Lord McNally’s speech to Inside Government forum 2015
Lord McNally, Chairman of the Youth Justice Board, speaks at the 'Delivering Integrated Mental Health Care in the Criminal Justice System’ event in London.
Introduction
The Youth Justice Board for England and Wales is the arms-length body of the Ministry of Justice charged with the oversight of young people in the criminal justice system who are between our age of criminal responsibility (10 years old) and their 18th birthday (legal adulthood).
The YJB was a creation of the 1998 Crime & Disorder Act and came in to being in the year 2000. Its creation followed a 1996 ground-breaking report, “Misspent Youth”, which identified the central problem of youth justice at that time as being the responsibility of many and the priority of none.
I think it fair to claim that in its fifteen year history the YJB has provided that priority by giving leadership and expertise at national level whilst at local level delivering a cross disciplinary, holistic approach to local authority-based and supported youth offending teams (YOTS).
During the fifteen years the YJB has been in operation, we have seen the number of young people entering the criminal justice system fall from over 80,000 at its peak to a little over 23,000 today. At the same time the number in our secure estate (under-18 young offender institutions, secure training centres, secure children’s homes) has fallen from a peak of about four thousand to about one thousand today – less than fifty of them girls.
That success is not because of the efforts of the YJB alone. Our partners in Children’s Services, Social Services, Probation, Policing and the Magistracy have all contributed, as have major inputs from the charitable and voluntary sector.
I give this prologue to my remarks because I believe the lessons learnt from the YJB’s holistic, cross disciplinary approach can readily be applied to our topic today. There is no doubt that early intervention, upstream of a child becoming involved with the criminal justice system, via diversion and alternative dispute resolutions such as Restorative Justice, has produced results. I think there are similar lessons to be learnt from the Troubled Families Initiative, where all too often YOTs are fishing in the same pool.
I was pleased to read the report from HM Inspectorate of Probation, the Care Quality Commission, Ofsted and HM Inspectorate of Constabulary which commended the contribution of YOTs to the Troubled Families initiative whilst pointing to what I suspect will become recurring themes during this conference: the need for clear leadership, the need for clear lines of responsibility and faster and better exchange of information at all times and at all levels.
Of course success in the Youth Justice system has also brought its own problems which will impinge on today’s discussions. We now have a more complex, damaged and difficult cohort concentrated within our care.
When I became Chairman of the YJB, 18 months ago, it did not take many visits to YOTs and the secure estate in order to meet with young people with clear mental health needs. Early on in my term of office I was told by a seasoned professional that there was often reluctance to identify mental health issues too early in a child’s life, that often children had a cluster of issues that fell below the threshold for mental health diagnosis and that there was sometimes fear by parents of their child being stigmatised.
The mental health professionals in the audience will know how much truth there is in those assertions.
A recent Freedom of Information Request by the NSPCC revealed that between March 2014 and April 2015, in 35 Mental Health Trusts across England, more than a fifth of children and young people referred to local NHS and mental health services were reportedly rejected from receiving treatment because the child “did not meet the high clinical threshold to qualify for treatment by CAMHS.”
According to Barnardos one third of children in custody, three times higher than the general population, have mental health needs.
- one in ten children and young persons between 5 and 16 have a diagnosable mental health issue
- children and young people who live in poverty or poor housing are more likely to have mental health problems
- one in fifteen young people have self- harmed
Now I am sure that in the course of the day we will hear variants on those figures from different reports and surveys. As the House of Commons Health Committee said in 2014: ”Those planning and running Child and Adolescent Mental Health Services have been operating in a fog”. So I am very pleased that the Minister of State for Community and Social care, Alistair Burt, announced on 22 October the first national survey of children and young people’s mental health since 2004.
So there is some hope that the fog might be lifting. We were fortunate that my colleague Norman Lamb gave such priority to mental health during his time as a minister in the Coalition Government. His successor, Alistair Burt has been equally positive. On taking office last May he said this:
Future in Mind (the report on mental health services commissioned by Norman Lamb and published just before he left office) established a clear and powerful consensus about improving children and young people’s mental health and wellbeing.
Of course, we’ve had a change of government, but not a change in direction.
That statement of intent has been backed up by the announcement that the Government will spend an extra £1.25 billion on mental health care in the next five years.
I make no bones about my desire to see some of that money ear marked, focussed and targeted at the mental health needs of children and young people on the cusp of, already in or emerging from the criminal justice system. That money should be overseen by a task force consisting of Health Minister Alistair Burt, Justice Minister Andrew Selous and Education Minister Sam Gyimah. Between them they could ensure that money is spent on the right things, in the right place at the right time – particularly if they were to draw on the readily available experience and expertise of the Youth Justice Board.
