“Miss, you’re cool!”

I knew from an early age that I wanted to work in the field of Psychology – especially working with children. I grew up in a Pakistani household and my mother suffered from post-natal depression and was unable to look after me as a baby; looking back, I think this built the determination I have to help young people.

Mental health was always a taboo subject for my family. I often found myself becoming stigmatised by the labels given to my mother, and opinions of me began to mirror the woman that I was growing up to be. At the time, I didn't realise that I, too, was struggling with my own mental health because of the conversations that I never got to have with my family when I was growing up.  

I was always an inquisitive child. At nine years old I remember asking a fellow student why they continued to misbehave in lessons. Looking back today, with the psychological understanding and knowledge that I have, I start to wonder about the challenges and difficulties he may have been experiencing during those times. 

Aged just ten, I took part in Childline's active listening and speaking training and became a 'Breaktime Buddy' for peers who felt lonely and needed someone to speak to. When I finished school, I was sure that I wanted to become a Clinical Psychologist.

The Youth Justice Liaison and Diversion Service

The Youth Justice Liaison and Diversion (YJLD) scheme was first implemented in 2008 (Haynes et al., 2012) to provide early intervention for young people aged 18 and under in custody. This was envisioned by Lord Bradley (2009), who reflected on the importance of addressing mental health needs of offenders.

The main objectives of the project were to improve early identification, reduce reoffending and improve the wellbeing of young people.

The pilot scheme was found to be effective in identifying mental health difficulties, learning disabilities, speech and communication difficulties among young people entering the criminal justice system and referring them onto the most appropriate support.

Following on from the pilot, practice and research recommendations were made to ensure the success of the delivery of the YJLD scheme. Some key recommendations were for services to have an evidence-based ethos, integrate with existing services and to encourage a community centred approach (Haynes et al., 2012).

Why YJLD?

I started out supporting clients with learning disabilities and challenging behaviour. I found myself drawn to the YJLD position after working in a male prison setting, where adults experienced a plethora of unresolved childhood trauma and Adverse Childhood Experiences (ACEs). I never thought I'd end up working in a prison; but when the opportunity presented itself, I jumped at it in order to learn more about mental health in a prison environment.

I was struck by the similarities of the inmates' childhood experiences and my own, and I began to consider the protective factors that prevented me from following a similar path. I observed missed opportunities for early intervention for many of these adults and the lack of safety throughout their life.

I then worked for St Giles Trust, providing early help to children and young people who were at risk of entering the criminal justice system, in addition to those who were experiencing family difficulties.

Young people in Youth Justice Services (YJS) are three times more likely to have mental health problems compared to their peers (The Mental Health Foundation, 2002). While working in Early Help, I found that a number of unmet mental health difficulties were present among young people who are at risk of exploitation and who were becoming entrenched with local YJS. It was then that I knew that I wanted to make a change and have an impact on young people's lives.

I began working as an Assistant Psychologist within Barnet Integrated Clinical Services (BICS) – a tier two mental health service for children. When they offered me the chance to work with the mental health of young people involved in the Youth Justice Service (YJS), I couldn't have been more excited. Not long after, I was encouraged to apply for the position of the YJLD full time.

Mental Health Screening

When young people are brought to the attention of the police they are often in a difficult emotional state. For many of the young people I support, when they see or hear the police they run the other way, regardless of their innocence. Perhaps interestingly, I have heard this more from young boys from BAME backgrounds. Unfortunately for them, society has been constructed in a way that means they are disproportionally targeted.

The young people I work with have a stigma attached to them already. They have felt ACEs, and for many, coming to the attention of the police for the first time is traumatising. I have found, though, that for some young people where it was not their first time being arrested, they are able to detach themselves from the process of being arrested.

Those persons who are detached from their actions are often difficult to engage with – often telling me they 'don't need to talk to anyone' or that they 'don't care about anything'. Clearly, this is a coping strategy used by young people to push trusted adults away. This creates a barrier to engagement.

Often, young people feel misunderstood and it is my role to offer them a mental health screening to identify any unmet needs. As a Liaison and Diversion Practitioner, I provide a safe space for young people away from their everyday lives. I am on hand to validate and listen to what they may be thinking and feeling. Previous service users have expressed their gratitude to the YJLD, for providing a safe space where they can be heard without judgement.

