Mental Health Needs in the Children Detention Schools

Siobhan Young (smyoung@justice.ie)17 November 2010

Overview

1. Review of mental health needs-Tool

-Team

-Training

2. Example of proposed model for team

Policy, Legislative and Research Framework

United Nations Convention on the Rights of the Child

Agenda for Children’s Services National Youth Justice Strategy Legislation Research

Mental Health Service Provision within the CDS

Oberstown Boys’ School (OBS) Oberstown Girls’ School (OGS) Trinity House School (THS)

Review included the Finglas Child and Adolescent Centre (FCAC)

Questions

Previous involvement with Child and Adolescent Mental Health Services (CAMHS)

Screening/Non-Clinical Assessment Access to Specialist Mental Health

Assessment and Intervention during Detention

Linkages with CAMHS in Preparation for Discharge

Methodology

File Review Staff Interviews Limitations

School Number of Files Reviewed

OBS 9

THS 14

OGS 5

FCAC 3

Number of Files Reviewed

File Review: How Mental Health Needs are Addressed

School Previous

CAMHS

Assessment on Admission

Access to

Specialist

Assessment

Access to

Programmes (i.e. mental health)

Linkages

to

CAMHS

OBS 55% 0 55% 0 0

THS 42% 0 100% 0 0

OGS 80% 20% 60% 0 0

FCAC 100% 66% 100% 0 66%

File Review: Other Themes

School Presence of Intellectual

Disability

Presence of Specific Learning

Difficulties

Experience of Substance Misuse

Experience of Significant Loss

OBS 44% 55 66% 77%

THS 27% 0 64% 35%

OGS 20% 20% 60% 100%

FCAC 33% 33% 33% 66%

Interviews

Main Mental Health Problems How Mental Health Problems are

Addressed• Assessment on Admission (Non-Clinical)

• Access to Specialist Assessment

• Linkages to CAMHS

• Access to Programmes

What Staff Think Should Happen

Interviews: Main Mental Health Problems

ADHD Depression Schizophrenia Personality Disorders Conduct Disorders Psychosis

Interviews: How Mental Health Problems are Addressed

Assessment on Admission (Non-Clinical)• “To profile young offenders”

• “It doesn’t necessarily inform about mental health” Access to Specialist Assessment

• “We use the psychiatrist more but that’s usually for the court, it doesn’t feed into anything practical here”

• “We have two in at the moment who are not here for assessment but both have mental health difficulties. That’s where we’re running into difficulties – the only option is to call the GP”

• “The young person presenting to an external person coming in is very different to how they present to someone who is here the whole time. A lot of reports are that the young person presented very well. Well, he did for an hour”

Interviews: How Mental Health Problems are Addressed

Linkages to CAMHS• “They’re gone by the time the young person gets here”

• “A lot of time they are seen when they are younger but by the time they get here, all those bridges are burned”

• “A dumping ground for all the special care units”

• “The minute they enter juvenile justice the case is closed with the HSE. Everything else shuts down and off you go”

Interviews: How Mental Health Problems are Addressed

Access to Intervention / Evidence Based Programmes• “There are programmes but not specifically for

mental health, they’re more generic”

• “We did have a drugs counsellor on campus, he was staff but he left. Now that would have to be bought in”

• “I mean surely when you get into that kind of important place with a young person that you would be able to offer a lot”

Interviews: What Staff Think Should Happen

Onsite Mental Health Professionals• “They don’t get the whole picture”

• “Gathering information”

• “Someone qualified on campus”

• “Gut Instinct” … “Winging it”

• “Very effective… with the right guidance”

• “Sometimes when it’s all mixed up behaviours, what you actually need is someone to give clarity so people can understand”

• “What’s going to change?”

Interviews: What Staff Think Should Happen

Training• “Incorporates some aspect of psychiatric

training but it would be a small part”

• “Techniques on how to talk to children”

• “Some type of basic training would be valuable”

• “Everyone knows that unless you are properly informed or trained you can sometimes do more damage than good with these kids”

Recommendations

1. All young people should be screened for the presence of mental health problems on admission.

2. All young people identified as having mental health problems should have access to evidence based assessment and intervention with a clinical team.

3. All staff should have training in basic mental health awareness and positive mental health promotion.

Commission to Inquire into Child Abuse Report (2009)

Office of the Minister for Children and Youth Affairs (2009)• Action 12 of the Ryan Implementation Plan

states that the HSE will develop a national specialist team for children in special care and detention in consultation with the Irish Youth Justice Service.

Example of Model

Forensic CAMHS

National Manager

Oberstown Team

St Patrick's Institution

Dublin Team

Limerick Team

Cork Team

.

National Assessment, Consultation and Therapy Service