Title: Young people who offend: Understanding and meeting health and wellbeing needs using experience based co-design.
Funder: Department of Health and Social Care

Abstract: It is estimated in the UK that 1 in 3 young people (10 to 17 years old) who offend have some form of mental health problem. Young people who commit crime have significantly worse health and social outcomes that persist and often increase in severity through childhood and later life. The mental health needs of young people, specifically those who offend, have become more widely recognised and a priority for the government and health agencies. A wealth of research has been undertaken that focuses on young people's health and well-being in the secure estate (e.g. custody) however, there is less research exploring young offenders experience of mental health in community youth justice settings. There is growing recognition of the potential value of developing earlier interventions to recognise and address problems to improve the outcomes of at risk youth. This research study aims to develop a better understanding of the health and well-being of young people who offend and to develop simplified ways of improving engagement between the NHS and youth justice system (YJS) to improve health services for at risk young people. There are three work-packages to the study: a systematic review of the literature; a qualitative study exploring young people's experience of vulnerability to mental health; and future pathway development. Work-package 1: A qualitative systematic review and meta-synthesis of the research literature on how young people who enter the youth justice system (YJS) experience mental health problems. The evidence produced from the review will add the context of mental health and young offenders in community settings and will inform and guide the development of a qualitative co-design study in work-package 2. Work-package 2: A qualitative co-design study utilising the experience based co-design (EBCD) approach will explore young people's experience of vulnerability to mental health problems in community youth justice settings (YJS). Experience based co-design (EBCD) is a participatory action approach in which staff and service users work together to identify and implement service improvements through capturing in-depth understanding of perspectives and experiences to co-design services. This study will broadly follow the six-defined stages of the EBCD approach and adapt the method accordingly to social care settings. Following a period of observational fieldwork in youth justice settings, up to 25 interviews with youth justice staff and up to 15 young offenders will be undertaken to explore in-depth individual and often complex experiences of delivering and receiving services. Edited films of young people's interviews will be used to stimulate discussions in a series of individual and group workshops to stimulate joint work with youth justice staff and young people to identify key priorities. Following on from this, participants will form small co-design groups to focus on key priorities and discuss ways to redesign services. Work-package 3: Development of future pathways. This work-package will bring together the findings from an informal celebration event' designed to highlight achievements to date through participation in the study and data gathered from work-pages 1 and 2 to develop and inform a theoretical basis for appropriate pathway development. This study will inform the development of contextually relevant early interventions that can better support young people who are vulnerable to mental health problems in the youth justice system (YJS). The main benefit to the NHS will be to facilitate service development that promotes effective engagement between young people, the youth justice system and NHS services.

Lay abstract: The term mental health refers to people's ability to cope with the normal stresses of life. In the UK it is estimated that 1 in 10 young people aged between 5-16 years old experience a mental health problem. Mental health problems in young people are often linked to being exposed to traumatic events such as sexual abuse, violence at home and childhood neglect and usually affect young people before the age of 14. Young people who commit offences are more likely to experience these types of traumatic events, making them more likely to develop mental health problems. If these problems are left untreated, they can lead to further problems such as drug and alcohol problems, teenage pregnancy, self-harm and exclusion from school and employment. Recent reviews of people with mental health problems in the criminal justice system suggest that prisons are not the most appropriate places for people with mental health problems and may even make problems worse. So far, research on young people's mental health problems has focused mostly on secure settings (e.g. youth offender institutes) and less so in the community (e.g. youth offending teams) where mental health problems could be identified earlier.For many young people, the first chance to think and talk about health and social problems often happens as a result of their offending behaviour (e.g. getting arrested). However, police and staff working in youth offending teams are not specifically trained to recognise and deal with such problems. Furthermore, often young people do not understand what mental health problems are and do not go on to seek help from mental health services. It is therefore important for staff working with young people to be able to recognise mental health problems earlier in young people's lives and to work with young people to seek help and support. This study aims to find out more about the mental health and well-being of young people who commit offences, so we can improve services for them. To do this, we need to understand what is like for young people to experience mental health problems. This study will look at previous research studies to get a better idea of the problems young people face. The study will then use an approach where young people and professionals come together in workshops to find ways of improving understanding of mental health. Part of the process involves the researcher observing what happens when a young person is arrested and what happens next, talking with staff who work in youth offending teams and in the police about their work with young people, and talking with young people about their behaviour and how they might be able to do things differently. With the help of the researcher, short films of the young peoples' interviews will be made to stimulate discussions about how staff and young people can work together to improve services. The study will involve young people in making decisions about their health and the care they receive and the results will be used to develop ways that could help redesign health services that are better suited for them.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH