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Children and adolescents

SUE BAILEY AND HEIDI HALES, Institute of Psychiatry, London, UK

Introduction

Violence is associated with young people as both victims and attackers: 3–6% ofmales in the general population are repeat offenders, accounting for between aquarter and a half of juvenile crime (Bailey, 2002).

There are a number of relevant laws. Under the Human Rights Act (1998)all young people should have their rights protected and needs met. In Englandand Wales 0- to 18-year-olds are protected by the Children Act (1989). TheMental Health Act (1983) also applies to this age group. In 1998, our YouthJustice System was completely overhauled: the Crime and Disorder Act wasintroduced and the Youth Justice Board set up. In local areas all professionalsworking with young offenders – Youth Offending Teams (YOTs), education, thecourts, social workers and health staff – are meant to work together.

In the UK, we lock up more children than occurs anywhere else in Europe.We also have, at age 10, one of the lowest ages of criminal responsibility.

We are developing more psychiatric secure units for young people withmental illness who commit serious crimes. These units admit a high proportionof people from ethnic minority backgrounds and far more boys than girls.

The factors that lead young people to become juvenile offenders need to beunderstood and managed so that in the future we might reduce them (Bailey,2003; Kroll et al., 2003).

Case scenarios

Imagine that you are a young person living in a home where there is domesticviolence and criminality. You are abused and dealt with inconsistently, neverknowing what to expect. Your teachers think you are lazy or the ‘class clown’when you have reading and writing problems (specific learning difficulties) oryou are fidgety and cannot concentrate (attention deficit hyperactivity disorder,ADHD). Your classmates either do not like you (peer rejection) or you findfriends (deviant delinquent peers) who think that some crime is fun (criminaldamage, trespass). You find something that gets rid of your worries (drugs,alcohol) but then need more money (dealing and stealing). You think, ‘Thatguy’s really pissing me off and I’m handy with my fists’ (actual bodily harm,ABH) and come to believe that it is not safe for you when you are out on the

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streets (possessing an offensive weapon). Taking cars is a thrill, police chases arereally exciting and you think, ‘I don’t care if I die’ (adolescent risk taking).‘Who am I? I don’t like myself ’ (children get depressed too). ‘They don’t likeme, they’re out to get me, why are they looking at me like that, talking aboutme, putting thoughts into my head?’ (early onset psychosis, drug-inducedpsychosis). ‘It won’t happen to me, I won’t get caught ... 24 hours a day lockedup ... nobody cares ... why don’t they stop this bullying ... what’s the point?’(suicide).

You might also think: ‘No one would believe me if I tell. Mum thinks he’sokay. At least we’ve got some money and he doesn’t touch my sisters ...’ (sexualabuse). ‘It just takes it away when I see the blood’ (deliberate self-harm). ‘Theyjust say that I’m attention seeking. He deserves it. I only lit a small fire. It’sbetter if I’m drunk’ (low self-esteem, low self-worth, depression, leading toarson). ‘We’ve got no money. It’s not too bad, just take precautions, not that car,he’s not safe’ (prostitution). ‘At least they know me in A&E. I’m dirty, I can’tget clean, must get rid of these germs, they will kill my family’ (severedepression). ‘It’s okay, I’ve got rid of them’ (arson with intent to endanger life).

Conclusions

The challenge for specialist mental health services within the juvenile justicesystem is to meet the needs of the young individual: habilitation, education,assessment, diagnosis and treatment, through care and aftercare work withfamilies. Offence-reduction programmes promote victim empathy and remorse,heal the trauma (post-traumatic stress disorder) help the young person to build alife, and help families to parent their own children.We also need to develop structured regional inpatient services to care for thosewith high risks, and community services for those who can be managed withinthe community. These services should be held within a structure of good, recip-rocal liaison and support between local mental health services (general adult,adult forensic, community child and adolescent) and the more specialistforensic adolescent consultation and treatment teams who work at interfacesand transitions.

References

Bailey S (2002) Treatment of delinquents. In Bailey S, Dolan M, eds. Young Offender: A Textbookof Adolescent Forensic Mental Health. London: Arnold Publishing (in press)

Bailey S (2003) Young offenders and mental health. Current Opinion in Psychiatry 16: 581–591.Kroll L, Rothwell J, Bradley D, Shah P, Bailey S, Harrington RC (2002) Mental health needs of

boys in secure care for serious persistent offending: a prospective longitudinal study. Lancet359: 1975–1979.

Address correspondence to: Heidi Hales, Department of Forensic MentalHealth Sciences, Box PO23, Institute of Psychiatry, De Crespigny Park, LondonSE5 8AF, UK. Email: H.Hales@iop.kcl.ac.uk

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