Mental health support

Children in secure care are some of our most vulnerable, disadvantaged and excluded in society (CYCJ, 2020a). These young people will often have already faced multiple adverse experiences, including abuse (sexual; physical and emotional); neglect (physical and emotional); household dysfunction (familial substance abuse; familial mental illness; domestic violence in the home; incarceration of a household member); moves of home and school; community violence; and associated losses and trauma (CYCJ, 2020a; Scottish Parliament Justice Committee, 2019; Gibson, 2020; 2021). As a result of these experiences, the day-to-day functioning and emotional wellbeing of children in secure care has often been compromised and these children will often have additional mental and emotional health and wellbeing needs, with children who have additional support needs overrepresented in secure care (Gough, 2016; Independent Care Review, 2020). They may need help and support to deal with distress, stress, depression, anxiety, self-harm and suicidal behaviour.

Children have rights to health and healthcare. Inspections by Care Inspectorate and Mental Welfare Commission found that the care provided by secure care centres was very good or excellent and that the mental health needs of children and young people were being met. More recently, areas for improvement have been identified including clarity and consistency of funding for mental health care and treatment across secure care to ensure every child has appropriate, regular and frequent access to mental healthcare provision; and the availability and in-reach of CAMHS support (Gough, 2017; Independent Care Review, 2019; Scottish Parliament Justice Committee, 2020).

Practice

Secure care centre staff are trained and should be supported to understand and meet children’s physical, mental, emotional and wellbeing needs, including awareness of and responding to concerns about self-harm and suicide (Scottish Government, 2020). The importance of relationship-based practice, holistic support and the provision of therapeutic and nurturing care and environments, as well as the use of day-to-day interactions and the life space is well understood (CYCJ, 2020). Each centre will have suicide and self-harm prevention policies and guidance for dealing with injuries and harm. During a child’s stay in secure care, this will include assessments of a child’s wellbeing, emotional and mental health needs when they enter secure care and throughout; risk-management plans and strategies that are tailored and proportionate to the needs of the individual child, their strengths, goals, hopes and risks; and arrangements for responding to, recording and communicating serious incidents. Staff will be aware of and monitor changes in a child’s mood, routine or behaviour and develop an understanding of the child’s experiences, triggers or events that may negatively impact on their physical, mental and emotional health and wellbeing. Support from external mental health professionals should be sought as required. Staff must also be aware of the impact of incidents of self-harm and suicidal intent on other children and staff members, and provide appropriate support.

The death of a child in, or who has previously been in, secure care is devastating for everyone involved. Where a looked after child or a child or young person who is receiving aftercare or continuing care services dies, or a serious incident involving a care experienced child and young people resident in regulated care services takes place, the Care Inspectorate at the time of their death must be notified (as well as Scottish Ministers in some cases). As a result, various review processes may take place (Care Inspectorate, 2020).

Staying connected

Children will often worry about their families when they are in secure care and vice versa (Gough, 2016). Being supported to be in touch with, have time with and stay connected with their family, friends and people they care about can reduce such concern and is extremely important to children:

“I was taken away from my family and felt broken. Getting time and visits with my family helped”

“I get contact with my family through calls, Skype and visits - I love this time to speak to my family and it definitely makes me feel happy to know they are fine” (Secure Care Pathway and Standards Scotland).

Children have rights to private and family life and to maintain regular and direct contact with their families in accordance with Articles 9 and 16 of United Nation Convention on the Rights of the Child (UNCRC), with Article 37 also stating that children deprived of their liberty should be supported to maintain contact with their families except in exceptional circumstances. Factors like being unable to access mobile phones, and distance between secure centres and home can make maintaining contact challenging, with the use of digital technology and upholding children’s rights to this an important factor (Gibson, 2021).

All professionals working with the child and their family should actively promote and support children to stay in touch with their family, friends and other people who are important to them, unless this is not in the child’s best interests, and to participate in discussions, decision making and plans for how and when this happens (Scottish Government, 2020). Families and people children care about should be encouraged and supported to stay connected; be treated with dignity, compassion and respect; and be provided with welcoming, friendly and comfortable environments to meet in (Scottish Government, 2020). Where such time requires to be restricted, supported or supervised, children and their families should be involved in decisions and planning for this, understand the reasons for such decisions, and these decisions should be recorded and detailed in the Child’s Plan (and may also be a condition of a Compulsory Supervision Order) (Scottish Government, 2020). Such plans, decisions and arrangements should be reviewed throughout. Children’s time with their family will take place within the secure care centre. There are restrictions on what can be brought into the secure care centre during visits for safety reasons, with information about this available from the centre and displayed throughout units.

Family work and family support

Family members should be involved throughout a child’s stay in secure care unless this is not in the child’s best interests. Support to, and work with family members, before, during and after a child’s stay in secure care is important (Scottish Government, 2011). Coordinating and providing such support is a key role of the Lead Professional and can involve third sector organisations, with families often involved as part of supports and interventions by the secure care centre.

Families may face numerous difficulties before, during and after a child’s stay in secure care. It is really important that support includes:

• The provision of multi-agency family support to the whole family, including siblings, to keep the child and others safe and prevent their liberty from being restricted
• Practical and emotional help such as to visit and keep connected with their child and mediation
• Involvement and participation of families in care planning and support
• Adherence to the principles of effective and intensive family-based support (Gough, 2016; Scottish Government, 2020; Independent Care Review, 2020)