A healthy approach to children and young people in trouble

The British Medical Association have published a report on the vital role doctors have to play in preventing vulnerable children and young people ending up in custody
Young lives behind bars: The health and human rights of children and young people detained in the criminal justice system, sets out how doctors can recognise risk factors for future offending and seize the opportunity to intervene.
Writing in the Foreword to the report, Juliet Lyon, Director of the Prison Reform Trust, said:
If you ever wanted to build up the adult prison population of the future, then you would lock up children and young people in bleak, unhealthy institutions. As outlined by the BMA, the need to take a consistent, professional approach underpinned by human rights principles cannot be over-stressed. Why? Because it is evidence-based, stands free of short-term political considerations and is the right thing to do.
Read the Foreword to the report below
The British Medical Association sets out with clarity and integrity the human rights principles that provide the foundation for good work with vulnerable children in trouble with the law. Its report comes at a time when the nature of child imprisonment is once more under Parliamentary scrutiny. New legislative proposals include the re-introduction of use of restraint, not only as a last resort to prevent harm, but also as a means to maintain good order and discipline.
The fundamental principle that governs a healthy prison system - that people are sent to prison as a punishment, not for punishment – all too often risks being undermined by political efforts to make regimes seem, or indeed become, more punitive and by a determined emphasis on ‘proper punishment’.
Yet most of the children and young people punished by imprisonment know about punishment already. Long before they get into trouble and become caught up in the criminal justice system, very many young offenders are used to punishment - not as a measured, proportionate response to wrongdoing but as random acts of cruelty or abuse often born of frustration and ignorance. What has not been part of their lives is consistent care, clear guidelines, a sense of wellbeing and an understanding of reparation and a means to make amends.
As this report makes clear, young offender institutions and other places of youth detention are not full of happy, healthy children and young people. The Prison Reform Trust commissioned a study of children in prison to learn more about the 6,000 children who went into some form of custody in the six months from July to December in 2008.  Led by Professor Mike Hough and Dr Jessica Jacobson and colleagues then at King’s College, the study, ‘Punishing Disadvantage’, focused on who are the children who end up in custody, and what crimes have they committed that necessitate being detained. Around 40 per cent of those children had been on the child protection register. About 70 per cent were already known to social services. High numbers had truanted and experienced parental neglect or untimely bereavement. Many had unmet mental health needs or a learning disability or difficulty.  A depressingly familiar story for health and justice professionals and others who care for vulnerable young people.
Colin Moses gave his views as he stepped down as longstanding Chairman of the Prison Officers’ Association: ‘When it comes to lights out time and you then could stand outside those prison wings and hear the chatter that goes on from the windows and those who’ve been bullied at school, those who’ve been bullied in their homes, many of whom have been sexually abused before they’ve come to prison and you hear them themselves being bullied again or taunting and that is the 24 hour cycle in a prison. The cries for help, those young men who go to bed at night and become bedwetters. Those young men who go to the library and pick up the book with the biggest pictures in, because they don’t want people to know that they can’t read and write. They may have the muscles of an adult, but what they really are are young men crying out for help. Yes there are some bad offenders in there, there are people who’ve done some horrendous things, but what we have is a system that is totally overburdened and under resourced that will not work in those circumstances.’
The BMA is right to challenge any policies, operational measures or institutional practices that do not meet exacting human rights standards. It asserts that ‘every child in the UK is born with an equal right to the conditions necessary for good physical, psychological and emotional health and wellbeing’. It points out that ‘tragically this is not always realised, not least for the thousands of children and young people who come into contact with the criminal justice system in the UK every year.’
This timely, authoritative report presents an overview of the complex reasons why children and young people offend, their multiple needs and the challenges they present. It enables practitioners and policy makers to reflect on their work with young people in trouble. And it asks the simplest of question which, in the context of criminal justice, are often the hardest to answer: ‘How can children begin to thrive? What helps keep vulnerable children and young people safe?
Not all, but very many, of the solutions to youth crime lie outside prison bars in early intervention, support for troubled families, child and adolescent mental health, social care, treatment for addictions and ensuring that children and young people are supported to take responsibility and find solutions for themselves. An almost 60 percent reduction in child imprisonment over the last seven years, a resounding triumph across departments and for successive governments, offers a tremendous opportunity for health and justice professionals to focus on the most vulnerable children and help them to get out of trouble.

