Rethinking mental health provision in the secure estate for children and young people: a framework for integrated care (SECURE STAIRS)

Abstract

Purpose The purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a psychologically informed framework, SECURE STAIRS (SS), aimed at improving outcomes. Design/methodology/approach The paper argues that there is a need for a fundamental shift in the way care and intervention for young people within the secure estate is delivered. It gives an overview of current challenges and needs and summarises the theoretical concepts and evidence base which can guide practice and form the foundations of the SS framework. Findings The framework recommends that intervention shift from focussing primarily on individual assessment and treatment to a greater emphasis on supporting the work of the wider system of care. Recommendations include promoting trauma-informed care, a focus on the system dynamics within institutions and how these impact on the care young people receive, and on the collaborative development with residential staff and young people of formulation-led care plans that include a focus on issues of sustainability after leaving the secure estate. Practical implications These include the establishment of discrete residential groupings with truly integrated and trauma-informed work across residential, mental health, education and criminal justice agencies. This involves addressing governance issues around shared record keeping, and challenges to sustainability and the accompanying need for local implementation plans for each establishment alongside central support at a strategic level. Originality/value This paper describes a new and innovative way of working within secure settings to ensure children and young people’s needs are better met.

Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People's Secure Estate (CYPSE) in England: study protocol

“…21 Understanding care provision within the CYPSE through a trauma-informed lens, 22 suggests there may be a risk of exacerbating previous experience of trauma, with practices such as restraint 23 and seclusion 3 increasing young people's risk of re-traumatisation and mental health difficulties. 18 Past research has highlighted limited resources within the youth justice system leading to significant challenges in meeting the complex needs of this vulnerable group. 24 Historically, many of the mental health needs of young people in custodial environments were not addressed, with difficulties often going undetected at reception 10 and treatment lacking for those in need.…”

“…With this range of overlapping risk factors, combined with restrictions on liberty, it is unsurprising that young people in custody have been identified as having multiple, severe and ongoing needs. 18 Although there have been significant improvements since the early 2000s, there remain concerns about ‘punishing disadvantage’ 19 and ‘double discrimination’, 20 with the potential of the custodial experience to reproduce the trauma associated with adversarial childhood experiences, exacerbating mental health difficulties. 21 Understanding care provision within the CYPSE through a trauma-informed lens, 22 suggests there may be a risk of exacerbating previous experience of trauma, with practices such as restraint 23 and seclusion 3 increasing young people’s risk of re-traumatisation and mental health difficulties.…”

“… 21 Understanding care provision within the CYPSE through a trauma-informed lens, 22 suggests there may be a risk of exacerbating previous experience of trauma, with practices such as restraint 23 and seclusion 3 increasing young people’s risk of re-traumatisation and mental health difficulties. 18 …”

“…This includes training and supervision to support staff to provide trauma-informed, developmentally attuned, psychologically based care, underpinned by multi-agency collaboration and coproduced formulation. 18 Culture change in this study describes the fundamental shift in the way care and intervention for young people within the CYPSE is delivered, 18 which the SECURE STAIRS Framework for Integrated Care facilitates. It will be driven through improved understanding of trauma and attachment in staff and reflected through improved staff well-being and staff–young people relationships, shifting more towards a trauma-informed therapeutic environment.…”

Evaluating a mental health service in a young offender’s institution: a thematic analysis of prison officer experiences

“…This population typically have poor and insecure attachment styles (Taylor et al , 2018), having experienced greater than usual levels of trauma and adverse childhood experiences (ACEs; Ryan and Mitchell, 2011). ACEs are generally associated with serious offending behaviour and recidivism (Ford et al , 2019).…”