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.

 
Foreword
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.