If you ever wanted to build up the adult prison population of the future, then you would lock up children and young people in bleak, unhealthy institutions. As outlined by the BMA, the need to take a consistent, professional approach underpinned by human rights principles cannot be over-stressed. Why? Because it is evidence-based, stands free of short-term political considerations and is the right thing to do.





inside of a prison cell with green walls and green bedding

Out of Trouble was a Prison Reform Trust campaign which worked to reduce the number of children and young people who are imprisoned in the UK.

Children as young as ten can be imprisoned for committing a crime in this country. Imprisonment involves a total loss of liberty and can be very damaging, particularly for those who are still growing and maturing.

30 children have died in custody since 1990, the youngest of whom was 14. Boys in prison are 18 times more likely to commit suicide than boys in the community. As well as being damaging, imprisonment doesn’t work – three quarters of all under 18 year-olds who are imprisoned will reoffend within a year of leaving - and is incredibly expensive, with two thirds of the Youth Justice Board's budget spent on locking-up children in England and Wales.

We believe prison should be reserved for children and young people who have committed serious crimes. Most children and young people have a better chance of turning their lives around and of keeping out of trouble if they serve their sentences in the community and get support from local services. If fewer were imprisoned, those inside could get the help they need to turn their lives around.

For most young people, out of trouble means keeping them out of prison.


care - a stepping stone to custody

Care – a stepping stone to custody

What I’ve heard from different police officers when I’ve been arrested, it’s like, ‘you’re a kid in care, you’re never [going to] get out of this way of life. You’re in care, kids in care are always on drugs, kids in care always make themselves unsafe, kids in care always self-harm’. So they sort of put a title on kids in care like they’re something bad.
16 year old girl with a conviction  
New research from the Prison Reform Trust and National Children’s Bureau (NCB), indicates looked after children are far more likely to be convicted of a crime and end up in custody than other children. 
  • Fewer than 1% of all children in England were looked after at 31st March 2011.
  • The 2010-11 annual survey of 15-18 year olds in prison found that more than a quarter of boys (27%), and over half of girls (55%), had been in care at some point before being sentenced to custody.
The research project was guided by an advisory group of young people in care and care leavers convened by Voice. The report’s recommendations, which draw on the children’s views on ways in which the care system can better support them, include:
  • Making sure local authorities fulfil their statutory obligations to looked after children wherever they are placed.
  • Allowing children to stay in placements where they are happy and involving them in the decisions which affect their lives.
  • Protecting children from regular changes in social work staff by ensuring every child in care has one consistent adult in their life who will respect and support them.
  • Making sure that local authorities treat children in care who get into trouble as any other parent would.
  • Maintaining contact with looked after children who end up in custody through regular visits and putting plans for their release in place at the earliest opportunity.

The National Children’s Bureau’s Dr Di Hart, an author of the report, said:
These interviews serve to remind us that there is no quick fix to reducing the involvement of looked after children in the criminal justice system.  Each child has their own unique strengths and vulnerabilities and the adults working with them must provide a care experience that reflects these. When it comes to the risk of offending, quality really does protect.
In his foreword to the report, Lord Laming said:
It is a huge step for the state to assume the parenting of a child or young person. With that comes the responsibility to provide stability, security and hope for the future. Sadly, the failure to secure   proper care and support at this time, so critical in the development of the child, results in the continuation of the downward spiral towards imprisonment. We must not stand by and allow wasted opportunities to result in wasted later lives.
Juliet Lyon, Director of the Prison Reform Trust, said:
Let down by families and local authorities alike, far too many children find themselves on the dreary, damaging route from care to custody. Too often the state proves to be a poor parent as the tiny minority of children in care become the substantial number behind bars.
Astrid Bonfield, Chief Executive of The Diana, Princess of Wales Memorial Fund, said:

Children in care are some of the most vulnerable young people in our society. Many have experienced abuse and neglect, others the death of a parent or sibling. Most experience a disrupted education and move home many times during the most formative period of their lives. This important report provides recommendations for policy-makers and practitioners on how aspects of the care system could be enhanced to reduce the risk of children and young people entering the criminal justice system. Coming as this does from those who have first-hand experience of the care system – looked-after children themselves - we would all do well to give it our special attention.


You can download the report by clicking this link

Out of trouble publications