Young People With Traumatic Brain Injury in Custody: An Evaluation of a Linkworker Service for Barrow Cadbury Trust and The Disabilities Trust

Neurological disability (ND) is a major source of human suffering and socio-health burden. Acquired Brain Injury (ABI) is one main form of ND where the brain is affected by a virus, stroke or trauma. Traumatic brain injury (TBI) is the main form of ABI and the leading cause of death and disability in children and young adults. TBI is widely acknowledged as a major global health and social concern.This report looks at individuals with ND who are 'at-risk' of offending and entering the Criminal Justice System (CJS). ND is a major issue in this population and TBI is particularly prevalent. For the purposes of this report we draw on the ND literature, in particular with reference to ABI and TBI. Where relevant we note the 'umbrella' of disorders referred to in specific studies and programmes. ABI and TBI are not directly interchangeable, and every individual with a ND may have various degrees of impairment severity, with limits set by society on their optimal life experience. Nevertheless, there is a substantial heterogeneity of experience across and within ND and key themes emerge that may apply to the care, treatment and support of this population.The development, organisation and evaluation of a service is discussed that addresses the needs of YP, aged 15-21 years with ND, particularly with TBI, and who are in the CJS. The term Young People who Offend (YPO) and/or Service User (SU) will be used as appropriate. The report draws conclusions from the study and makes recommendations that will optimise care, support and better outcomes for this vulnerable population

A systematic review of the prevalence of foetal alcohol syndrome disorders among young people in the criminal justice system

Given the established association between foetal alcohol spectrum disorders (FASD) and risk of criminality and criminalisation, this systematic review examines the prevalence of FASD within youth justice systems. Four relevant sources were identified. Each source suggests a disproportionate prevalence in comparison to the general youth population. However, this masks significant variation between studies, and a much-heightened prevalence of FASD among Aboriginal youth in custody. The continued lack of research establishing prevalence, limits the potential for strong conclusions and suggests an imperative for improved processes of identification. This highlights systematic deficits in the ability to assess or even screen for FASD, with particular challenges for the youth justice system. Until such challenges can be resolved, it is likely that young people with FASD will remain hidden within a system in which they are at great risk of inadequate support, discrimination and criminalisation

The impact of the COVID-19 pandemic on children and adolescent mental health in-patient service use in England: interrupted time-series analysis of national patient records

Background During the initial phases of the COVID-19 pandemic, children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function and be safely delivered. Aims To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdown 1 (started 23 Mar 2020) and lockdown 2 (started 5 Nov 2020) of the COVID-19 pandemic in England. Method Routinely collected, retrospective English administrative data regarding psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID-19 lockdowns 1 and 2 on service use trends. We analysed data of 6250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey–West standard errors to handle autocorrelation and heteroscedasticity. Results Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell even further during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was higher, and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. Conclusions During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked-after children suggests that these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases

Trajectories of distress and recovery, secondary stressors and social cure processes in people who used the resilience hub after the Manchester Arena bombing

Background: Terrorist incidents lead to a range of mental health outcomes for people affected, sometimes extending years after the event. Secondary stressors can exacerbate them, and social support can provide mitigation and aid recovery. There is a need to better understand distress and mitigating factors among survivors of the Manchester Arena attack in 2017. Aims: We explored three questions. First, what experiences of distress did participants report? Second, how might secondary stressors have influenced participants' psychosocial recoveries? Third, what part has social support played in the relationships between distress and participants' recovery trajectories? Method We conducted a cross-sectional online survey of a convenience sample of survivors of the Manchester Arena bombing (N = 84) in January 2021 (3 years 8 months post-incident), and a longitudinal study of the same participants' scores on mental health measures over 3 years from September 2017. Results: Survivors' mental well-being scores in early 2021 were significantly lower than general population norms. Longitudinal follow-up provided evidence of enduring distress. Secondary stressors, specifically disruptions to close relationships, were associated with greater post-event distress and slower recovery. We found an indirect relationship between identifying with, and receiving support from, others present at the event and mental well-being >3 years later. Conclusions: The Arena attack has had an enduring impact on mental health, even in survivors who had a mild response to the event. The quality of close relationships is pivotal to long-term outcome. Constructive support from family and friends, and people with shared experiences, are key to social cure processes that facilitate coping and recovery

People's experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017

Background Distress after major incidents is widespread among survivors. The great majority do not meet the criteria for mental health disorders and rely on psychosocial care provided by their informal networks and official response services. There is a need to better understand their experiences of distress and psychosocial care needs. Aims The aims of our study were to enhance understanding of the experience of distress among people present at the Manchester Arena bombing in 2017, identify their experiences of psychosocial care after the incident and learn how to better deliver and target effective psychosocial care following major incidents. Method We conducted a thematic analysis of semi-structured interviews with 18 physically non-injured survivors of the Manchester Arena attack, who registered with the NHS Manchester Resilience Hub. Results Distress was ubiquitous, with long-lasting health and social consequences. Initial reluctance to seek help from services was also common. Early and open access to authoritative sources of information and emotional support, and organised events for survivors, were viewed as helpful interventions. Inappropriate forms of psychosocial and mental healthcare were common and potent stressors that affected coping and recovery. Conclusions This paper extends our understanding of how people react to major events. Provision for the large group of people who are distressed and require psychosocial care may be inadequate after many incidents. There is a substantial agenda for developing awareness of people's needs for psychosocial interventions, and training practitioners to deliver them. The findings have substantial implications for policy and service design

Survivors' experiences of informal social support in coping and recovering after the 2017 Manchester Arena bombing

Background Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors. Aims We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery? Method Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed. Results Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth. Conclusions We recommend that people who respond to survivors' psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation

The impact of the COVID-19 pandemic on children and adolescent mental health inpatient service use in England: An interrupted time-series analysis of national patient records

Background: During the initial phases of the COVID 19 pandemic children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function, and be safely delivered. Aims: To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdowns 1 (started 23/032020) and 2 (started 05/11 2020) of the COVID 19 pandemic in England. Methods: Routinely collected, retrospective, English administrative data looking at psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID 19 lockdowns 1 and 2 on service use trends. We analysed data of 6,250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey-West standard errors to handle autocorrelation and heteroscedasticity. Results: Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell further even during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was older and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. Conclusions: During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked after children suggests these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases