Mental health support

Children in custody are some of our most vulnerable, disadvantaged, distressed and excluded in society, often having experienced significant adversity and trauma (CYCJ, 2020). There is a complex interplay for children in custody around pre-existing vulnerabilities, re-traumatisation (e.g. from noise, lights, strip searching, violence, separation) and context specific trauma related to the environment of YOIs and prisons (e.g. violence, witnessing self-harm and suicide, separation) (Vaswani and Paul, 2019). As a result, it is important to recognise that even with the best available training and programmes, prison cannot create safety and trusting relationships and a “truly trauma informed approach is not possible in an environment that is shaped by a criminal justice system that has punishment at its core” (Vaswani and Paul, 2019: 18), raising questions about the appropriateness of a prison environment for children, with the inevitable additional vulnerabilities involved. However, when children are placed in custody:

“The provision of adequate mental health support to prisoners and the appropriate training of staff that work, or provide services, in HMP&YOI Polmont is vital to the mental health and care of the young people held there” (Scottish Government Justice Committee, 2019, p.29).

Practice Talk to Me

Talk to Me is the Scottish Prison Service (SPS) (2016) prevention of suicide in prisons strategy, the aims of which are:

• To assume a shared responsibility for the care of those ‘At Risk’ of suicide;
• To work together to provide a person-centred care pathway based on an individual’s needs, strengths and assets;
• To promote a supportive environment where people in custody can ask for help.

To achieve this, numerous key areas are focused on including:

• Assessment
• Care
• The provision of a supportive environment and regime
• Partnership working, including with children, young people and their families
• Support on release and reintegration, including enabling access to any specific support services the young person may require
• Staff training

Improved family involvement where an individual has given consent is one of the priorities of Talk to Me. Families are often concerned about the mental health and wellbeing of children in custody, may notice changes in behaviour of concern, and the breakdown in family relationships can be a factor in suicidal ideation and behaviour. The SPS has a procedure for handling contact from families who express concerns about a family member. The Families Outside information sheet Are you worried about a prisoner’s health? contains further information and the SPS family contact officers and Chaplains can offer support and signpost.

Tragically in Scotland, in the ten years since 2009 two children under the age of 18 have taken their own lives whilst in a Young Offenders Institution (YOI) and 24 young people under the age of 25 have died whilst in a prison or YOI, 15 of which are formally recorded as being suicides (Lightowler, 2020). Half of the young people under the age of 25 who died in prison or a YOI in Scotland since 2009 were there on remand, rather than being convicted (Lightowler, 2020).

The review of the provision of mental health services for young people entering and in custody at HMP&YOI Polmont (HMIPS, 2019) found that ‘being traumatised, being young, being held on remand and being in the first three months of custody increases the risk of suicide’ (HMIPS, 2019: 11). The review also found that in HMP&YOI Polmont 67% of deaths by apparent suicide occurred in the first three months of being in custody, with 91% occurring in the first year (HMIPS, 2019). The accompanying review of evidence about the mental health and wellbeing of young people in custody found that in Scotland information about a young person’s risk of suicide was frequently known but sharing and crucially acting upon this information was problematic (Armstrong and McGhee, 2019). The importance of social isolation was highlighted as being of major importance for young people in custody, and the need to support engagement with family and friends, and enable access to belongings was identified as a key area for improvement (Armstrong and McGhee, 2019). The review made multiple recommendations to improve the mental health support to children in custody, with work underway to implement these, including the development of a bespoke suicide and self-harm strategy for young people, an enhanced approach to Talk to Me and improvements to the Death in Prison Learning Audit and Review (DIPLAR) processes (HMIPS, 2019).

Following any suicide, the critical incident response and support process will be implemented which should include SPS and NHS staff:

• Following any death in custody, a DIPLAR will be conducted internally by SPS and NHS Health Boards which enables consideration of the circumstances of the incident and any immediate actions taken, as well as recording any learning and identified actions and opportunities to improve services.
• Following a death in custody, and prior to a DIPLAR, SPS Chaplaincy provide support and act as a link between families and prisons. A Family Support Booklet has been developed by SPS Chaplaincy and Families Outside detailing the DIPLAR process, Fatal Accident Inquiries and signposting to support.
• A fatal accident inquiry (FAI) will be held in a sheriff court, summaries from which are published.

Staying Connected

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. Research by Smith, Dyer and Connelly (2014) highlighted the importance of family members as a source of support for boys and young males in custody and the prevalence of young people returning to their families of origin on leaving custody. While this may be less likely for girls and young women, relationships are crucial to stability and desistance when a child returns to the community (Bateman and Hazel, 2014). Staying connected to family and people who are important is also crucial in mitigating against social isolation, with the need to support engagement with family and friends identified as a key area for improvement as recommended by Armstrong and McGhee, 2019 (p.41):

“Do not deny access to family, belongings and support even when being disciplined: if there is an unavoidable reason a young person requires temporary separation from others this should be on a justified and tightly limited basis and with continued access to personal belongings, family contact and supportive engagement with staff”.

The benefits of family contact extend not just to the child but also their families and by communities (Barkas et al., 2021).

Maintaining contact with family can however be difficult for various reasons. The families and communities people in custody are from have often experienced adversity, hardship and victimisation, which can be compounded by the already significant impacts of having a family member in prison (Barkas et al., 2021). Maintaining contact with and supporting the child in custody can further compound pressures and bring significant financial and emotional costs (Barkas et al., 2021). Families may feel they have been let down by professionals previously and the justice system exercises considerable power over families, including in determining how and when contact can take place, and approaches to contact such as prison visits, telephone calls and letters (Barkas et al., 2021). These are often restrictive ways of communicating and can be particularly so for children and young people, which may limit engagement (Barkas et al., 2021). Barriers to contact and lack of support to address these barriers, such as access to technology, distance between YOIs and a child’s community and family, lengths of visits, and costs and processes involved can make it difficult or impossible for contact to be facilitated. Families can feel judged, stigmatized, or be treated in such a way that they are made to feel they have committed the offence, impacting on their ability to maintain contact (Barkas et al., 2021). Children in custody also report feeling that contact, rather than being their right, is dependent on their behaviour (Barkas et al., 2021). In addition, the nature of the offence, length of sentence, or because they themselves were victims of the offence may result in the family severing contact; the child may do so; or this may be legally prevented.

Family work and family support

Family members should be involved throughout a child’s stay in custody unless this not in the child’s best interests. Support to, and work with family members, before, during and after a child’s stay in custody is important (Scottish Government, 2011). Coordinating and providing such support is a key role of the Lead Professional and can involve third sector organisations. Where a child:

• Intends to return to reside with their family on return to the community
• Is subject to a Compulsory Supervision Order
• Is entitled to statutory throughcare/aftercare supportor
• Will be released on licence

…work with their family should be included as part of the Child’s Plan as appropriate.

The impacts of family imprisonment on children, families and relationships can be significant, deeply distressing and wide ranging, impacting directly and indirectly, and differently for each individual with it important such diversity is recognised (Weaver and Nolan, 2015; Barkas et al., 2021). Likewise, family contact cannot be assumed to be positive for the child and/or family members. It is therefore important children and families of people in custody are identified; individualised and holistic assessments are completed; and that support is provided (Weaver and Nolan, 2015; CJAs, 2015; McGinley, 2018). In doing so, it will be important to work with the child to identify who they define as their family, considering this in the broadest sense, and who are the people that are most important to them that they may want to stay connected with (Barkas et al., 2021). It is particularly important to consider the role of, and support to, siblings and arrangements for contact where a child is in custody concurrently to another family member (either within the same YOI or in other establishments), including how these relationships can be supported and as necessary developed and repaired (Deacon, 2019a). Relationships and interactions between the child, their family and YOI staff are important in supporting contact (Barkas et al., 2021). High quality opportunities for contact should be provided, including different types of visits suited to family’s needs and that afford opportunities to do routine “family things” and to make special celebrations; letters; phone calls and use of technology (Barkas et al., 2021; see resources below). Barkas et al. (2021) have posed a number of questions for reflections to work towards getting it right for families affected by imprisonment, grouped around the themes of:

• Recognising that families affected by imprisonment are not all the same
• Recognising need as well as risk
• Minimising the (largely negative) effects of imprisonment on families
• Responding to the (often overlooked) views of children and young people
• Mitigating the impact of COVID-19
• Promoting families’ rights as citizens

In addition, support should be provided to families in their own right as detailed in the Good Practice Guidance for the Support of Families Affected by Imprisonment and Framework for the support of families affected by the Criminal Justice System. In doing so it is important to recognise that different members within any one family may require specific and distinct support (for example, young people have identified support and attention often focuses on children) (Deacon, 2019a). The third sector has an invaluable role in providing information and support for families. For example, Families Outside offer an independent support and advice helpline and information about contact (see resources below). In addition, each YOI in Scotland has at least one family contact officer, who should be available as a contact point for families, and staffed visitor centres outside the YOI.

Children in custody can be supported in respect of family contact and staying connected by their Personal Officer, family contact officers, in some cases parenting officers, community-based social worker/Lead Professional and wider staff involved with the child.

Information for children

Regardless of whether a family wishes to maintain contact, discussing a family member’s imprisonment with children is often difficult. Information about how to approach this and publications for children and young people are available from Families Outside and KIN (see resources below).