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

This paper provides an overview of transitions across forensic child and adolescent mental health services in England and Wales. The aim of this paper is to delineate the national secure services system for young people in contact with the youth justice system. 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. We 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. 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. We need to develop, test and evaluate models of transitional care that improve mental health and wellbeing of this group. 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. 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

Prevalence of mental disorders and symptoms among incarcerated youth : a meta-analysis of 30 studies

Incarcerated youth have high levels of mental disorders. However, there are no up-to-date reviews examining the prevalence rates of a broad range of mental disorders and symptoms across youth justice populations. The current review aims to bridge this gap. We conducted a systematic search of the literature using PsycINFO, Medline, Embase, and Web of Science databases. We used meta-analyses to produce pooled prevalence figures for each mental health disorder and symptoms, and meta-regression to test for the moderating effects of covariates, such as gender. Thirty studies were included involving 8,153 participants. Meta- regression analysis showed that females had higher prevalence rates for depression, separ- ation anxiety disorder and suicide. Males had higher prevalence rates for conduct disorder and emerging antisocial personality disorder. Emerging personality disorders (borderline per- sonality disorder: 21%; 95% CI: 13–28%; antisocial personality disorder: 62%; 95% CI: 39–82%) were relatively common in both genders. The findings of this meta-analysis show the need for robust mental health services in custody settings. Adopting a developmentally focused approach would increase understanding of incarcerated youths’ needs and help to early detection of emerging personality symptoms. To improve young people’s mental health, we need to ensure that services do not misidentify young people’s needs due to diagnostic limitations

Conceptualising the separation from an abusive partner as a multifactorial, non-linear, dynamic process: a parallel with Newton's laws of motion

The present study focused on the dynamics and factors underpinning domestic abuse (DA) survivors’ decisions to end the abusive relationship. The experiences and opinions of 12 female DA survivors and 18 support workers were examined through in-depth, one-to-one, semi-structured interviews. Hybrid thematic analysis was conducted to retrieve semantic themes and explore relationships among the themes identified and the differences in survivors’ and professionals’ narratives of the separation process. The findings highlighted that separation decisions derived from the joint action of two sets of factors, the “promoters” and the “accelerators.” Whilst the “promoters” are factors leading to the separation from the abuser over time, the “accelerators” bear a stronger and more direct connection with survivors’ decision to end the abusive relationship. Despite their differences, both these factors acted as propelling forces, leading survivors to actively pursue the separation from the perpetrator. To portray the dynamic links among these factors, we propose a conceptualisation drawn from Newton’s laws of motion. Our findings also highlighted important differences in the views of survivors and support workers, as the former conceived themselves as proactive in ending the abuse, whereas the latter described the leaving process as mainly led by authorities and services supporting survivors. This study has potential implications for research, policy and clinical practice, as it suggests that far from being a linear sequence of multiple stages, leaving an abusive relationship results from a complex interplay of factors that facilitate (“promoters”) or drastically accelerate (“accelerators”) the separation process. We argue that future research should aim at improving our current understanding of the subjective and situational factors that can act as “accelerators” or “promoters” for women’s leaving decisions. Moreover, clinicians and policymakers should invest in creating interventions that aid victims to recognise and leverage promoters and accelerators, thus increasing their readiness to end the abuse

“Renegades, outsiders and lone warriors”: a qualitative study exploring perceptions of professional identity among counsellors working with children and young people in the United Kingdom

The present study investigates how counsellors working with children and young people (CYP) perceive their professional identity, and how the ‘Practitioner Manual’ and BACP Competence Frameworks, commissioned by the British Association for Counselling & Psychotherapy (BACP; 2014/2019a), can contribute to the strengthening of CYP counsellor professional identity. Participants were qualified counsellors working with CYP clients in England and Scotland. Interpretative Phenomenological Analysis (IPA) was used to analyse data. Findings were organised under three master themes: individual perception of professional identity; others’ perceptions of professional identity; role of resources on formation and development of professional identity. Sub-themes included: discomfort with the concept of professionalism; misunderstandings and misconceptions; a desire for a recognised professional identity. Findings indicate that the provision of counselling for CYP clients could be enhanced by establishing a recognised professional identity underpinned by required minimum training standards and leading to registration with a recognised professional body

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

Purpose There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services. Design/methodology/approach The electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined. Findings Approximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services. Practical implications The results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice. Originality/value These results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities

Exploring men's attitudes to mental fitness through sportspeople's lived experience

An interpretative phenomenological analysis sought to explore how male audience members experienced listening to mental health nurses alongside sportspeople who shared their lived stories of mental health problems in public through mental fitness sessions carried out by the mental health charity, State of Mind Sport. Six male participants were interviewed about their experience after attending an mental fitness session. Three superordinate themes emerged: ‘Evolving male openness about mental health’ looks at how the male audience members' perspective on being open about their mental health changed having been to the mental fitness session. Second, ‘Sportspeople's influence’ reflects upon the positive influence sportspeople's involvement in the mental fitness sessions has on male audience members. Finally, ‘The process of learning about mental health’ explores the educational impact the sessions appear to be having. The results demonstrated the mental fitness sessions had a positive impact and using sportspeople can improve mental health interventions with males and this has potential implications for mental health nursing interventions

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

This study tracked young offenders transitioning from national adolescent forensic medium secure units to adult services in the UK within a six-month period. We used a mapping exercise to identify eligible participants moving during the study period from all national adolescent forensic medium secure units in England. Young people older than 17.5 years or those who had turned 18 years (transition boundary) and had been referred to adult and community services were included. Of the 34 patients identified, 53% moved to forensic adult inpatient services. Psychosis was the most prevalent symptom among males (29%), and emerging personality disorder symptomatology was commonly reported among females (18%) followed by learning disability (24%). The mean time for transition to adult mental-health services and community settings was eight months. There were no shared transition or discharge policies, and only two hospitals had discharge guidelines. The findings highlight the need for consistency between policy and practice among services along with the development of individualised care pathways. Future qualitative research is needed to understand and reflect on young people’s and carers’ experiences to improve transition service delivery

Challenges and facilitators during transitions from adolescent medium secure units to adult services in England : interviews with mental healthcare professionals

Young people moving from child and adolescent secure hospitals present with complex needs and vulnerabilities and are more likely to experience poor transition outcomes. Previous research has indicated the presence of several risk factors in periods of transition, such as poor liaison among services, lack of proper planning, shortage of beds in adult services, multiple transitions and lack of emotional readiness. However, little evidence exists about the processes and outcomes of transitions from adolescent secure services to adult settings. This study aims to bridge the gap in the existing literature by exploring the views and experiences of key professionals involved in the transition process from six adolescent medium secure units to nine adult secure and community services in England. Thirty-four key workers from 15 child and adolescent (N = 21) and adult (N = 13) forensic hospitals were interviewed to provide information about potential barriers and facilitators to transitions. Face-to-face semi-structured interviews were conducted between January 2016 and December 2017. Thematic analysis was used to identify challenges and facilitators to transitions. Three primary themes were identified: (1) transition processes and preparation; (2) transition barriers and challenges; (3) success factors to transition. Key differences in adult and adolescent service care-models and lack of emotional and developmental readiness to moving onto adult-oriented settings constitute major barriers to positive transition outcomes. Practice and policy implications are considered to address the need for service transformations