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EMA Challenges and issues that may impede therapeutic services in juvenile offender’s institution

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EMA
Challenges and issues that may impede therapeutic services
in juvenile offender’s institution.
Summary
This report will look at the challenges that may complicate therapeutic service within a forensic setting. For any therapy to work effectively prison need to adjust its way of exerting punishment teach young people discipline by implementing therapeutic treatment models to reduce the rate of violence and self-harm in prison. Prisons are known to exacerbate certain behaviour such as violence for survival reasons. However, treatment such as Cognitive Behaviour Therapy might be an effective means of dealing with violence.
Prisoners should have a choice to get into therapy rather than being forced into it. Since prisoner who are not ready may not benefit from the service as they will not be ready to disclose information about themselves especially ones that involves crime they have committed, their emotional health such as fear, anxiety and depression. Prisoners believes expressing these types of behaviour to be a sign of weakness, the fact that may make them vulnerable to their fellow inmate. If prison is to be effective then it needs to offer young offenders treatment which will allow them to be able to express their feelings without exposing them as seemingly being weak
Certain treatments such as Cognitive Behaviour Therapy (CBT), Multi-Systemic Therapy (MST) and Meditational Mindfulness are known to be effective ways of treating young offenders who are suffering from mental health issues. However, some of these treatments have drawbacks which can be easily overcome by incorporating the treatments with activities that young people enjoy as a way of shaping behaviour. One of the techniques that is believed to be successful is art therapy, which is known to allow prisoners to express their thoughts, anger and fully express their emotions without putting them at risk of being judged by their fellow inmates.

Introduction
As the numbers of young institutional facilities are declining, meaning more young people than ever before end up in prison. Prison staff need to learn effective ways to deal challenging behaviour to allow therapists the ability to gain trust with young juveniles in order to build a good relationship with their the client (offender). Prison environment forces offenders, to have a desire to appear tough to their fellow inmates for survival reasons, as a result this increases the numbers of violence within prisoners to gain respect. Accordingly, there is a need to offer therapy which will incorporate team work as part of the treatment.

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This report intends to highlight some of the challenges that may be faced by a prison planning committee to instigate therapeutic services to young juveniles. Over the last few years there has been an increase in crime rates. According to Ministry of Justice, (2010 cited in Open University, 2017) 74% of offenders from youth prisoners and 68% of youth on community sentences reoffend within a year of been released. Over and above that the numbers of reoffending has also been on the rise. The National Audit Office estimated that, social and economic costs of reoffending by those who are released from short term sentences alone are estimated to be between 7-10 billion a year (Ministry of Justice, 2010).
Environment, culture, age and gender can complicate therapeutic service in prison. This report aims to look at treatment methods which may be effective in treating young offenders in prison. The report will identify what treatment works better in shaping behaviour of young offenders and highlights the draw backs of the treatments. The focus on the report will be on addressing how effective the treatment may be on dealing with mental health problems in prison. The report will also look at early attachment and how it is linked to crime. However, due to the lack of research done on young offenders in prison settings there is no enough evidence pin pointing the best therapeutic approach.
Discussion
The Prison reform trust (2010-2011) found that around 25% of children who offend have very low IQs of less than 70. This shows that there is a need within the prison system to offer education in order to help young offender to widen their knowledge. As explained above one of the major issues that offenders must deal with in a prison environment is trust and fear of being victim of attack from their fellow inmates. Equally, when the therapist works in prison setting they may encounter similar challenges that may affect their ability to effectively deliver treatment to their client since the lack of self-disclosure impedes the opportunity for the therapist to form and maintaining relationship to young offenders.

