Working with Young People: Self-harm and Suicide A local, multi-disciplinary approach to supporting...

Working with Young People:

Self-harm and SuicideA local, multi-disciplinary approach to supporting children and young people in Cheshire

and Merseyside

Join the conversation#STORMevent

Young people in the criminal justice systemEvidence from the Bradley Commission7 October 2015

Young people who offend

Lifelong vulnerabilities that precede crime:Parental mental ill healthNeglect, abuse and maltreatmentEarly starting behavioural problemsSchool exclusion (52%)Sexual abuse & exploitation (29% young women)

Looked After Children 15 times more likely to enter youth justice system

High rates of mental ill health and disability

95% of children in custody have a mental health problemAt least half have conduct disorderHigh rates of:

Acquired brain injuryLanguage and communication difficulties (60%)

5% have symptoms of psychosisHigh risk of self-harm and suicide

Young people in gangs

About 6% of young peopleTwice as likely as other youth justice entrants to have multiple vulnerabilitiesGirls have higher still levels of vulnerability and different reasons for joining gangs

The Bradley Report

Published April 2009Made 82 recommendations including:

Criminal justice and mental health teamsTraining in mental health and learning disability for justice professionals14 day waiting time for hospital transfer

Key recommendations adopted by successive governments

The Bradley Commission

Independent commission led by Lord BradleyReviewed progress in implementation over five yearsFocused on areas needing more investigation:

Black and minority ethnic communitiesYoung adults in transitionPersonality disorder

Liaison and diversion

National programme to put L&D services in all police stations and courtsCurrently 50% coverage using all-ages operating modelAll age approach needs to reflect specific needs of children and young adults

Specific issues for young adults

Low levels of service access and help-seeking: stigma and fear of clinical servicesMultiple transitions:

CAMHS to adult mental healthChildren’s services to adult social careYouth to adult justice system

Disrupted relationships with professionalsAccount for 18% of self-harm incidents (9% custody population)

Examples of promising approaches

The Integrate Movement: ‘streetherapy’ with young men in gangsYSS: intensive support for young adults with ‘sub-threshold’ needs St Giles Trust Project SOS: mentoring and practical support“They’ve been there themselves and what they’re offering is based on reality”

Key success factors for work with young adults

Primary focus on wellbeingConsistent and continuous relationshipsService user leadership and involvementAddressing multiple needs and transitionsInteragency and collective workingBeing accessible and available when needed

Opportunities for earlier intervention

Perinatal mental health careInterventions for early starting behavioural problems:

Family Nurse PartnershipsGroup parenting programmes

School awareness of risks and signs, with clear referral pathwaysEffective therapies for adolescents, eg multi-systemic therapy, functional family therapy

What next?

Finish the job on liaison and diversionIntervene early for children at risk of offending and gang involvementInnovate and evaluate improved support for young adultsIntegrate with mainstream mental health care (child and adult)Listen to young people

Thank you

For more information: Contact andy.bell@centreformentalhealth.org.ukfollow us @CentreforMH @Andy__Bell__visit: www.centreformentalhealth.org.uk

Working with Young People:

Self-harm and SuicideA local, multi-disciplinary approach to supporting children and young people in Cheshire

and Merseyside

Join the conversation#STORMevent

Consent Considerations in Adolescent Self Harm

Dr Laurie van Niekerk7 October 2015

Aims

• Brief overview

• Legislation

• Local example

Overview

What are the main factors to take into account?

– Age of the child/young person (language)– Capacity/Competence– Young person’s view (empowering)– Parents/Carers views (inclusive)– Level of Risk (timely response)

What should be discussed?• their condition(s)• the purpose of investigations and treatments you propose and what

that involves, including pain, anaesthetics and stays in hospital• the chances of success and the risks of different treatment options,

including not having treatment• who will be mainly responsible for and involved in their care• their right to change their minds or to ask for a second opinion.

Confidentiality

• Where a competent child ask you to keep their confidence, you must do so, unless you can justify disclosure on the grounds that you have reasonable cause to suspect that the child is suffering, or is likely to suffer, significant harm.

• You should however seek to persuade them to involve their family, unless you believe it is not in their best interest to do so.

Legislature for Health Staff • *GMC guidance on Confidentiality/Consent• <16 vs >16• “Gillick Competence”• Mental Capacity ACT * (components & Cases)• Mental Health ACT [S136; S2; S3; S5(2)]• Children’s ACT: Scope of Parental Consent• If in doubt, speak to your senior – arrange

consultation with Psychiatry, Legal/Court of Protection, Defense Union, IMCA, IMHA,

Health Passport/Care Plan

• Partners: Young people; CAMHS; A&E and Paediatric staff (nursing/medical)– information about me; health condition and

confidentiality/consent statement; – how best to help me (non-judgemental; what

works/has worked; other agencies already involved – key worker/contact); preference of male/female staff; preferred pain relief etc

Thank you

Working with Young People:

Self-harm and SuicideA local, multi-disciplinary approach to supporting children and young people in Cheshire

and Merseyside

Join the conversation#STORMevent