Out of Sight
A recent (October 2021) report by the Centre For Mental Health looks at the needs of girls in the Children and Young People Secure Estate (CYPSE). Out of Sight, authored by Lorraine Khan, Androulla Harris and Curtis Sinclair, was commissioned by NHS England and NHS Improvement in partnership with the Youth Custody Service. The review is informed by interviews with girls who had been in the CYPSE, conducted by Leaders Unlocked.
Out of sight finds that girls entering the CYPSE are a highly vulnerable group, with high levels of trauma and poor mental health. Girls from racialised communities are over-represented in the CYPSE but may be less likely to have their needs recognised and met. Incidents of serious self-harm are more common among girls than boys in the CYPSE, and of particular concern in single gender settings. This is the most common reason for the use of force or restraint with girls, which can be traumatic and erase trust in staff.
Girls experiencing such high levels of adversity and multiple needs require support that is gender-responsive and trauma-informed, and these approaches are being employed in some settings. At the same time, gaps in community support for vulnerable girls increase their risk of being placed in the CYPSE. There is a crucial need for earlier intervention to support girls who are facing trauma and adversity, and for more community-based alternatives to the CYPSE.
This report provides an overview of key concerns and issues for girls in the CYPSE, and makes recommendations of changes needed to better support girls’ needs.
You can watch a video of the main findings summarised by lead author Lorraine Khan below.
Trauma
Girls entering the CYPSE (both welfare and justice placements) are highly likely to have complex trauma resulting from prolonged and pervasive experiences of abuse and adversity. are especially likely to have been sexually abused (often with ongoing sexual exploitation by older males) or to have faced persistent gender-based violence. Complex trauma means that children have severe difficulties soothing themselves and managing their behaviour, anger and emotions – particularly when highly anxious, stressed or frightened.
Custody as re-traumatising
Girls’ complex trauma is worsened by their transition into the CYPSE, by some experiences in these settings and by
uncertainty surrounding release/discharge. Girls find coming into the CYPSE ‘petrifying’ and re-traumatising. Many feel ‘terrified’, ‘confused’, ’isolated’, ‘lost’ and ‘sad’. Some girls entering secure welfare placements through child protection legislation (e.g. due to concerns about sexual or criminal exploitation and running away from placements) felt punished, and confused about why they had been locked up when their perpetrators were not.
Racial disparity
Girls from racialised communities are over-represented throughout the youth justice system, in the CYPSE and especially in larger justice secure settings. But they are less likely to have their mental health needs or risks recognised.
There is evidence from academic studies that LGBTQ+ girls are likely to be overrepresented in the CYPSE and face a greater likelihood of victimisation. At the time of writing, data was not available in the UK.
Away from home
Girls are much more likely than boys to be placed in a justice secure setting away from their local area. This is because they are far fewer in number than boys and there are fewer establishments available for girls. In 2019, eight out of ten girls were more than 50 miles from home, compared with just under four out of ten of boys.
Family support
Family support and communication was really important to girls. Many said that they did not have enough links with family, especially when placed far from home. Some girls did not have family and felt especially isolated.
Integrated care
The Framework for Integrated Care (SECURE STAIRS), a whole system trauma-informed therapeutic approach, is currently being developed in the CYPSE. This approach prioritises the development of strong and authentic relationships between staff and children, focusing on their stories of their journeys into the CYPSE and supporting therapeutic work to help children better understand and manage responses to ongoing stressors.
Gender-responsive approaches
Gender-responsive approaches (GRAs) are an effective means of meeting the needs of girls with experiences of gender-based violence and abuse. Staff working in the CYPSE told the researchers that gender-responsive approaches had often
been developed through learning ‘on the hoof’, through intuition, through research and as part of SECURE STAIRS practice.
Girls’ experiences of custody
Several girls described positive and nurturing relationships with staff in the CYPSE. A few described ‘bad staff’ who eroded their trust. Girls wanted more support from staff – particularly with the huge amounts of anxiety they experienced as they came in. Many girls felt ‘forgotten’, ‘neglected’ and voiceless. They generally expressed not feeling listened to and not feeling able to shape the environment they were in or how they were supported. Some girls said they felt much safer in these settings than in the community and that they were able to develop and grow through educational opportunities. Others felt unsafe and found the environment unpredictable and volatile.
Physical Restraint
Girls felt incredibly disempowered and retraumatised by being restrained (sometimes by male staff) or by witnessing restraints. Staff said that many restraints involve attempts to intervene and prevent girls from self-harming. When restraint occurred, trust was said to be much more difficult to repair among girls.
Recommendations
The report makes a number of recommendations:
- Staff should have good listening skills, be non-defensive, be patient, have a positive attitude, enjoy working with girls and be reliable. Very importantly, they should be committed to avoiding the perpetuation of victimising, controlling and bullying behaviours.
- Staff need more detailed and bespoke training and resources on the management of self-harm.
- Smaller secure settings are generally better than larger ones.
- There is a clear need for more effective integrated support and early intervention for girls entering the secure estate. Without it, girls’ difficulties are left to fester and escalate into crisis.
- There is a need to improve transitions out of custody which are often chaotic and confusing, especially for girls in welfare placements. This often ‘unravelled’ important progress that girls had made as they became overwhelmed by anxiety and frustration. This deterioration in girls’ progress then led to further delays in finding accommodation.
