A new NHS England report summarises the findings of the first (scoping) stage of a service evaluation, evaluating the provision of secure services for detained young people, under 18 years of age, from England, between February and September 2016. This involved identifying every secure unit in Great Britain that could detain young people from England and establishing the basic characteristics of each unit, in order to identify similarities and differences between them, prior to further exploration in the later stages of the study.
The term ‘secure’ is used to mean any setting that deprives a young person of their liberty, such that the young person cannot leave if they choose and there are additional physical security measures above and beyond that available in open residential, educational or mental health units, under one of three legal frameworks used to detain young people in England. The three legal frameworks under which young people can be deprived of their liberty in England are: The Mental Health Act (1983, as amended 2007) placing them in hospital (in High Dependency Units (HDUs); Psychiatric Intensive Care Units (PICUs) or low or medium secure units); Section 25 of the Children Act (1989) placing them in a secure children’s home (SCH); or under the Youth Justice Service on remand or serving a sentence in a SCH, secure training centre (STC) or Young Offender Institution (YOI).
This report addresses two questions: to what extent and in what ways are the types of secure service for children similar or different? The graphic below summarises the overall characteristics of all types of secure unit.
I was surprised to see that the average stay in a secure hospital for a child is a year (10.5 months in a low secure unit, 14.2 months in a medium secure unit).
Who runs which units where?
There are 60 secure units for young people in Great Britain:
- 28 hospitals in England and one in Wales (a mixture of high dependency units (HDUs), psychiatric intensive care units (PICUs), low and medium secure units)
- 14 SCHs in England, five in Scotland, one in Wales
- Three STCs, all in England
- Four YOIs for under 18s in England, three in Scotland, one in Wales
These units are not equally distributed around England. The closest unit might not be suitable to meet the young person’s needs. The southwest of England is poorly served with hospital units and there are no STCs in the north or southwest of England.
Both the independent sector and the NHS provide secure hospital beds; the independent sector dominate psychiatric intensive care and low secure provision and the NHS dominates medium secure provision. SCHs may be run by local authorities or charities. SCH placements are commissioned either by local authorities (welfare placements) or the YJB, very few YJB beds are available in SCHs in the south of England. There is a lack of any SCH provision in the midlands and East Anglia. All units are able to take national referrals / placements for young people from across England.
Distribution of beds
Within England, there are 1,773 secure beds. Just under two thirds, 1,260 beds, are for Youth Justice Board (YJB) placements (111 SCH, 243 STC and 906 YOI), just under a quarter, 402, (27 HDU, 147 PICU, 138 low secure and 90 medium secure) beds are for people detained under the Mental Health Act and a small number, 111 beds, are for welfare placements.
The distribution of beds specifically for males and females varies across the different settings. In HDUs and PICUs, there are more designated female beds, whereas a higher proportion of medium secure beds are specifically for males. All YOIs only take males.
The age range for admission/reception varied across units; some units stated that there was no minimum age, though the majority of units stated that the minimum age of admission was 12 years. Most units reported an upper age limit for discharge of 19, though one hospital stated it could take people up to the age of 25. SCHs tend to take the younger children considered to need secure care. It should be noted that the age of criminal responsibility in England is 10, and therefore the youth justice system (YJS) can accommodate young people aged from 10 to 18.
Although some units are specifically designed to accommodate young people with learning disabilities, there appears to be limited availability and variety of placements for young people with other neuro-developmental disorders who require a secure environment, particularly for those without co-morbid mental illness.
Neurodevelopmental disorders were the most commonly identified specialism in hospital settings, but also the most commonly identified exclusion criteria. There appeared to be a lack of specialist secure care for young people with eating disorders.
The scoping report concludes by identifying a number of points of interest:
There is an uneven geographical spread of units. There is a paucity of STCs in the north of England and a lack of SCHs with YJB beds in the south of England. Some young people might be placed long distances from their families or homes; this is likely to have an impact both on the young people and their families.
The spread of beds across the secure system is uneven, with the number of welfare placements particularly low (111). Does this represent less demand for welfare beds, or are young people who require welfare secure accommodation being directed elsewhere?
It is interesting that in hospitals, neuro-developmental disorders was the most commonly identified specialism, but also the most common exclusion criteria. This suggests that for a young person with a learning disability or autistic spectrum disorder, there are only a selection of specific places they can be accommodated. It is unclear from this scoping exercise whether the number of beds for this population reflects the demand.
In general, referrals come from within the same system (for example, a mental health professional refers to hospital, and a social worker refers to a welfare SCH placement). It is not clear from this scoping exercise what impact this might have; does this reduce ability for movement across the types of secure accommodation?
This report provides a deep insight into the nature of regimes where our children can be detained. It will be invaluable for all stakeholders involved in planning the next generation of secure schools (see one concept of a different approach here).