The aim of this dissertation is to examine the claim of authors such as Harrington and Bailey (2005) that a substantial proportion of young offenders in the UK suffer from severe mental illness. In accepting this claim, the secondary aim of this paper is to glean a greater understanding of why this is the case; do these offenders acquire mental illness as a result of the modern prison regime and regardless, why is the modern youth justice system so ineffective in dealing with this seemingly widespread problem?

The researcher of this paper shall argue that the currentyouth justice system needs, if it to achieve one of its primary aims,namely to rehabilitate youth offenders and prevent them from becomingrecidivists, to focus their research and practice more heavily on thepsychological processes which cause a young person to offend, so thatsuch offenders, who are clearly suffering from mental problems, can bemore easily identified and, where possible, positively helped toresolve these issues whilst they are serving their custodial sentencesso that upon release these individuals are more likely to desist fromcriminality.

The principle methodology of this paper will be a literature review,a review of both primary and secondary sources from the subject fieldsof forensic psychology, criminology and penology.

Introduction:

The primary issue which will be raised and explored throughout thisdissertation is the contention that the current youth justice system,and in particular the youth prison system, is failing to adequatelyaddress the psychological needs (or as they are described by manycriminologists: ‘criminogenic needs’) of youth offenders in the UK.Such an argument necessarily involves a simultaneous examination notonly of the statistics which are available regarding the prevalence ofmental illness in youth prisons and the rates of recidivism of thoseyouths who have been previously sentenced to immediate custody, butalso an examination of the latest psychological research in prisons,the current (and, to a lesser extent, historical) policies andpractices pertaining to the ‘treatment’ of those imprisoned offenderswho have been diagnosed with mental illness and also the writings ofexpert researchers in these relevant fields who provide originalinterpretative insights into the problems associated with mentalillness in youth offenders and potential approaches to minimise thisapparent epidemic.

The structure of this review shall take the following form: Thisdissertation will commence with a brief overview of past and presentsystems of caring for children serving custodial sentences and howtheir mental health needs were and are now met, including anexamination of the changing definition of ‘needs’ in this context. Theresearcher, using research from government enquires, literature andreports concerned with this issue will then seek to identify thoseyouth justice policies and practices which are apparently ineffectiveand/or inappropriate in reducing this problem and, in conclusion, makerecommendations for future necessary/ effective reforms and also futureresearch which should be conducted to assist in our understanding ofthe psychological causes of crime and to assist in the formulation ofsuch reforms.

The researcher of this paper is greatly interested in the subject ofthis paper: After reading in Society Guardian articles about our youngprison population the researcher was surprised to learn that there areover 11,000 young people between 15-20 in jail in England and Waleswith a diagnosable mental disorder, that 10% will suffer a severepsychotic disorder in comparison with 0.2% of the general populationand that the UK has the highest number of prisoners under 21, incomparison with the rest of Europe, 3000 of them being held in youthoffenders institutes. Similar surprise ensued from discover of researchconducted by the UK Office for National Statistics which found thatnine out of ten youth offenders in the UK suffer from a mentaldisorder. The researcher feels strongly that more research needs to beconducted into these issues so that these worrying findings can bediluted; it is primarily for this reason that the researcher has chosento conduct this research on that topic. Intending to pursue a career inthe youth justice system working with young offenders in the UK, theresearcher also feels strongly that a deeper substantive knowledge inthis area will aid not merely his professional development but also hisability to help reduce the incidence of mental disorder in the UK youthjustice system.

The researcher concedes that the objectives of this research didchange direction at various points of the review: Initially, the aimwas to identify the current practical failings of the youth justicesystem and to convincingly demonstrate that these failings directly orindirectly contribute to the problematic prevalence of mental illnessin youth offenders and to likewise suggest practical reforms whichshould be employed to reduce this phenomenon; latterly, the researcherunderstood that rather than suggesting changes in practical reform thathe should attempt to identify the failings in the current research andthe strategies employed by the justice system, and to suggestalternative strategies and ideas for future research which will then inturn result in more effective justice practice.

The structure of this paper, as described in paragraph two of thisintroduction, has been carefully constructed to complement itsarguments: the historical analysis of trends in UK penal policy andpractice (pertaining to youth offenders) over the past fifty years,with which this paper will commence, provides ample support for thelater contention that the current approach employed by the youthjustice system in the UK to reduce the incidence of mental illness inits prisons is inadequate and also for those policy reforms which willbe recommended by the researcher in this paper’s conclusions.

