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Working in the community with young offenders with mental health problems


Working in the community with young offenders with mental health problems Lambeth Youth Offending CAMHS: The Odyssey Health Team Clare Hurley Team Manager – PowerPoint PPT presentation

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Title: Working in the community with young offenders with mental health problems

Working in the community with young offenders
with mental health problems
  • Lambeth Youth Offending CAMHS
  • The Odyssey Health Team
  • Clare Hurley
  • Team Manager

Lambeth the context
  • Lambeth is the second largest inner London
    borough and one of the most densely populated
    districts in the country. It is the 5th most
    deprived borough in London.
  • It has one of the most diverse communities in the
    country, with 38 of the population from a BME
    community, and it has the largest Portuguese
    community outside Portugal.
  • High level of social care referrals and
    involvement with families

Offending in Lambeth
  • Crime rate is above the national average
  • Serious offending by young people is higher still
    in 2009-10, 20 of offences were violence
    against the person, 15 robbery, 13 drugs
    related and 4 burglary.
  • High levels of gang activity.
  • Reoffending 2009-10, 119 further offences were
    committed per 100 young people.
  • Custody rate 13 of disposals sentenced to
    custody (high custody rates, targets set to
    reduce this).
  • BME young people are over-represented in the
    criminal justice system in Lambeth BME young
    people constitute 40 of 10-17 year olds in
    Lambeth, but constitute 65 of the youth justice
  • 84 of YP within the YOS are male, 16 female.
  • High levels of serious and violence crime,
    high levels of recividism

So what is the mental health provision within
this context? The Odyssey Health Team
  • Odyssey is the recently rebranded in-reach mental
    health team, situated with Lambeth Youth
    Offending Service (YOS) in Brixton. Rebranded in
    an attempt to address stigma and increase YPs
    access to treatment
  • It is a tier 3 service and provides mental health
    assessment and intervention to young people on an
    order to Lambeth YOS, providing they have a
    Lambeth GP and are under 18.
  • The team provides
  • Comprehensive mental, emotional and behavioural
  • Evidence based interventions including CBT, EMDR
    and psychotherapy
  • Training and consultation to YOS staff
  • Contribution to interagency risk management
  • AIM service for young people displaying sexually
    harmful behaviour
  • Medication prescribing
  • Specialist forensic and psychiatric assessments
  • Support and treatment to carers and families
  • Collaboration with looked after children teams
  • Dual diagnosis treatment

The multi-disciplinary team
  • The team consists of
  • Consultant Psychiatrist (0.2 w.t.e)
  • Team Manager (social worker/CBT therapist)
  • CAMHS practitioner (art therapist)
  • AIM coordinator/practitioner (social worker)
  • Looked After Childrens CAMHS practitioner (0.2.
  • Substance misuse CAMHS practitioner (0.1 w.t.e)

  • The team has grown considerably in the past 12
    months, and increased activity levels and
    presence within the YOS are noted.
  • Referrals are predominantly received from YOS
    officers, although social workers and other CAMHS
    teams do refer in when it is known that young
    person has a YOS order.
  • In 2009-10, a total of 106 referrals were
    received. 83 of these were accepted and offered
    assessments. The majority were offered initial
    assessments within 15 working days, as per the
    Youth Justice Board (YJB) guidelines. This
    highlights the quick turnover of cases in the
    team compared to standard CAMHS.
  • 67 of these referrals were offered treatment.

Demographics of new referrals.. Gender
  • Gender there was a higher proportion of females
    referred into the team than would be expected in
    light of their profile within the YOS (16 YOS
    population were female, compared to 26 of
    referrals). This reflects the research which
    repeatedly highlights the high levels of mental
    health need amongst female offenders

Demographics.. Ethnicity
  • Disproportional numbers of BME young people in
    the youth justice system reflected in referrals
    to the team (61). Over-representation also of
    young people from mixed heritage backgrounds
    referred into the team (18), compared to local
    picture (9)

Demographics Age
  • Largest age cohort was 14-16 year olds (69),
    followed by 17-18 year olds (21) and 12-13 year
    olds (10).

Social care involvement
  • 24 of new referrals were looked after children
    (LAC) and a further 24 had some other form of
    social care involvement, typically being subject
    to Child In Need or Child Protection Plans.
  • Translates to case loads that require a high
    level of interagency collaboration and
    significant levels of case management

Diagnosis of new referrals
  • Comprehensive CAMHS assessments take place over a
    number of sessions, allowing clinicians to build
    a rapport with the young person, thereby
    generating more valid information about their
    mental state and needs.
  • Parents/carers are invited to assessments,
    although are often difficult to engage in
    treatment role of stigma in local community?
  • Practitioners also prioritise liaising with
    relevant partnership agencies during this
    assessment period as cases tended to have large
    networks of professionals, who with long
    histories with these clients.
  • Variety of standardised measures utilised in
    addition to clinical interview e.g. Becks Youth
    Inventory, Mood and Feelings Questionnaire, SDQ,

Treatment options
  • CBT for depression and anxiety disorders
  • Trauma focussed CBT and EMDR
  • Art psychotherapy
  • Motivational interviewing
  • Dual diagnosis work
  • Solution focussed and narrative models
  • Family therapy
  • Group work (girls) in development

AIM project for sexually harmful behaviour (SHB)
  • Pilot funded for 12 months (from underspend in
    CAMHS grant). Partnership between CAMHS, social
    care and YOS multi-agency framework is pivotal.
  • AIM is a structured assessment model to work with
    12-17 year old males who have committed SHB
    against a child/young person.
  • Provides assessment of risk to victim risk of
    further SHB identifies needs, strengths and
    resilience capacity of carer level of
    supervision required.
  • AIM is now live in Lambeth policies and
    procedures signed off, steering group with
    strategic leads from partner agencies, 25 staff
    across the borough have received training to
    complete AIM assessments, YP receiving AIM.
  • AIM project co-ordinator situated within Odyssey
    Health Team and manages referrals etc.

Areas for improvement
  • Continuing to build on YOS staff knowledge and
    skills in mental/emotional health through
    training and resources early identification by
  • Promotion of joint working across partnership
    agencies a seamless experience for YP
  • Openness / transparency / networking between
  • Increased involvement in pre-sentence report
  • To continue to raise the profile of and
    confidence in the service in the borough
  • Treatment interventions for conduct disorder (and
    often ADHD) in this group, and funding a
    provision to offer this

  • Retaining clients in treatment their levels of
    motivation transient population YOS order ends
    placement ends
  • Links between treatment completion and
  • Addressing stigma in local communities whilst
    respecting cultural values
  • Managing risk with clients in treatment gangs,
    violence, safeguarding
  • High level of case management and interagency
    collaboration warranted, thus to be effective
    need to protect smaller caseloads
  • Need for an assertive outreach model but
    balancing that with corporate demands for high
    caseload numbers
  • Strengths and difficulties in working with
    partnership agencies positive links with
    educational psychology and substance misuse teams
    in the YOS, difficult relationships with social
  • Finding and retaining suitable trained,
    experienced and passionate staff who can engage
    the client group and protect their own sanity!