Sue Bailey

Adjustment disorders: the state of the art

Adjustment disorders are common, yet under-researched mental disorders. The present classifications fail to provide specific diagnostic criteria and relegate them to sub-syndromal status. They also fail to provide guidance on distinguishing them from normal adaptive reactions to stress or from recognized mental disorders such as depressive episode or post-traumatic stress disorder. These gaps run the risk of pathologizing normal emotional reactions to stressful events on the one hand and on the other of overdiagnosing depressive disorder with the consequent unnecessary prescription of antidepressant treatments. Few of the structured interview schedules used in epidemiological studies incorporate adjustment disorders. They are generally regarded as mild, notwithstanding their prominence as a diagnosis in those dying by suicide and their poor prognosis when diagnosed in adolescents. There are very few intervention studies.

Mental health, educational and social needs of young offenders in custody and in the community.

Purpose of review The purpose of this review is to highlight recent findings from research on mental health, educational and social needs of young offenders and the implications for key agencies that commission or provide services. Recent findings Young offenders have high levels of morbidity in a number of areas, including mental health. A substantial number of young offenders have learning disabilities, which has implications for educational provision and delivering interventions. Other learning problems, such as low reading and comprehension ages, also have consequences for society in a number of areas, including occupational functioning and the associated development of a skilled workforce. There is some evidence that female offenders and persistent offenders are particularly at risk of psychosocial problems. Need is often unmet due to the lack of adequate assessment. Other reasons include inaccessibility of services and difficulties experienced in engaging young people in treatment. Young offenders in the community and those from ethnic minorities are particularly at risk of having poor access to services. Summary Providing services for young offenders requires investment from all the agencies in prioritising their needs. Research can continue to contribute by informing policy and practice, although further understanding of the developmental trajectories of high-risk groups is still needed.

Child and adolescent females who present with sexually abusive behaviours: A 10-year UK prevalence study

Abstract Relatively few studies have investigated the prevalence of young females with sexually abusive behaviours, and there is a lack of research comparing females with sexually abusive behaviours to a sample of non-sexually abusive delinquent females. The current pilot study explored the prevalence of sexually abusive behaviours in a sample of delinquent females referred to an outpatient Forensic Adolescent Consultation and Treatment Service (FACTS). A retrospective casenote study was conducted to compare the characteristics, offending behaviours and mental health of those with sexually abusive behaviours to their non-sexually abusive peers. Of the 258 females in the study, 31 (12%) presented with sexually abusive behaviours. Consistent with previous studies, females with sexually abusive behaviours were significantly more likely to have been victims of abuse themselves and to have learning disabilities/difficulties. They were less likely to engage in other antisocial behaviours, including aggression and violence, criminal damage, self-harm and substance misuse.

Recent advances in the development of screening tools for mental health in young offenders.

Purpose of review To describe recent advances in the development of mental health needs screening tools for use with young offenders and implications for this vulnerable group. Recent findings The literature shows that young offenders in North America and Europe have high levels of diverse needs that often go unmet because of lack of methods for recognizing and assessing them. Effective screening could play an important role in improving recognition of these needs. Substantial developments have been occurring in the United States, England and Wales and the Netherlands in developing screening tools for this purpose and for this population. Now, the literature is beginning to provide a broad understanding of the optimal psychometric properties, utility and limitations of the screening tools that are required. Summary Several centres are engaged in work to construct mental health screening and assessment tools for use with young offenders. Psychometric measures are being used to determine their validity and reliability. The work has highlighted deficiencies in the healthcare of young persons involved in criminal justice systems but should assist policymakers, healthcare strategists, planners and commissioners to come to better informed decisions about how to utilize most appropriately the limited mental health expertise that is available and how to enhance awareness of nonhealth professionals of basic mental health risks, problems and disorders.

Young people: victims of violence

Purpose of review The purpose of this review is two-fold. (a) Highlight recent research, practice and policy developments in the field of young people, victims of crime across home, school and community. (b) Increase awareness across health, education, justice and social care about the need to recognise psychopathology in young victims and to refer on for appropriate interventions. Recent findings Recent findings include developing early identification, recognition and reporting mechanisms in A&E services. There is under-reporting of assaults against young people to juvenile justice services. The importance of utilizing the young users perspective to inform this field of practice and research. The complex interactions of community and family violence, including the impact of siblings and peers, influence of ethnic and cultural background and under-recognition of the impact of dating violence on adolescent girls. Differences and similarities of violence perpetrated by girls and boys. The rise in gun-related crime and involvement of youth in hate crime. Refined understanding of the process of victims into victimizers, including sexual victimization. The importance of secondary prevention strategies targeting young people at risk of violent behaviours and good outcomes in spite of threats to adaptational development, resilience limited by co-existing vulnerabilities. Developing programmes in neighbourhoods and schools and specific approaches for traumatized young people. Summary The recent evidence base in the field of young people as victims of violence is beginning to identify processes, mechanisms and interventions that can start to counteract the damage done to the individual, families, communities and generations of children.

Learning disabilities and educational needs of juvenile offenders

This article is based on a study that was commissioned by the Youth Justice Board for England and Wales. We report on the learning profiles and education needs of a cohort of young offenders who were recruited for the study. The research was a national cross‐sectional survey of 301 young offenders who were resident in custodial settings or attending youth offending teams in the community. The young people were assessed using the WASI and the WORD measures to obtain psychometric information (IQ scores and reading/reading comprehension ages). One in five (20%) young people met the ICD‐10 criteria for mental retardation (IQ<70), while problems with reading (52%) and reading comprehension (61%) were common. Verbal IQ scores were found to be significantly lower than performance IQ scores, particularly in male offenders. It is clear from these results that a large proportion of juvenile offenders have a learning disability, as characterised by an IQ<70 and significantly low reading and reading comprehension ages. The underlying aetiology of this association is less clear and may be a consequence of both an increased prevalence of neurocognitive deficits and the impact of poor schooling. There is some evidence that developmental pathways may be different for boys compared with girls.

The development of the comprehensive health assessment tool for young offenders within the secure estate

Health inequalities are high among offending groups. The comprehensive health assessment tool (CHAT) is a semi-structured assessment developed to provide a standardised approach to health screening for all young offenders admitted to the secure estate. The four sections of the CHAT (physical health, mental health, substance misuse and neurodisability) were evaluated within a two-phased study of male adolescents (aged 15–18 years) within a young offenders institution in the north-west of England. Within Phase 1, a consecutive sample of 127 new receptions was assessed using the physical health, mental health and substance misuse sections of the CHAT against a range of reference standard assessments. Phase 2 of the study evaluated the neurodisability section on 93 male adolescents against reference standard tools. The four sections of the CHAT demonstrated fair to good convergent validity when compared against reference standard tools in male offenders. The diagnostic accuracy rate was 76% for mental health, 63% for physical health, 83% for substance misuse and 53% for neurodisability when compared against reference standard assessment tools. The introduction of the CHAT offers the opportunity to enhance existing reception screening practices and create an integrated approach to the assessment of health needs across the secure estate.

Manifesto for a healthy and health-creating society.

Brexit and the troubled state of the NHS call for re-thinking the UKs approach to health. The EU referendum vote reveals deep social divisions as well as presenting the country with important decisions and negotiations about the future. At the same time, health problems are growing; the NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the European Union likely to exacerbate many problems including staffing issues across the whole sector. However, new scientific developments and digital technology offer societies everywhere massive and unprecedented opportunities for improving health. It is vital for the country that the NHS is able to adopt these discoveries and see them translated into improved patient care and population health, but also that the UK benefits from its capabilities and strengths in these areas.

Ending lethal discrimination against people with serious mental illness.

Each year in England 33 000 people diagnosed with a serious mental illness (SMI) die from causes that could have been avoided. Our mental-health-specific Atlas of Variation is the first to demonstrate the extent to which these inequalities and inequities affect mortality nationally.

“What matters to someone who matters to me”: using media campaigns with young people to prevent interpersonal violence and abuse

While media campaigns are increasingly advocated as a strategy for preventing interpersonal violence and abuse, there is little evidence available regarding their effectiveness.