One of the approach’s that therapists often use in prison settings is the object-relations technique which focus on attachment theory. Object-relations look at the offender’s relationship with his/her parents, siblings, teachers and other people in their life. Some theorists, believes early relationships are very important throughout life and they believed relationships can heal people. John Bowlby (1988) on his attachment theory stressed that, people’s physical and emotional development and how they interact with others is linked to their early childhood memories and attachment style (Open university, 2017) Therefore, the type of behaviour intervention programme that offers nurturing and a support centre for young offender might make a different in shaping behaviour especially those who self-harm as these centres will offer support when required.
Because therapists who work in prisons are duty-bound to disclose to the parole board any information that may put high risk on the security of the prisoner staff, other in mates and the offenders themselves, this will challenge the type of treatment to be used to treat mental health issues in prison. This is because therapists will need to share these boundaries to offenders at the beginning of the session. Consequently, this will further diminish the offender’s chances to self-disclose and as such the offender will not be fully engaged in the therapy. This will make it difficult for the therapist to successfully treat the client.
The British Association of counselling and psychotherapy (BACP) guidelines on ethical framework, highlight the importance of respecting the client’s privacy and confidentiality, which means it is important for the therapist not to disclose the client’s information during sessions to build a relationship and trust (cited at Open University, 2017). Because some of the techniques in therapy sessions encourages offenders to disclose any issues which might have caused their distress such as crime or any experience they encountered in their life including any issues related to neglect or childhood abuse, there is a need for prison to respect the therapy’s guidelines and allow therapist the freedom to deliver the service without the interference of prison staff. Especially, when inmates can often find it had to talk about their childhood experience to the therapist alone never mind on the presence of prisoner office – this causes immediate safe guiding issue on the therapist point of view.
Majority of research conducted on young offenders shows high numbers of young offenders were at one point associated with gang related offences such as violence, drugs and addictive behaviour. It is fair to say that the types of treatment intervention which targets to change young people’s behaviour and their way of thinking in and outside prison may be the most effective in treating mental health problems in prison. In this case cognitive therapy and multi-systemic therapy (MST) which both target the influence of social-economic theories of human development including family, schools and community seems to tick all the boxes.
Cognitive Behaviour Therapy (CBT) is a mixture between cognitive and behavioural therapy, which involves a wide range of conceptualisation and treatment for mental health problems. The Development Service Group (2010, cited at Open University 2017) stressed the importance of CBT to mainly focus on automatic thoughts and beliefs and the importance it has on behaviour. CBT aims to change people’s way of thinking (such as, I am a criminal and I will always be a criminal) to more healthier thoughts (such as, I want to change, I don’t want to be a criminal). CBT also focus on future planning, goals and life structure. CBT shape behaviour of the individual by teaching them to respond and act on their thoughts which help shape how individuals respond to their environment and community in general.
CBT can be delivered individually or in groups, in the case of young offenders the group approach will be more suitable since young people prefer to work in groups. Group therapy will also give young offenders a chance to build friendships with other inmates. However, this is not always the case as in certain circumstances group sessions can sometimes cause friction within the groups and increase levels of violence. This could be easily managed by starting with individual sessions then followed by small groups sessions.

One of studies conducted by Di Placido (2006) investigated the use of CBT on 80 male offenders, 40 gang members and 40 non-gang members in prison, which they compared with 80 non-treated controls. The study found prisoners who received high intensive CBT treatment had significantly reduced violence and low rates of reoffending in both gang and non-gang members compared to non-treated control.
Accordingly, it is fair to say that CBT treatment does offer some advantages in reducing violence in prison as well as rates of reoffending (Madden. V, (2013). Though the results show some promising results, one could argue that the sample size was too small and did not involve a wide enough variety of prisons enough to say CBT is an effective treatment in young offender’s prison. Moreover, because the study involved adult offenders not young offenders it could be argued that, if the study was to be carried on young offenders the results might have been significantly different from the above findings.
Another possible treatment option that could be used to treat young offenders with mental health issues is Multi-systematic Therapy (MST). MST aims to target serious anti-social behaviour in this case personality disorder, violence as well as self-harm. This model is suitable for young offenders as it assumes that, individual distress and mental health problems come from their relationships, language and interaction within their communities. In view of the fact that, MST is very family orientated, MST might be hard to implement in prison settings because it is impossible to get the offenders families and communities involved in the program (Vivian-Byrne, 2001, cited at Open University 2017).
Additionally, because MST uses the circular questioning technique it requires the involvement of other inmates to express their view on their fellow inmates as such this might create tension between inmates. Although this technique might be successful in treating older offenders such as those in Brandon unit, this treatment may not work in young offender’s prison. Possibly due to the environmental settings of the prison. Other reason could be because older offenders have commitment outside prison and they are willing to do what is takes to get out of prison.

Some MST techniques such as miracle question might work well in young people’s prison setting because the technique involves the use of the questioning technique which may allow a prisoner to talk about how they think the future will be different when they come out of prison, which may be very useful in future planning for young people and allow to set goals (De Shazer’s, 2005 cited at Open University, 2017).
Meditation and mindfulness is another treatment that therapists often use in prison settings. Its aim in prison is to reduce prisoner’s aggressive behaviour, addictive behaviour and rates of reoffending. Orme-Johnson (2011, cited at Open University, 2017) study found offenders who used mindfulness as part of their treatment were between 33% and 47% less likely to reoffend in and outside the prison. However, because prison environment is known to be noisy, cramped and at times very chaotic, meditation and mindfulness techniques can be a challenge to be successfully implemented in prison settings. Moreover, since young people prefer to be expressive and nurtured, meditation and mindfulness is a type of treatment that may not be suitable for young offender.
Some therapists have adapted the use of the mixture between CBT and Mindfulness together as a part of their service. The mixture of these two techniques has been found to be effective in treating depression, anxiety, addiction, self-harm as well as reducing violent behaviour and the rates of reoffending. The drawbacks of Meditation and Mindfulness on treating young people are related to the way the model encourages people to accept their thoughts and feeling as they are rather than trying to change them. Accordingly, this may be problematic to young offenders as they still require learning behaviour modification skills, especially for those who are struggling with automatic thoughts, anger, self-harm and suicide thoughts.

