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Health of boys in secure care

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Boys in secure care because of serious or persistent offending are clearly a highly selected population at high risk of mental health problems. The mental health needs of boys in four secure units have been assessed (L Kroll and colleagues.

; see also Commentary, ibid: 1956–7).

Ninety-seven boys aged 12–17 years were assessed on admission to secure care and while still in care 3 months later. More than a third of the children had been in social services care before admission, more than half had had at least two previous care placements, and almost three quarters were not attending school. They had committed serious or repeated offences (42 boys had committed offences that if committed by an adult would carry an expected prison sentence of 14 years or more). The mean age was 14.9 years, mean reading age 11.4 years, and mean reading comprehension age 9.9 years. Twenty-six had an IQ under 70.

At the time of admission the mean number of cardinal mental health problems per child was 8.5. Depression, anxiety, aggression, drug or alcohol misuse, and social and educational problems were all common. In some aspects the needs were well met. These included education, substance misuse, self care, and diet. After 3 months the mean number of cardinal problems had fallen to 2.9 but often problems persisted or new problems arose. Some problems were probably contained by secure care rather than managed successfully. Admission itself appeared to precipitate depression, anxiety, or post-traumatic stress in some boys. Assessment and provision for mental health needs was deemed inadequate. Three important needs are highlighted: better treatment for emotional disorders, better assessment and treatment for aggressive behaviour, and better treatment for substance misuse.

In the USA innovative approaches to the problems posed by young offenders include special drug courts, mental-health courts, and peer courts in which fellow adolescents play important parts. New approaches to sentencing include “multisystem therapy” and “wraparound” community based sentences

Young serious offenders have many mental health needs and current provision is inadequate. Newer legal approaches and sentencing provisions need to be considered along with better health services.

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