).…”