The most common misconception from young people is that mental health screening will result in them being diagnosed with mental health difficulties. My role is not to provide a label for the young person, but to identify areas of concern that may require further assessment and therapeutic support. It is my belief that young people in the criminal justice system are prone to too many labels. They are often called a 'troubled child' or 'challenging', and the important part of screening is to understand what the child may actually be communicating through their behaviour.

The Power-Threat-Meaning Framework

The Power-Threat-Meaning framework can be useful in understanding a child's maladaptive adaptations to society as a young person attempts to take control of their life. I feel that it is helpful to share this framework in a child-friendly manner to ensure that the young person feels empowered, and that they can make of their life and why they feel the way they do. Often, they have had little control growing up and have been exposed to distressing experiences that they had no choice about.

This is particularly true among the growing number of young people that carry knives. There appears to be a pattern in their histories where fathers have not been present; often, the young person has had little control over this, they begin to feel threatened within a community and they can only rely on themselves to protect themselves.

Interventions

Engagement with wider services is the most common recommendation and outcome for the Barnet Learning and Development (BLD) service. For some young people, their support within the YJS is already in place, however, many will need to be referred or signposted to an appropriate service.

I have noticed that one major difficulty young people have is dealing with the feeling that as soon as they start to develop a rapport with myself or other Practitioners they are quickly referred elsewhere. This can be unsettling and can impact the openness these young people bring to our meetings. On being told about a referral, some have disengaged with the process and others have asked what will happen if they don't like the next professional. To counter this, I offer to be present at handover meetings to ensure they don't feel they have to retell their story.

Another common recommendation and outcome for the BLD service is to provide psychoeducation, using a Cognitive-Behavioural Therapy (CBT) approach, for young people with mild mental health difficulties. Psychoeducation is important for young people who are entering the criminal justice system and it has been found to help reduce reoffending rates (Ford & Hawke 2012; Koehler et al., 2013). Psychoeducation creates a roadmap for young people to understand their mental health difficulties and to establish and learn the coping mechanisms needed to manage their negative thoughts and feelings.

Young people often talk about feeling angry, but when explained to them that they may have a smaller window of tolerance and zones of regulation they are able to build awareness and manage their emotions better. Often, this can play a key role in framing the context for the young person to engage in therapy with basic interpersonal communication skills and mental health services.

Opening up

The therapeutic side of my role is particularly enjoyable. I get to see young people tap into their strengths and trust me as a person that they can open up to. I like to bring in play and creativity to these sessions using art, creative writing and therapeutic games and this approach has proved successful.

A recent scenario that stands out for me is from a session I conducted with a young person focusing on their worries and triggers. I was helping them to understand how their fears made them anxious and caused unsettling emotions to surface as frustration and anger towards others. As he began to understand and develop an insight into his feelings, he appeared surprised and said: "Miss, you're cool!"

Multi-Disciplinary Working

Partnership working is essential in helping vulnerable young people stay connected and supported. As a member of the YJLD, it can be demotivating to look at the number of services that have been involved in a young person's journey. Out of 50 young people referred to the BLD between November 2021 and June 2022, 40 were previously supported by Early Help, 41 had previous MASH referrals, and 34 had been on Child in Need plans.

Part of my job requires me to attend weekly Out of Court Disposal (OOCD) panels with multidisciplinary teams, including the police, to discuss intervention plans for young people who have received community sentences for less serious offenses. The OOCD is child focused and prevents young people from attending court systems, that can be extremely daunting.

Research has shown that those who experience four or more ACEs have an increased likelihood of presenting criminogenic risks (Wasvani, 2018). When young people are presented at the OOCD, we think together about the unmet needs in a trauma-informed way and agree to an intervention that would meet these needs. Sometimes we will vote for a less severe outcome based on the information shared, as we are able to mentalize the young person's experiences. It is promising and feels fulfilling to be part of this change that focuses on the child first and the offender second.

Challenges

People who are involved with the police are harder to engage with than those who are not (Khan, 2010) and one of my key responsibilities is to try and engage with young people involved in the YJS and provide a mental health screening. Our very first meetings have a considerable impact on a young people's impression of what YJLD can offer them. I try to meet them in an environment that feels safe to them, such as home or in school, as a setting that is informal and friendly can help young people feel more comfortable talking to others.

