chapter  4
31 Pages

Cognitive behaviour therapy with adolescents in secure settings

ByKirsty Smedley

Over the past decade a number of policy documents have been published which have focused on the mental health needs of children and adolescents. In 2004, for example, the Department of Health (DH) set out a vision within the National Service Framework (NSF) for a comprehensive child and adolescent mental health service (CAMHS). Voicing similar aspirations to those in the document Changing the Outlook (DH and HMPS 2001), the NSF argued that children and young people in custody should have the same right to access this comprehensive CAMHS service as do those in the general population. More recently a cross-department government strategy document, Healthy Children, Safer Communities (DH, DCSF and Ministry of Justice 2009), has highlighted the need for children and young people in contact with the criminal justice system to be viewed holistically. This document argues for the early identification of their mental health difficulties, whether they are directly related to their offending behaviour or not. This represents a shift away from previous thinking that only mental health difficulties directly related to offending behaviour should be the subject of psychological interventions in custody. Healthy Children, Safer Communities aims ‘to help tackle youth crime and anti-social behaviour, and contribute to community safety in England’. The strategy notes that the health needs of children and young people in the secure estate are noticeably higher than for those in contact with the youth justice system in the community. The document also discusses the opportunity provided by time in custody to attend to children’s unmet needs. It

recognises, however, that while there are promising developments in the provision of health care, there are also huge challenges. Those challenges include the need for a balance between providing an appropriate secure setting and yet also meeting the therapeutic needs of vulnerable children and young people.