Dr Charlotte Lennox from the University of Manchester illustrates the health challenges for children in custodial settings and highlights a research project designed to develop health improvements and policy recommendations for future major incidents/pandemics
Children remanded or sentenced to custody in England and Wales can be placed within one of three types of custodial setting.
Young Offender Institution (YOI) – large ‘prison-like’ settings run by Her Majesty’s Prison and Probation Service (HMPPS) or private providers, for boys aged 15-17 years old, as well as 18-year-olds who are coming to the end of their sentence or awaiting a transfer to the adult prison estate.
Secure Training Centre (STC) – smaller than YOIs, run by private companies, for children aged 12-17 and provide 30 hours of education and training a week, following a school timetable.
Secure Children’s Homes (SCH) – smallest of the three setting types, run by local authorities, for children aged 10-14, provides a therapeutic environment and 30 hours of education and training a week, following a school timetable.
As of March 2022, there were 422 children (under 18’s) in custody. The custody population is overwhelmingly male (96%), and the majority (95%) are aged 15 – 17. The custody population has fallen dramatically, by nearly 70% in the last decade.
Vulnerable children in a challenging environment
It is well documented that children in custodial settings have much higher rates of trauma, mental health problems and neurodiversity, in comparison to the general population of children . In an earlier study  we found that on admission to custody, 60% of children had at least one physical health need, 37% a mental health need, 93% a substance use need and 81% a neurodiversity need. Children in custody face a multiplicity of need, associated with poverty, deprivation, marginalisation, and stigma. They are also more likely to have experience of the care system and ethnic minority status.
Many children in custody are involved in aggressive and violent behaviour, self-harm and/or have attempted suicide . Due to the prevalence of vulnerability, children’s violent behaviour should be reframed as distress behaviour which highlights the levels of unmet need.
Prior to the COVID-19 pandemic distress behaviour indicators such as rates of restrictive physical interventions (RPI; where force is used to overpower or with the intention of overpowering a child), assaults and self-harm had all been increasing rapidly, despite the falling population. For example, the number of self-harm incidents had increased by 35% since 2018-19 .
Children in custodial settings and COVID-19
COVID-19 has been an unprecedented public health crisis. In March 2020, like the rest of the country children in custodial settings were also ‘locked down’. Changes to legislation meant that children in YOIs and STCs could be confined to their rooms for up to 22 hours a day, in the same way adult prisoners were. Access to education and health was reduced or stopped and visits from families cancelled. The picture within the SCHs was different, with greater flexibility for not being under HMPPS and prison legislation.
Children, and in particular children in custody are very often a forgotten and unheard group. For example, when the terms of reference were drawn up for the government’s upcoming COVID-19 public inquiry there was no specific mention of children; when the roadmap for easing COVID-19 restrictions in prisons were published, secure settings (YOI/STC) featured very little; and when the Ministry of Justice (MoJ) and Public Health England published an interim assessment of the impact on COVID-19 containment of various population management strategies in prisons, it did not include children in custody.
The needs of children in custodial settings are vastly different to those of adults in prison, and therefore separate plans and processes are needed in recognition of their extreme vulnerability and complex needs. Our research plans to capture what has happened for children in custody in relation to their health and how COVID-19 was managed to inform policy decisions on recovery, but also to mitigate the longer-term impacts on children’s wellbeing.
What does our research involve?
Funded by the National Institute for Health and Care Research (NIHR; Grant number 202660) and approved by Wales Research Ethics Committee 4 (21/WA/0380).
In phase 1 we will obtain centrally held anonymised NHS data on COVID-19 rates, distress behaviour and health needs, for YOIs, STC and SCHs pre COVID-19 and during COVID-19.
In phase 2 we will conduct a series of semi-structured interviews with health and other professionals working in the YOIs, STC and SCHs, children who experienced being in custody during COVID-19 and family members.
In phase 3 we will combine the data from phase 1 and phase 2 to create several explanations for any changes in distress behaviour and health across different groups, with a focus on recommendations for health practice and service delivery. These will be presented at stakeholder events to develop a consensus to produce policy recommendations for health improvement.
The next steps
We have started data collection and will share our findings with you early next year. In the meantime, if you would like to contact the research team to discuss this research, or are a member of staff, child, young person, or family member who would like to participate, please get in touch.
 Hales, H., et al., (2018). Census of young people in secure settings on 14 September 2016: characteristics, needs and pathways of care. NHS Central and NW London.
 Chitsabesan, P., et al., (2014) The development of the comprehensive health assessment tool for young offenders within the secure estate, The Journal of Forensic Psychiatry & Psychology, 25:1, 1-25, DOI: 10.1080/14789949.2014.882387
 Youth Justice Board/MoJ (2021). Youth Justice Statistics 2019/20: England and Wales. London: Youth Justice Board/MoJ https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/956621/youth-justice-statistics-2019-2020.pdf
Note: This project is not supported by Youth Custody Services.
The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.
Please note: This is a commercial profile
© 2019. This work is licensed under CC-BY-NC-ND.
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