There is also the challenge of keeping them engaged in assessment and intervention. I try to embed mentalisation in my work, to better understand how they may be feeling and thinking. I try to break down barriers to engagement by showing compassion, empathy, and respect to young people. I do this by using the language they use, being curious and speaking about every-day things to learn about who they are as a person, and not only about what difficulties they may be experiencing.

The Solution-Focused approach treats clients as bringing expertise about themselves, which is how I see the young people (Jong & Berg, 2001). I think of the developmental stage teenagers are at while finding their identity and the impact of their limbic system development on their decisions making (Goddings et al., 2014). One of the most common disorders that young people in the juvenile justice system are diagnosed with is Conduct Disorder. This is reflected in the Barnet YJLD mental health screenings, where parents and teachers often report that young people exhibit behaviours that are challenging or antisocial. The young people also demonstrate inattention and hyperactivity. If these concerns are apparent, I make onward referrals to CAMHS for ADHD assessment.

I believe in the importance of psychoeducation for whether symptoms are due to ADHD or a response to trauma. Children exposed to trauma may experience symptoms such as hyperarousal and impulsiveness that often overlaps with ADHD (Van Der Kolk, 2005). I think that of all the diagnosis around different forms of challenging behaviour and how one can get lost in these definitions. If that is how I think, I wonder about the young people.

There are some young people who have witnessed domestic violence in their homes or had an inconsistent parent who has not met their needs. Quite often, these are the young people who I will observe as fiddling with pieces of paper on the table as we conversate or move around the room. I felt this while working with a young person with Oppositional Defiant Disorder and Conduct Disorder. I asked him how he felt about all these diagnoses, and while some have shared that they feel understood and relieved, this young person explained he didn't understand and felt the school had seen a young person with a traumatic childhood, felt bad for him and thought the labels would help. I was taken aback by his response but also reflected on the narratives he must have been told in his life to come to this conclusion.

BAME disproportionality

BAME disproportionality is a key issue that YJLD services need to address. The Lammy Review (Lammy, 2017) found that young people from BAME backgrounds are disproportionately represented in YJS and Children and young people's mental health services. Research suggests that ethnic and cultural differences in mental health reporting and experiences may account for the differential treatment of BAME young people in society (Maguire and Miranda, 2008). Following this, the mental health screening has been developed to identify cultural aspects and give meaning to individual differences in client behaviour in hopes to improve YJLD accessibility for minority groups.

A young person I had screened in the past was told by his parents, who were of African ethnicity, that there was something spiritually wrong with him, which is why he was feeling low and crying all the time. I thought of how difficult it must have been to manage this belief of the parents despite professionals attempting to explain mental health to them. The young person had taken courage to talk to me about his difficulties with managing his mood and together we were able to ensure he was given the correct therapeutic support.

What's next?

The YJLD service continues to develop. The research currently available is primarily based on adult Liaison and Diversion services, so, the National Institute for Health and Care is funding Manchester University to undertake research on how YJLD services share information about the young people and understand what best practice looks like for this remit. Recommendations will look towards improving referral rates into YJLD and better identify the vulnerabilities young people may be experiencing.

I am looking forward to seeing the changes that come about to the YJLD service as a result and how we can continue to tackle early prevention and intervention for youth entering the YJS who have experienced past traumas.

References

Bradley, K. J. C. B. (2009). The Bradley Report: Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system (Vol, 7). London: Department of Health.

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De Jong, P., & Kim Berg, I. (2001). Co-constructing cooperation with mandated clients. Social work, 46(4), 361-374.

Disley, E., Gkousis, E., Hulme, S., Morley, K. I., Pollard, J., Saunders, C., & Sutherland, A. (2021). Outcome evaluation of the national model for liaison and diversion. RAND.

Ford, J. D., & Hawke, J. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Maltreatment & Trauma, 21(4), 365-384.

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Lammy, David. 2017. The Lammy Review: An independent review into the treatment of, and outcomes for, Black, Asian and Minority Ethnic individuals in the Criminal Justice System. https://www.gov.uk/government/publications/lammy-review-final-report

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Mental Health Foundation. (2002. The Mental Health Needs of Young Offenders. London: Mental Health Foundation.

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Vaswani, N. (2018). Adverse Childhood Experiences (ACEs) in Children at High Risk of Harm to Others.