MHYO Project Volume II
Manual for improving professional knowledge,
skills and developing advocacy programme
As evidence mounts regarding the relatively high prevalence of mental health problems among youth offenders and the apparent inefficiency and lack of coordination/cooperation between juvenile justice and health care systems to deal with them, juvenile justice systems are looking for guidance on how to respond. For this reason, ‘MHYO Manual for improving professional knowledge and skills, and developing advocacy programme’ has been developed as a global manual for all the stakeholders in contact with young offenders with mental health problems.
The first section ‘MHYO Training Tools for improving professional knowledge and skills’ has been designed to guide the reader through the pathway of young offenders with mental health issues through the criminal justice system. From the moment of arrest to the moment of release, each point of contact between young people and health/justice agencies is described to expose the different challenges. For each contact point, a list of professionals involved is provided as well as specific training exercises for them. Crucial intervention points are also identified.
The second section ‘MHYO Advocacy Tools’ is a toolkit for advocacy. It aims to help national stakeholders and experts to develop an advocacy and evaluation programme to improve the provision of services for young offenders with mental health problems. To this end, three tools have been developed which can be used to develop a country specific programme of action or as tools in themselves. Finally, Section 2 includes the IJJO Opinion and the IJJO Recommendations to provide further assistance to nations to identify and resolve existing problems with regards to the situation of mentally ill young offenders. These consist of recommendations for the international level; for the European level and for the national level.
Section 1 - MHYO Training Tools for improving professional knowledge and skills
This training manual has been designed to take the reader through the pathway of a young person as they move through the criminal justice system. Each point of contact with certain agencies and professionals is broken down and the reader is shown the important points to consider at each time. Section I can be used as a reference booklet or as a training tool to expand the knowledge of the professionals that work with young offenders.
Each chapter contains: information on what to do at critical points in the young offenders’ journey and how certain issues may be addressed; definition boxes on key issues; best practice examples from across the world, what the young person’s needs are at each stage of the process; reminders of what you can do for a young person at each stage and questions and exercises for discussion or self reflection. Moreover, Section 1 starts off with a general definition of mental problem, illness and disorder; and the different types of these.
This chapter begins by describing the causes of crime and provides a list of risk and protective factors including family, school, community and individual/peer factors. Within risk factors, abuse – physical, sexual and emotional – and neglect are explained more in detail. As next, the chapter explains the causes of mental health problems, illnesses and disorders, clustered into four main types: difficult family background, trauma, attachment, and genetics and inheritance. The chapter continues by explaining what crime prevention is, defining it as ‘the work undertaken by professionals to stop children and young people from committing crimes’. The three categories of prevention – primary, secondary and tertiary – are further elaborated on and an example of good practice is given for each type. As last, the types of professionals involved in prevention are enlisted and key points to consider are outlined. It is argued that professionals should be systematic, strategic, well coordinated, creative and flexible when designing prevention programmes. The crucial intervention points are identified as being early intervention – intervening in families at risk as early as possible -, interventions in school and at service entry points at any time.
The chapter explains what happens when a child is arrested. It first lists the child’s needs at this time and the different types of professionals involved. Crucial points in the process of arrest are then identified and elaborated on individually. The first is the question of appropriate response from the police when dealing with a suspect with a suspected mental health problem. The second crucial point is the time of arrest, and the authors describe the obligations the police have at this time. The third point to consider is the detection of a mental health problem, and for this the chapter provides an extensive list of warning signs that could be noticed and should be taken seriously by the police. The next crucial point is interrogation and several suggestions are made as how to best interrogate children. The fifth point is the possibility and types of diversion which is said to be a favorable option for children with mental health difficulties. As next, the process of investigation and charge is explained and important aspects to consider are mentioned. The last crucial point is police custody and the authors make recommendations as to what the police should take into consideration when deciding whether to detain a young person and what behaviors might indicate that the person might pose a danger to themselves or others. The chapter concludes with specific exercises and discussion points for training.
Trial and Court Proceedings
During the trial process, there are several important considerations: children’s understanding and age must be taken into account; the trial should be conducted in a friendly environment, e.g. in special juvenile courts; and professionals – judges, lawyers, psychologists – should cooperate. The authors again list the child’ needs at this time, the types of professionals involved and what they can do. As next, crucial points in the trial process are identified and described in detail. Before a trial takes place, a young person’s fitness to plead should be determined and the authors outline the main criteria to do so. The extent of mental health problems of young suspects should also be explored by preparing a pre-sentence report which addresses the following issues: culpability, risk posed by the health problem, feasibility of any type of diversion/sentence, and the question of supervision. When a mental health problem is identified, appropriate experts should be consulted to collect further assessment on the physical/psychological/social needs of a person and the possible impact of any custodial sentence on the young person’s mental problems. Within forensic evaluations, the authors mention several ethical aspects to consider. During the actual trial, the authors emphasize that the language used during this process should be adapted in a child-friendly manner. Finally, when delivering a sentence, the authors outline what the judge should take into consideration. The chapter concludes with specific exercises and discussion points for training.
Deprivation of Liberty and preparation for release
Depriving children of their liberty is psychologically and physically harmful to them; especially for young people with a mental health problem. Young people in detention are reported to have very high rates of psychiatric disorders. After outlining the needs of children and the types of professionals involved at this time, the authors identify the crucial intervention points. They argue that deprivation of liberty prior to trial, also known as remand, should be avoided unless a young person is considered a danger to the public. At the time of transfer and admission into a secure establishment, young people should have already been assessed for mental health problems and should have received information on the imposed measure and the characteristics of the destined facility. The authors highlight the first night and week after admission as the most crucial point where mental health screening should take place, as self-inflicted harm and suicide rates dramatically increase during this time. Once in detention, the authors emphasize that intervention plans should be designed to foster the youth’s progress with the ultimate goal of successfully reintegrating them into society upon release. The characteristics of an effective intervention plan are also described. Appropriate treatment should also be available and should be adapted to the individual’s needs. Seclusions and restraints must only be used in emergency situations when the child or other children or staff members are in danger. Finally, this chapter also concludes with specific exercises and discussion points for training.
Community based sanctions
This chapter explains the child’s needs, list of professionals and the crucial intervention points involved in the execution of community based sanctions. Community based sanctions are defined as those punishments imposed by a judge for the young person to carry out in the community. They can involve an obligation to behave in a certain way, correct wrongdoings, perform specific work, or participate in educational classes. They usually also require supervision from an appropriate body such as a social worker or probation officer. The authors identify the supervisor’s duties to be: develop close relations with the child, set realistic goals for the child, foster family involvement and utilize multimodal intervention types. In the case of noncompliance, liberty should not automatically be withdrawn but instead, the sanction or measure should be modified according to the specific needs of the child.
Inclusion and prevention of recidivism
In this chapter, the authors argue that continuity of care is essential and while they acknowledge the existing difficulties, they propose a number of ways to achieve this. They also list children’s needs and the type of professionals involved and what they can do to help. The crucial intervention points during this phase are the following: transition whereby the authors note that withdrawal and ending of treatments/services and transition from one service to another may evoke strong emotions and reactions from young people. Therefore, one needs to ensure that this is discussed in advance with young people and that there is enough time and sufficient support for the young person to accept and adjust. When planning for the release of a child, the prevention of relapses is crucial. The release of a child should be gradual and make use of outings and day release. Upon release, aftercare services should be available to create and complete the gradual transition of the young person from living in establishment to living independently in the outside world.
Section 2 - MHYO Advocacy Tools
‘MHYO Advocacy Tools’ is a toolkit for advocacy. It aims to help national stakeholders and experts to develop an advocacy and evaluation programme to improve the provision of services for young offenders with mental health problems. To this end, three tools have been developed to allow the development of national advocacy programmes:
- Developing Law reform
- Charter for the rights of children deprived of liberty with mental health issues
- Evaluation and assessment
Developing Law reform
Any reform that takes places for young offenders with mental health problems needs to have support both at the government level and from the wider community. To be effective, the authors propose several essential elements including identification of problems and their causes, drafting proposals, checking the compatibility of national laws with international standards, performing a cost analysis, consulting and building consensus, dissemination, training, monitoring and evaluation of reforms and their impact. Strategies that can assist the development of fair and effective law and policy reform are looking backwards as well as forwards, identifying the political context, listening to public opinion, taking a holistic approach, using good practices and using the available support from international entities.
Charter for the rights of children deprived of liberty with mental health issues
The Charter for the rights of children deprived of liberty with mental health issues is designed as a safeguarding tool. The Charter reminds professionals what rights these vulnerable children have and how they are to be upheld. It outlines the specified rights that deserve the attention of all the professionals who work with children in juvenile justice and health care settings: admission to closed child mental health institutions, right to information regarding treatment, right to participate in the formulation of the treatment, right to participate in the running of the establishment, right to quality care, right to respect for privacy, right to personal and familial relationships, restrictive measures, right to legal counsel, right to education and right to cultural and recreational activities. The Charter is a version based on the one developed in Belgium by the Ministry of Health in collaboration with the secure hospital, The Centre Hospitalier Jean Titeca in Brussels. They began the process of setting up the charter in 2010. It was aimed at those working in residential, secure hospitals that were set up for children presenting both psychiatric and behavioral problems.
Evaluation and assessment
Improving services and outcomes for young offenders with mental health problems requires a robust method for evaluation and assessment. The IJJO, inspired by the UNODC Criminal Justice Assessment Toolkit, designed a similar one as a standardized and cross-referenced set of tools to enable international, national, governmental and other organizations or individuals to: conduct comprehensive assessments of criminal justice systems, identify areas of technical assistance, assist agencies in the design of interventions that integrate United Nations standards and norms on crime prevention and criminal justice, and assist in training on these issues. The Tools have been grouped within criminal justice system sectors, with the first four sectors as follows: Policing, Access to Justice, Custodial and Non-Custodial Measures, and Cross-Cutting Issues. The questions outlined in the following sections have been modified from the original handbook by UNOCD experts in order to be more relevant to the topic of young offenders and mental health.
IJJO Opinion on the situation of young offenders with mental health issues
In addition to the three tools, Section 2 includes the IJJO Opinion which can be used to highlight the problems and needs of young offenders with mental health problems, provide the basis for consultations among key stakeholders including the general public and civil society members and provide a baseline with which to assess existing national practice and legislation.
The Opinion touches upon several aspects related to the topic. First, it acknowledges that mental health problems are a widespread issue among young offenders. Young people in detention are more likely to experience mental health difficulties, however, often there are no appropriate services to provide the necessary treatment; hence making their condition worse. With regards to prevention, detection and evaluation of mental disorders, it is argued that early screening and assessment are crucial and they should be done as early as possible to provide effective interventions for children at risk.
On the penal responsibility of children with mental health problems, the opinion states that careful consideration must be given in the case of children when determining their penal responsibility, as they will have not yet reached full penal majority and are different from adults, especially when suffering from mental health difficulties. Several assessments should be carried out before establishing the presence of mental health problems and their effect on children’s culpability. Once established, the court should take into account what is the best measure to be imposed. The authors believe that developing close cooperation between the judicial, health care and educational systems can results in more effective intervention programmes.
In terms of mental health assessments, there is a need for close links between the health and justice sectors. While both sectors have their own interests and aims, they should nevertheless keep in mind the one they have in common, namely safeguarding the best interest of children at all times. Moreover, there should be a multi-disciplinary training of stakeholders and professionals in contact with mentally ill young offenders. Basic mental health training for professionals is desirable as it would create common ground for the different sectors and hopefully would enhance their cooperation.