Working in the community with young offenders with mental health problems

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Lambeth the context. Lambeth is the second largest inner London borough and one of the most densely populated districts in the country. It is the 5th most deprived borough in London. It has one of the most diverse communities in the country, with 38% of the population from a BME community, and it has the largest Portuguese community outside Portugal.High level of social care referrals and involvement with families.

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Working in the community with young offenders with mental health problems

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1. Working in the community with young offenders with mental health problems Lambeth Youth Offending CAMHS: The Odyssey Health Team Clare Hurley Team Manager

2. Lambeth – the context Lambeth is the second largest inner London borough and one of the most densely populated districts in the country. It is the 5th most deprived borough in London. It has one of the most diverse communities in the country, with 38% of the population from a BME community, and it has the largest Portuguese community outside Portugal. High level of social care referrals and involvement with families

3. Offending in Lambeth Crime rate is above the national average Serious offending by young people is higher still – in 2009-10, 20% of offences were violence against the person, 15% robbery, 13% drugs related and 4% burglary. High levels of gang activity. Reoffending: 2009-10, 119 further offences were committed per 100 young people. Custody rate: 13% of disposals sentenced to custody (high custody rates, targets set to reduce this). BME young people are over-represented in the criminal justice system in Lambeth – BME young people constitute 40% of 10-17 year olds in Lambeth, but constitute 65% of the youth justice population. 84% of YP within the YOS are male, 16% female. High levels of serious and violence crime, high levels of recividism

4. So what is the mental health provision within this context? …The Odyssey Health Team Odyssey is the recently rebranded in-reach mental health team, situated with Lambeth Youth Offending Service (YOS) in Brixton. Rebranded in an attempt to address stigma and increase YPs access to treatment It is a tier 3 service and provides mental health assessment and intervention to young people on an order to Lambeth YOS, providing they have a Lambeth GP and are under 18. The team provides: Comprehensive mental, emotional and behavioural assessments Evidence based interventions including CBT, EMDR and psychotherapy Training and consultation to YOS staff Contribution to interagency risk management panel/planning AIM service for young people displaying sexually harmful behaviour Medication prescribing Specialist forensic and psychiatric assessments Support and treatment to carers and families Collaboration with looked after children teams Dual diagnosis treatment

5. The multi-disciplinary team The team consists of: Consultant Psychiatrist (0.2 w.t.e) Team Manager (social worker/CBT therapist) CAMHS practitioner (art therapist) AIM coordinator/practitioner (social worker) Looked After Children’s CAMHS practitioner (0.2. w.t.e). Substance misuse CAMHS practitioner (0.1 w.t.e)

6. Referrals The team has grown considerably in the past 12 months, and increased activity levels and presence within the YOS are noted. Referrals are predominantly received from YOS officers, although social workers and other CAMHS teams do refer in when it is known that young person has a YOS order. In 2009-10, a total of 106 referrals were received. 83% of these were accepted and offered assessments. The majority were offered initial assessments within 15 working days, as per the Youth Justice Board (YJB) guidelines. This highlights the quick turnover of cases in the team compared to standard CAMHS. 67% of these referrals were offered treatment.

7. Demographics of new referrals.. Gender Gender: there was a higher proportion of females referred into the team than would be expected in light of their profile within the YOS (16% YOS population were female, compared to 26% of referrals). This reflects the research which repeatedly highlights the high levels of mental health need amongst female offenders

8. Demographics.. Ethnicity Disproportional numbers of BME young people in the youth justice system reflected in referrals to the team (61%). Over-representation also of young people from mixed heritage backgrounds referred into the team (18%), compared to local picture (9%)

9. Demographics… Age Largest age cohort was 14-16 year olds (69%), followed by 17-18 year olds (21%) and 12-13 year olds (10%).

10. Social care involvement 24% of new referrals were looked after children (LAC) and a further 24% had some other form of social care involvement, typically being subject to Child In Need or Child Protection Plans. Translates to case loads that require a high level of interagency collaboration and significant levels of case management

11. Diagnosis of new referrals

12. Assessments Comprehensive CAMHS assessments take place over a number of sessions, allowing clinicians to build a rapport with the young person, thereby generating more valid information about their mental state and needs. Parents/carers are invited to assessments, although are often difficult to engage in treatment – role of stigma in local community? Practitioners also prioritise liaising with relevant partnership agencies during this assessment period as cases tended to have large networks of professionals, who with long histories with these clients. Variety of standardised measures utilised in addition to clinical interview e.g. Becks Youth Inventory, Mood and Feelings Questionnaire, SDQ, SCARED.

13. Treatment options CBT for depression and anxiety disorders Trauma focussed CBT and EMDR Art psychotherapy Motivational interviewing Dual diagnosis work Solution focussed and narrative models Family therapy Group work (girls) in development

14. AIM project for sexually harmful behaviour (SHB) Pilot funded for 12 months (from underspend in CAMHS grant). Partnership between CAMHS, social care and YOS – multi-agency framework is pivotal. AIM is a structured assessment model to work with 12-17 year old males who have committed SHB against a child/young person. Provides assessment of risk to victim; risk of further SHB; identifies needs, strengths and resilience; capacity of carer; level of supervision required. AIM is now live in Lambeth – policies and procedures signed off, steering group with strategic leads from partner agencies, 25 staff across the borough have received training to complete AIM assessments, YP receiving AIM. AIM project co-ordinator situated within Odyssey Health Team and manages referrals etc.

15. Areas for improvement Continuing to build on YOS staff knowledge and skills in mental/emotional health through training and resources – early identification by YOS Promotion of joint working across partnership agencies – a seamless experience for YP Openness / transparency / networking between professionals Increased involvement in pre-sentence report recommendations To continue to raise the profile of and confidence in the service in the borough Treatment interventions for conduct disorder (and often ADHD) in this group, and funding a provision to offer this

16. Challenges? Retaining clients in treatment – their levels of motivation; transient population; YOS order ends; placement ends Links between treatment completion and reoffending? Addressing stigma in local communities whilst respecting cultural values Managing risk with clients in treatment – gangs, violence, safeguarding High level of case management and interagency collaboration warranted, thus to be effective need to protect smaller caseloads Need for an assertive outreach model but balancing that with ‘corporate’ demands for high caseload numbers Strengths and difficulties in working with partnership agencies – positive links with educational psychology and substance misuse teams in the YOS, difficult relationships with social care… Finding and retaining suitable trained, experienced and passionate staff… who can engage the client group and protect their own sanity!

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