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Rhyme Reason and Risk

Rhyme Reason and Risk. Dr Julie Withecomb Consultant Forensic Adolescent Psychiatrist. Young people in care and offending Interplay between care/parenting experiences, offending and mental health Genesis of very high risk behaviours What works?.

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Rhyme Reason and Risk

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  1. Rhyme Reason and Risk Dr Julie Withecomb Consultant Forensic Adolescent Psychiatrist

  2. Young people in care and offending • Interplay between care/parenting experiences, offending and mental health • Genesis of very high risk behaviours • What works?

  3. Children & teenagers make up 25% of the total population in the UK. • Criminal activity peaks at 15-17 years for males and 13-15years for females. • Theft, car crimes and criminal damage account for over 90% of crime.

  4. Harsh and inconsistent parenting • West and Farrington

  5. 23% of prison population and 30% of children in custody have spent time in care

  6. Of children who have experienced care by 16 years, about one third will go to custody and two thirds will have a conviction by early 20’s

  7. Frequent moves associated with higher risk of criminal behaviour

  8. 45% of children in care have mental health disorder

  9. The prevalence of mental health problems in young people in custody around three times higher than general population (Hagell, 2002) • Bailey and Harrington (2004) - 31% of a YOT and incarcerated group had mental health needs: depression (18%); anxiety (10%); PTSD (9%); and hyperactivity (7%). 25% LD

  10. Young people in care are up to 4 times more likely to drink, smoke and use drugs and likely to start earlier and use more heavily • Of 500 young people in the secure estate, 97% has used an illegal drug

  11. Structured Assessment of Violence Risk in Youth • Borum, R, Bartel, P and Forth, A

  12. Domestic violence • Experience of abuse or neglect • Care giver criminality • Early care giver disruption • Poor parental management

  13. Conduct Disorder is a persistent pattern of behaviour in which the rights of other are violated • most commonly occurring psychiatric disorder in 5- to 15-year-olds, (5% of young people in Meltzer’s (1999) study)

  14. Conduct problems shown to predict later offending (Kratzer and Hodgins, 1997), with earlier onset and a wider range of antisocial behaviours increasing later risk.

  15. Covert pathway -recidivist delinquency -acquisitive Overt pathway -violence and homicide Authority conflict -early onset, early Finish -victimless

  16. Stable traits • Aggression • Callous unemotional disregard • Anxiety • Executive functioning and social skills

  17. Callous unemotional disregard • Found in subset of those with conduct problems • Highly heritable • Expression influenced by social factors

  18. As maltreatment increases • adolescent conduct disorder increases • and adult violence becomes more likely

  19. Experience of early abuse and maltreatment leads to changes in neurotransmitters e.g MAOA • Changes in MAOA leads to changes in response of amygdala to aversive stimuli

  20. Epidemiological studies of those who offend and are violent • R Loeber – Pittsburgh study

  21. Neurocognitive studies • J Blair

  22. Most mentally disordered offenders have multiple problems present since childhood

  23. Offending associated in schizophrenic group with psychopathic traits • Poor parenting increases risk of violence in those with schizophrenia

  24. Studies of mentally ill offenders • S Hodgins

  25. Sexually harmful behaviour • Assessment, Intervention and Moving on (G-Map in Manchester)

  26. Poorer outcome associated with: • Experience of trauma or neglect of any kind including exposure to domestic violence • Family dysfunction especially harsh discipline • Pattern of discontinuous care or poor attachment • Rejected by carers • Poor parental supervision

  27. Better outcome associated with: • Consistent care history • Good communication in family

  28. Firesetting Risk Interview • Kolko, D J & Kazdin, A E (1989) Journal of Abnormal Psychology

  29. Recidivism not associated with more dysfunction in the family

  30. Interventions • Home visit from fire-fighter • Fire safety education • Instruction and practice in safety skills • Cognitive behavioural therapy • Enhancing pro-social skills • Improving parent-child relationship

  31. Abuse and neglect commonest reasons for being ‘looked after’

  32. What works? • Pharmacotherapy • Emotional regulation; reward deferral; interpersonal skills training; cognitive behavioural approach • Attachment • Parenting programmes • Multi-systemic therapy • Specialist foster placements

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