The Structure of the Literature Review:

As noted previously in the introduction, above, the literaturereview of this paper will not confine itself to any one particulardiscipline; after all, the subjects of criminology, forensicpsychology, social work and, to some extent, penology are havededicated varying proportions of their research on the issues withwhich this paper is concerned; namely the prevalence of mental illnessin young offenders in the UK Youth Justice system, in particular thoseoffenders currently serving custodial sentences in young offendersinstitutes, and practical methods for reducing this problematicphenomenon. A clear concern to any researcher conducting amulti-disciplinary literature review of this kind is that the order ofthe analysis is prone to be confusing; a researcher could choose toperform a separate review of the literature from each respectivesubject area or, alternatively, a researcher might choose to make nosuch division but rather separate the review into the relevantquestions and under each separate heading utilize the literature fromany relevant discipline in no particular order. The researcher of thispaper has chosen to adopt the latter of these two approaches; he feelsthat to divide the review analysis according to topic area is whollyartificial, especially in light of the fact that any research orliterature which will be discussed will be wholly relevant to the sameissues pertaining to young offenders.

With this methodological approach in mind, the questions which thisliterature review will seek to discuss and, where possible, answer, areas follows:

1] What is defined as ‘mental illness’ and how has this definition changed over the past 60 years?

2] How prevalent is mental illness in young offenders who arecurrently serving custodial sentences in young offenders’ institutes inthe UK?

3] To what extent is this a recent phenomenon? And to what extent isthis a phenomenon which is particular to young offenders serving asentence in a secure institution rather than to those young offenderswho are serving non-custodial sentences or those young persons who havenot been involved in the Youth Justice system at all?

4] Historically, how has the UK Youth Justice System responded tothe problem of mental illness in young offenders who are currentlyserving custodial sentences in young offenders’ institutes?

5] Is there convincing evidence which suggests that there is linkbetween this prevalence of mental illness and the high rates ofrecidivism in young offenders serving custodial sentences?

6] What is the approach which is currently employed by the UK Youth Justice System to tackle this problem?

7] To what extent is the current policy approach of the UK YouthJustice System appropriate in achieving its objectives in this regard?

8] How is this policy approach being implemented by the UK Youth Justice System?

9] Are these practical reforms appropriate in light of the policyapproach adopted to reduce the incidence of mental illness in youthoffenders in the UK?

10] What changes should be made to the current policy and practiceof the UK Youth Justice System to effect a more successful reduction ofthis problem?

11] What further academic research is needed to assist in the formulation of these new policies and practices?

1] What is defined as ‘mental illness’ or ‘mental health’ and how has this definition changed over the past 60 years?

Any literature review on the prevalence of ‘mental illness’ in aparticular population, in this case young offenders serving custodialsentences, would be incomplete without a preliminary discussionpertaining to the definition of ‘mental illness’ or ‘mental health’ inthat context.

Within the context of young offenders, it is interesting to notethat there is very little consistency in the definition of ‘mentalhealth’: In fact, ‘a review of over 60 national and local education,health and social care documents (policy, strategy and guidance)revealed little consistency within, as well as, across agencies. Therewere 10 different terms or phrases used to label the positive end ofthe mental health continuum and 15 to describe the negative’ [JointCommissioning Strategy for Child and Adolescent Mental Health Servicesin Kent, Draft Report, 15th January 2007, p6].

This having been said, it does not seem that the definition of ‘mentalhealth’ in this context is particularly contentious. The Kent andMedway Multi Agency CAMHS Strategy Group have provided a workingdefinition which incorporates each of the individual definitions foundduring their literature review of relevant policy documents: ‘Mentalhealth can be defined as: The ability to develop psychologically,emotionally, intellectually and spiritually, to initiate, develop andsustain mutually satisfying personal relationships, including theability to become aware of others and to empathise with them, and theability to use psychological distress as a developmental process, sothat it does not hinder or impair further development’ [JointCommissioning Strategy for Child and Adolescent Mental Health Servicesin Kent, Draft Report, 15th January 2007, p6]. 

