Young men and young women in secure care: gender differences in the placement of those with mental health needs

Annie Bartlett,Louise Warner,Jared G. Smith,Heidi Hales

doi:10.1186/s12888-021-03440-7

Abstract

BackgroundThe system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems.MethodsThe detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher’s exact tests.ResultsNumerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account.ConclusionsNo definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.

Highlights

The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities
Data was sourced from 3 High Dependency Units (HDUs), 10 Psychiatric Intensive Care Units (PICUs), 9 Low Secure Units, 7 Medium Secure Units, 19 Secure Children’s Homes (SCHs), 3 Secure Training Centres (STCs) and 5 Young Offender Institutions (YOIs)
Data cited below are derived from census questionnaires which were received on 93% of the 1322 young people

Summary

Introduction

The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. The system of secure care in England and Wales (see Fig. 1), as elsewhere [2, 3] involves multiple types of unit, differing levels of security and several separate bodies of legislation It comprises secure hospital units (high dependency units, low and medium secure units), secure children’s homes and youth justice facilities (Young Offender Institutions and Secure Training Centres). It is managed, inspected and run by different agencies It shares the common purpose of detention of a young person but the explicit ethos of the mental health, welfare and youth justice facilities varies, as the terms imply. Those who spend more than 13 weeks in prison acquire “Leaving Care” status on release

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