We have already had influence and input in to “Future in Mind” to which I referred earlier, so that it made specific mention of the needs of children and young people in the youth justice system. We have also successfully influenced guidance to local areas to include specific references to youth justice services. This should enable YOTs to influence the development of strategies and commission decisions locally. Reports back from YOTs thus far has, however, reported a worrying lack of engagement by Health and Wellbeing Boards in welcoming YOT input in to the Transformation Plans they have been charged to develop. There is also a worrying patchwork of availability of CAHMs provisions in England in contrast to a uniformity of good provisions across Wales.
I am often asked “What exactly does the Chair of the Youth Justice Board do?” Well, all too often, fifteen years after we started, the job is still to knock on ministerial doors to ask that the needs of young people in the criminal justice system are given the priority they deserve. I have asked to see Alistair Burt and will raise with him this worrying lack of YOT engagement in the CAMHS provision transformation plans.
It is essential that those plans take full account of the needs of children and young people in the youth justice system and that YOTs are able to influence the development of strategies and commissioning decisions locally. To that end we are willing to work closely with NHS England on this problem, reported by many YOTs, of them finding increasing difficulty in gaining effective access to CAMHS services as well as the need for them being fully involved in local decision making. These are relatively early days yet. So I do not despair, simply call it work in progress.
I referred earlier to the need for a better, quicker exchange of information between the various agencies responsible for a young person’s care. When I was a minister between 2010 and 2013 I had responsibility for DATA protection. I was aware of widespread concerns that the state would be able to know everything about us at the touch of a button.
Since becoming Chair of the YJB I have become aware of a more immediate danger: namely that key decisions are made about individuals without the person making those decisions having as full a picture as possible about the vulnerabilities and needs of the young person in their care. In response to that danger the YJB is helping develop an integrated pathway for children & young people in the youth system which will give as full a picture as possible, at every stage, to help the right decisions be made about a child’s welfare and safety.
There is progress, too, on other fronts:
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Police cells will no-longer be used to detain under 18s with mental health issues.
- The police are showing commendable enthusiasm for early triaging and liaison and diversion of those with mental health needs – a key recommendation of the Bradley Report. We still have the benefit of Lord Bradley’s Report as a check list of issues facing young people with mental health problems or learning disabilities. His follow up report in 2014, five years after his first one, found that progress had been made in the last five years; but another five years of sustained action was still required to make his vision a reality. Let us hope that in 2020 he will be able to report “Mission accomplished”.
- In another area The Laming Committee, on which I sit, is looking at the specific needs of looked after children in the youth justice system, including their mental health needs.
- We now have a High Court Judge, Mr. Justice Davis as the first Judicial Lead for Youth Justice in England and Wales. His appointment comes as a direct recommendation of the Carlile Report on the operation of the youth court and I am in regular contact with the Magistrates Association on how to make court proceedings more understandable to vulnerable young people.
I recently received a letter from a senior barrister who wrote: “I have become increasingly concerned about the way that the Criminal Justice System is able to accommodate and cope with young people with autism and other spectrum difficulties.” He goes on to say “ Recognition of the condition and early diagnosis with reference to schools, clubs or other communities who see young people may be of assistance and certainly the early stages of the criminal justice system would benefit from greater assistance and recognition of the condition”. I have similar letters on my desk from the Royal College of Speech and Language Therapists, Dyslexia Behind Bars, academics and campaign groups.
We are clearly only in the foothills of understanding the changes which take place in the brain between early teens and mid-twenties. Certainly the brain does not make the quantum leap between childhood and adulthood which the law does at 18. There is also need for continuing research about the link between brain injury and offending.
Research thus far suggests that the most common disorders among young people in the youth justice system are conduct disorder, followed by anxiety and depression. It also seems that the prevalence of personality disorders, psychosis, attention disorder, post -traumatic stress and self-harm are all notably higher than in the general population.
In moving forward to Lord Bradley’s 2020 target we should recognize the grounds for optimism at the progress being made as well as a the serious nature of the challenges which still remain.
In my “optimism” folder is the Sun’s “Stamp out the Stigma” campaign which seeks to end the stigma of kids’ mental health, calls for greater resources and priority for children’s mental health and makes helpful suggestions about how social media, often a cause of bullying, anxiety and depression among young people can be used, via the best apps available for youngsters looking for help, advice and support. I commend the Sun for a campaign which is both timely and constructive in an area which still has too many taboos.
Having outed myself as a Sun reader let me conclude by repeating the clear commitment of the Youth Justice Board and its youth offending teams to give the highest priority to ensuring that young offenders with mental health needs have those needs addressed.
I have the distinct impression that, in spite of budget cuts, comprehensive spending reviews and the other joys of the age of austerity, this is an idea whose time has come. So let us use the cross disciplinary, holistic, silo mentality dismantling, information-sharing approach the YJB has pioneered these last fifteen years to make it a reality.