However, to find a comprehensive definition of ‘mental illness’ in thiscontext is not so straightforward: It would seem that practitioners inthe field of forensic psychology have divided mental ill-health intothree separate categories separated on the basis of severity ofsymptoms; namely, ‘mental health problems’, ‘mental health disorders’and ‘mental illness’.

Mental health problems, the least serious form of mental ill-health,‘may be reflected in difficulties and/or disabilities in the realms ofpersonal relationships, psychological development, the capacity forplay and learning and in distress and maladaptive behaviour. They arerelatively common, and may or may not be persistent’ [JointCommissioning Strategy for Child and Adolescent Mental Health Servicesin Kent, Draft Report, 15th January 2007, p6].

Mental health disorder is the term subscribed to those persons whoare suffering from persistent mental health problems which affect theirfunctioning on a day-to-day basis. Whilst most young people will atsome stage in their development suffer from mental health problems, itis not normal to expect such persons to suffer from mental healthdisorders. As noted by the Kent and Medway Multi Agency CAMHS StrategyGroup, mental health disorder, as a term, ‘[implies] a marked deviationfrom normality, a clinically recognised set of symptoms or behaviourassociated in most cases with considerable distress and substantialinterference with personal functions or development’ [JointCommissioning Strategy for Child and Adolescent Mental Health Servicesin Kent, Draft Report, 15th January 2007, p6].

Finally, mental illness, the most serious of the three forms ofmental ill-health, can be recognized in those young persons sufferingfrom severe clinical psychosis or neurosis, e.g. those suffering fromschizophrenia.

These definitions provide a clear and useful taxonomy from which wecan begin to analyse the statistics on the prevalence of mentalill-health in young offenders in the UK. However, before we commencethis analysis, it is first important to briefly examine the perceivedhistorical relationship between mental ill-health and crime ; afterall, it has often been the case in the past that societies across theworld have attributed certain (if not all) aspects of criminality tosymptoms of mental ill-health, in particular mental disorder and mentalillness. For example, The USSR during the Cold War often incarceratedpolitical ‘criminals’ on the basis that they must be mentally insanefor holding such opinions and beliefs.

Whilst the above example would shock most people of today, thisphenomenon is not that far removed from how the UK government hastraditionally treated the mentally ill: ‘In the UK, mental health carewas for decades provided only in large ‘asylums’ – keeping ‘mentallyill’ people out of society believing this to be for their own good andthat of their communities. Beginning in the 1950s and accelerating atthe end of the 1980s, government policy switched to providing moreservices in the community and in most cases limiting hospital treatmentto when it is needed most acutely’ [All-Party Parliamentary Group onPrison Health, House of Commons, November 2006, p2].

In light of the fact that historically the mentally ill have beendealt with in the same way as convicted criminals, it is not toodifficult to understand why there has developed a publicly perceivedlink between mental illness and criminality. This misconception hasalso been given weight by a small number of brutal homicide cases inwhich the perpetrator was schizophrenic; whilst social workers andpsychiatrists of today realise that schizophrenia does not necessarilycause its owners to be criminally violent, public opinion is still notas understanding: ‘Our understanding of mental ill health has…developed [since] that time, though public debate on the topic has notalways been in step… the popular assumption that mental ill health andcriminality are inextricably linked needs to be broken and policyinformed by a deeper understanding of the complex links between mentalill health and offending’ [All-Party Parliamentary Group on PrisonHealth, House of Commons, November 2006, p2]. Therefore, whilst theremay be certain links between mental ill-health and criminality, thereis no intuitive similarity between these two respective phenomena.

2] How prevalent is mental ill-health in young offenders who arecurrently serving custodial sentences in young offenders’ institutes inthe UK?

N.B. At the outset of this section of the literature review it isimportant to remind ourselves that secondary reviews of primary datacan often be misleading or, worse, erroneous. For example, to quote asection from the website of the government’s ‘Crime Reduction Toolkit‘A recent report by the Office for National Statistics, PsychiatricMorbidity Among Young Offenders, found that 9 in 10 young offendersaged between 16-20 years old showed evidence of mental illness’. Thisstatement would, using the taxonomy of mental ill-health discussed insection [1] above, appear to suggest that 90% of young offenders in UKPrisons are suffering from severe psychiatric illnesses such aschizophrenia: such a contention is clearly erroneous as if this werethe case then 90% of young offenders in Prison should in fact not be inprison at all but rather in secure mental hospitals. What the statementshould have said is: ‘A recent report by the Office for NationalStatistics, Psychiatric Morbidity Among Young Offenders, found that 9in 10 young offenders aged between 16-20 years old showed evidence ofmental ill-health’. Hopefully this example has shown how careful onemust be when attempting to describe or analyse the data findings fromprimary research.

