Young offenders in forensic institutions in the Netherlands after committing serious crimes: Contribution of mandatory treatment and reduction of reincarceration.

BACKGROUND: In the Netherlands, young offenders who have been convicted of a particularly serious offence may be subjected to a so-called 'Placement in an Institution for Juveniles' (PIJ) measure if they are considered to pose a high ongoing risk to public safety. They form a rarely studied distinct group. Treatment in specialist forensic custodial institutions for young people (FYCI) is an intervention of last resort and costly. The most serious young offenders tend to be the hardest to rehabilitate while preventing further offending. Treatment is focussed on reducing risk of harm as well as improving health and other protective factors. AIMS: To explore the contribution of treatment in an FYCI under a forensic treatment order-the PIJ-measure-to the reduction of risk of reoffending. METHODS: In a pre-post intervention study, the Juvenile Forensic Profile (JFP) was used to score complete case files of 178 young offenders at the start and end of their placement in an FYCI under the PIJ-measure, 59% of those serving between the years 2013 and 2016 inclusive. The JFP covers risk and protective factors in seven domains encompassing criminal behaviour, family, environment, risk factors, psychopathology, psychology and behaviour during incarceration. Change or stability in scores was tested against reincarceration within 2 years of PIJ-measure completion. RESULTS: Impulse control and alcohol and drug use problems showed the greatest improvements. Behaviour that deteriorates during the stay is primarily related to obtaining more autonomy during reintegration efforts, including furlough. Reincarceration in the 2 years of community follow-up was unusual (13.5%). The two main variables associated with reincarceration were problematic behaviour during the pre-discharge year and lack of behavioural improvement during treatment. CONCLUSIONS: Outcomes of mandatory treatment in this group of serious young offenders have not previously been studied in a rigorous pre-post intervention study design. We found evidence of an overall tendency to improvement over time in mental state and social skills, reflected by risk assessment scale scores. Continued substance use problems while incarcerated and continuing social skills deficits were most strongly associated with reincarceration suggests a possible need for review of these areas in the PIJ-measure programme. Results contribute to knowledge about risk assessment, treatment and preventions of harms by serious young offenders and may inform evidence-based policies and practices in the Netherlands and beyond.

Youth custody is no place for mentally ill children and young people.

OBJECTIVE: We review issues with incarcerating mentally ill children and young people in Australia, highlighting key demographics, rates of mental disorders, consideration of brain development, developmental trauma and children's experiences of custody. METHODS: Population relevant literature will be outlined as applicable. RESULTS: Children and adolescents in custody have high rates of mental illness, cognitive impairment and comorbid diagnoses. Childhood adversity and trauma impacts on psychosocial development from an early age. Almost half of all young people in custody are First Nations children, a 20 times over-representation. Youth custody is frequently experienced as an additional trauma for young people. Mental health diversion into community treatment is effective and reduces costs to young people, their families, communities and society generally. CONCLUSION: Youth custody is an inappropriate setting for children and young people with mental disorders, and can be further traumatising. Economic and health benefits for mental health diversion away from youth custody are manifest.

A descriptive study of primary health care practices in Ontario's youth custody facilities.

BACKGROUND: Adolescents admitted to youth custody facilities are often in need of physical and mental health care. OBJECTIVES: To describe primary health care practices in Ontario's youth custody facilities. METHOD: A questionnaire regarding facility characteristics and primary health care practices was distributed to the directors of all youth custody facilities in Ontario. RESULTS: Most (87.8%) facilities obtained medical histories after the youth arrived, and 92% used health care professionals to perform that assessment. Intake medical examinations were performed on each youth admitted to custody at 94% of all facilities; however, only 57.2% of facilities reported that these examinations were performed by a doctor within 72 h of admission. Performing suicide assessments on all youth at intake was reported by 77.6% of facilities. Continuous health education was provided by 76% of facilities. Facility type and type of management appear to be related to some areas of health services provision. CONCLUSIONS: Youth custody facilities in Ontario are providing primary health care services. Weaknesses are, however, evident, particularly in relation to untimely intake medical examinations, failure to provide continuous health education and failure to conduct suicide assessments on all youth at intake. Future research on barriers to health service provision in Canadian youth custody facilities is recommended.

HISTORIQUE: Les adolescents admis dans des établissements de garde ont souvent besoin de soins physiques et mentaux. OBJECTIFS: Décrire les pratiques de soins de première ligne dans les établissements de garde d'adolescents de l'Ontario. MÉTHODOLOGIE: Les directeurs de tous les établissements de garde d'adolescents de l'Ontario ont reçu un questionnaire sur les caractéristiques de leur établissement et les pratiques de soins de première ligne qui y sont offertes. RÉSULTATS: La plupart des établissements (87,8 %) obtenaient les antécédents médicaux de l'adolescent après son arrivée, et 92 % faisaient appel à des professionnels de la santé pour ce faire. Dans 94 % des établissements, chaque adolescent subissait un examen médical à l'arrivée, mais seulement 57,2 % des directeurs ont déclaré que ces examens étaient effectués par un médecin dans les 72 heures suivant leur admission. Tous les adolescents devaient se soumettre à une évaluation du risque de suicide à leur arrivée dans 77,6 % des établissements. Une formation continue dans le domaine de la santé était assurée dans 76 % des établissements. Le type d'établissement et le type de gestion semblaient liés à certains aspects de la prestation de services de santé. CONCLUSIONS: Les établissements de garde d'adolescents de l'Ontario fournissent des soins de première ligne. Les faiblesses sont toutefois évidentes, notamment en ce qui a trait à l'examen médical effectué trop longtemps après l'admission ainsi qu'au défaut de fournir une formation continue dans le domaine de la santé et de procéder à une évaluation du risque de suicide auprès de tous les adolescents à leur admission. D'autres recherches sont recommandées sur les obstacles à la prestation de services de santé dans les établissements de garde du Canada.