All of the literature and research supports the contention thatmental ill-health among young offenders in UK Prisons is prevalent. Arecent Report suggests that “Young people in prison have an evengreater prevalence of poor mental health than adults, with 95% havingat least one mental health problem and 80% having more than one. [Laderet al., 2000, cited by Sainsbury Centre for Mental Health, March 2006,p3]”. This same conclusion is reported by Singleton et al. (1998): ‘95per cent of young prisoners aged 15 to 21 suffer from a mentaldisorder. 80 per cent suffer from at least two. Nearly 10 per cent offemale sentenced young offenders reported already having been admittedto a mental hospital at some point.’

A more recent research study conducted by Professor RichardHarrington and Professor Sue Bailey on behalf of the Youth JusticeBoard, entitled ‘Mental Health Needs and Effectiveness of Provision forYoung Offenders in Custody and in the Community’, found thatapproximately 33% of the young offenders sampled had at least onemental health need, approximately 20% suffered from clinicaldepression, approximately 10% of these young offenders had a history ofself-harm  and approximately 10% suffered from post traumatic stressdisorder and severe anxiety . This study also found that approximately5% of the young offenders sampled had symptoms indicative of clinicalpsychosis and that 7% of the sample population seemed to suffer fromhyperactivity. [Harrington and Bailey, 2005].

In conclusion, it seems indisputable that mental ill-health isprevalent among young offenders in the UK, in particular among thoseyouths serving custodial sentences.
3] To what extent is this a recent phenomenon? And to what extent isthis a phenomenon which is particular to young offenders serving asentence in a secure institution rather than to those young offenderswho are serving non-custodial sentences or those young persons who havenot been involved in the Youth Justice system at all?
Whilst there is evidence that even as far back as 200 years ago UKPrisons were occupied to some extent by persons who suffered frommental problems, disorders and illness [Thomas Holmes, 1900], it isdifficult to ascertain whether this was due to the same reasons whichcause the phenomenon today, or whether these offenders were simply putin prison because of their mental ill-health, a practice which, asdiscussed above, was common in the nineteenth century. Unfortunately,in regards to the historical position, this is not a problem which canever be easily resolved, and it is a question which is still relevantto a discussion of the phenomenon of today: Is the prevalence of mentalill-health among young prisoners due to their treatment within theyouth justice system or did these individuals suffer mental ill-healthprior to their involvement with the justice system?
Hagell (2002) p37 suggests that mental ill-health is more prevalent inyoung offenders than in their law-abiding peers, but this still doesnot answer the question of whether the reason that these individualsbroke the law in the first place was because of their mental problems,disorders or illness: “there is little doubt that young people caughtup in the criminal justice system do have elevated rates of mentalhealth problems when compared to other adolescents. A conservativeestimate would suggest that the rates of mental illness in these youngpeople is three times as high as that for their peers.”
Likewise, an article by Sir David Ramsbotham entitled ‘The Needs ofOffending Children in Prison’, which was published in the Report fromthe Conference of the Michael Sieff Foundation entitled ‘The Needs ofOffending Children’, at p19, that whilst 95% of young offenders incustody are suffering from mental ill-health, only 10% of the generalpopulation are suffering from such problems, disorders or illnesses.
This finding is supported in result, if not precise figures, by aresearch study which was conducted by the Mental Health Foundationentitled: The Mental Health of Young Offenders. Bright Futures: Workingwith Vulnerable Young People [Hagell, 2002]. This study stated:“Despite methodological hindrances, it is clear from this review of theliterature that there is a consensus that young people who offend arelikely to have much higher than usual levels of mental health problems.Estimates from research studies suggest that the rates of problems wereapproximately three times as high as for their peers in the generalpopulation. In general, the mental health needs of young offenders arethe same as those of the general adolescent population but more acute.”[Hagell, 2002, p28].

Regarding whether the prison regime itself is responsible for thisprevalence, or merely the fact of incarceration, a study by Nicol et al(2000) found that there was very little difference between the levelsof mental needs in those young persons held in prison and those held inother forms of welfare establishment. This implies that the same mentalproblems, disorders and illnesses which lead a young person to beincarcerated in a welfare institution are also present in those youngoffenders who break the law and are subsequently sentences toimprisonment.

A study commissioned by the Youth Justice Board [Harrington andBailey, 2005, p8] seemed to suggest that the mental needs of youngpersons were reduced as a result of being sent to Prison: “Youngoffenders in the community were found to have significantly more needsthan those in secure care…Needs increased for young offendersdischarged from secure facilities back into the community, suggestingthat needs are only temporarily reduced while in custody.

In conclusion, there is no doubt that the prevalence of mentalill-health amongst young incarcerated offenders is not a newphenomenon, although it is impossible to state with any certaintywhether this phenomenon is worse now than it ever has been in historypreviously. Regarding whether this phenomenon is particular to youthoffenders over their law-abiding peers, it would seem that it iscertainly more pronounced with this former group, but also with thoseoffenders serving community sentences and those young persons who arebeing held in welfare establishments.

4] Historically, how has the UK Youth Justice System responded to theproblem of mental illness in young offenders who are currently servingcustodial sentences in young offenders’ institutes?

As noted earlier, ‘In the UK, mental health care was for decadesprovided only in large ‘asylums’ – keeping ‘mentally ill’ people out ofsociety believing this to be for their own good and that of theircommunities. Beginning in the 1950s and accelerating at the end of the1980s, government policy switched to providing more services in thecommunity and in most cases limiting hospital treatment to when it isneeded most acutely’ [All-Party Parliamentary Group on Prison Health,House of Commons, November 2006, p2].

During the 1950’s and 1960’s the link between mental ill-health andcriminality had arguably never been stronger; all prisoners wereregarded as patients who could be effectively ‘treated’ to prevent themfrom re-offending in the future and whilst little specific attentionwas paid to the individual mental needs of offenders, the types oftreatment reforms which were offered by the Criminal Justice System atthis time were very similar to the kinds of group treatment therapiesbeing offered to those mentally disordered and mentally ill patients inthe mental asylums and hospitals of the day. During the 1970’s thisparadigm of offender treatment was abandoned primarily as a result ofresearch studies conducted into the success of some of these treatmentreforms: conclusions from several research studies into theeffectiveness of these criminal treatments on reducing criminalbehaviour strongly suggested that ‘nothing works’ (Thomas-Peter, 2006,p29). These embarrassing findings caused the pendulum to swing awayfrom rehabilitation towards a firmer commitment to incapacitation andpunishment through positive custody.

During the 1980’s, the wave of ‘new public management’ was born(Thomas-Peter, 2006, p30). This movement focussed heavily upon theprocedural roles of the Prison and Probation Services in reducingre-offending. The Prison service started to contract out some of theirprimary responsibilities in a quest to encourage more efficient servicefrom both their private sub-contractors and also their remaining statePrisons who would have to meet their performance targets to avoid beingprivatised in the same way as so many other Institutions had been.Likewise, the Probation service was reorganised and reintegrated toencourage greater efficiency of performance: ‘[The Probation Service,rather than] a loosely co-ordinated collection of individual socialworkers [became a unified and managed service] with a clearer sense ofdirection and purpose, which was more able to engage on equal termswith other services and to contribute and give effect to nationalpolicies’ (Faulkner, 2007, p7).

During the 1990’s researchers revisited the studies conducted in the1970’s and found that rather than demonstrating that ‘nothing works’,rather they supported the contention that certain types of treatmentinitiatives were working with certain types of individuals: Whilst only10% of a group may have responded well to that treatment, if thesimilarities between those responding offenders could be identifiedthen for this new group, the reform could be said to be verysuccessful. This has lead researchers such as Harper and Chitty (2005)to argue that the new question should not be ‘what works?’ but ‘whatworks for whom, and why’? This paradigm shall be discussed in greaterdetail in section [6] of this literature review.

It is important to note that, except for the changes made to theProbation Services in the 1980’s, the above discussion summarizes thedevelopments in the paradigm of Criminal Justice generally and does notspecifically answer the question of how the Criminal Justice system hashistorically dealt with the problem of mental ill-health in youngimprisoned offenders.

The fact is that even as late as 2002, there was no real unifiedsystem implemented to deal specifically with this particular problem.Research on this topic was sparse and focused rather than on nationalstrategies, on local remedies such as the pioneering work done by theAdolescent Forensic Services in the Midlands. Generally, where YoungOffenders Institutions were involving forensic psychiatrists or mentalhealth social workers this was not being done with the aim of treatmentor rehabilitation but rather for the purposes of assessment. Also,rather than assessing each young offender, these processes tended to beused for those offenders who were clearly suffering from mentalill-health and those offenders who specifically asked for suchassistance. A report published by the Mental Health Foundation in 2002,entitled ‘The Mental Health of Young Offenders. Bright Futures: Workingwith Vulnerable Young People’ [Hagell, 2002, p23] summarized theposition at that time in the following way: “As far as the MentalHealth Foundation is aware, there is no recent research data availableon the provision of psychological and psychiatric services to youngoffenders across the criminal justice system. However, at the time ofwriting it is clear that, from existing fragmented information, thereis no routine, standardised screening employed across the criminaljustice system and that responses to problems are inadequate andfragmented.”

Whilst it is true that certain practical initiatives were introducedfrom the mid-nineties, such as Youth Offending Teams, Detention andTraining Orders, Parenting Orders and Child Safety Orders, thediscussion of the effects of these reforms shall be reserved forsections [6] and [9] of this literature review, in which we shallanalyse the current policy and practical approach employed by the YouthJustice System in dealing with the problem of prevalent mentalill-health among young prisoners.

5] Is there convincing evidence which suggests that there is linkbetween mental illness and the likelihood of being sentenced toimmediate custody? Is there convincing evidence which suggests thatthere is link between mental illness and the prevalence of mentalillness and the high rates of recidivism in young offenders servingcustodial sentences?

One would be right to question the relevance of this enquiry to themain purposes of this research paper; after all the objective of thispaper is to examine the current strategy in dealing with the problem ofmental ill-health in young offenders institutes and to proposerecommendations for future clinical research and immediate reform.However, the researcher of this paper has chosen to dedicate a sectionof its literature review to the issues raised in the title of thissection because he feels that, if a convincing link between mentalill-health and criminality/criminal recidivism can be demonstrated thenit would provide additional support for the importance of reform inthis area. After all, the youth of today are the adults of the future,and if it can be shown that reducing the prevalence of mentalill-health in young offender institutions has a positive (reducing)effect on the rates of recidivism then the Criminal Justice System maybe compelled to dedicate extra time, money and resources on furtherresearch in this area and also on the implementation of reformsdesigned to reduce the prevalence of this problem.

The first point to note is that there is a body of research whichsuggests that young persons with mental disorders are more likely to bearrested, charged and convicted for their criminal behaviour than thoseyoung people in similar circumstances who do not have such severemental problems [Teplin, 1984]. This is supported by the research studyconducted by Singleton et al (1998) which found that the majority ofprisoners who had been diagnosed as having mental illness had, prior tohaving contact with the Justice System, already had contact with theNHS and other welfare services.

These findings cannot be squared easily with the findings of otherresearch studies which suggest that “further offending [is] notpredicted by mental health needs or alcohol and drug abuse problems.[Harrington and Bailey, 2005, p8]” After all, if mental ill-health canpredict first instance-offending in young persons, then it must alsosurely be a predictor of recidivism in these persons also. Thisresearcher is therefore more inclined to rely upon other researchstudies which suggest that this is not the case: For example, the studyconducted by the Mental Health Foundation [Hagell, 2002, p24] foundthat: The outcomes for young offenders in need of mental healthservices include: further offending and worsening mental healthproblems if the needs are not met. The two are interlinked. While theoffending may have been a risk factor for mental health problems in thefirst place, it has long been understood that mental health problems inturn go on to be a risk factor for continued offending (Kandel, 1978;Rutter et al 1998). Early detection may reduce the likelihood thatyoung offenders will persist into adulthood.”

6] What is the approach which is currently employed by the UK Youth Justice System to tackle this problem?

As discussed earlier