Most prisons often tend to focus more on security and less on the rehabilitation of prisoners. In young institutes there is a need not to focus on issues such as punishment of the adolescence for minor offences rather than the mental health of the young offenders. Prison needs to accept certain behaviour patterns are a part of growing up process. It is also important to know that the treatment approaches mentioned above may not be able to offer the right diagnosis and treatment since prisoners are known to have multiple disorders which means treatment can take longer to be successful.

Statistics shows over 50% of prisoners are likely to be diagnosed with multiple personality disorders such as, borderline personality disorder and anti-social personality disorder (Open University, 2017). It is important to bear in mind that treatment for some of mental health problems can last between 1-2 years for treatment to be effective. As such, this is one of the most common problems therapists face when providing treatment to offender’s due to the offender’s availability to finish the program because the prisoner often moves between prisons or are released before the treatment is finished. As such, before putting the young offender forward to start therapy there is need to insure the long-term availability of the offender.

Recommendations
There is a need for a treatment that targets factors that are likely to cause young people to be involved in violence and self-harm. A treatment model that will aim to make changes within the prison environment might be most successful. A model which targets to educate all prisoners, as well as accepting and taking in to account their biopsychosocial factors which drove them to commit crime in the first instance. A model which targets moral and cultural beliefs to change behaviour and encourage empathy and affection towards fellow inmates, one that better equips youngsters to respect others and will dramatically reduce the numbers of violence behaviour. These methods seem to have worked in the Bandon unit and might be worth further investigation.
Rather than using interventions that are effective in prison settings (such as hush punishment) to try to shape young people’s behaviour, maybe it would be better to offer treatments which will be beneficial to young people in prison and when they are released in to their communities to reduce their chances of committing further crimes. There is also a need to offer a support network for families of the offenders to be able to support the young people once they are released from prison. Though this might seem to pose a threat on prison staff for not exerting punishment on offenders, in a long run this method will be successful and it may instore trust between prisoner staff and young offenders. As a result, young offender might feel more comfortable to disclosing their feelings to the allocated prison staff, thus, this might reduce the number of self-harm
Evidence from Nuffield research conducted by Hagell, (2012) emphasised the importance of family relationships on young people, they reported that young people feel more comfortable, empathy and warmth at home with parents. Therefore, taking young people away from their parents as punishment is like adding petrol to a fire as the youngster misses the opportunity to learn from parents. Though, one could argue that some families do influence criminal behaviour, although this might be the case, prisons are known to change the way people act and behave in a bid to survive in the prison environment. Consequently, some young people are more likely to come out the prison worse than when they went in. As such, there is a need for prisons to have strict rules on the availability of drugs to prevent those who have never taken drugs before to start taking while in prison. This can only be achieved by educating the offenders, their family, friends and prison staff to make prisons drug free and weapon free environment to reduce the number of violence.

Young people now days are targeted by the media and marketing groups from an earlier age which could easily force them to commit petty crime to feed their needs. Government should put strict rules on media and marketing not to target young people to reduce minor petty crimes within communities since in most cases young people criminal behaviour starts with minor offences which grows into chronic offences. Therefore, there is a need for a multi-system of intervention that will target problems rooted deep in societies where these young people come from. This notion was supported by Elliot, Hazinga and Ageton, 1985; Liberman 2008; Swenson et al., who found the main cause of antisocial behaviour in young people within communities to be linked to low education attainment, negative peer’s groups, parental conflict as well as easy availability of weapon and drugs within their communities. As such, intervention which just focus on providing treatment at prison alone will not be effective since the offender are still in contact with their community while in prison.
Art therapy is one form of treatment that can be a very effective treatment in prison if it is combined with CBT. Research has shown that using art as a part of therapy is found to be very effective in helping offenders expressing their feeling and has also shown to reduce the numbers of disciplinary reports on inmates who take part in art therapy program (Brewster, 1987, cited at Gussak, D (2013), equally California Department of Corrections (1987, cited at Gussak, 2013) found art therapy to be affective in reducing the rate of reoffending on the prisoners who took part in the program. Therapists could use this method together with other methods as a way of gaining the client emotional thoughts without the need to ask questions in a group session. Art therapy could also be a good way for the therapist to introduce youngsters to working as a team and at the same time improving their life skills which is crucial in outside world. One of the most beneficial aspect of art therapy is that, it can be used with prison staff as part of routine.

Other treatments could incorporate music and drama as part of the treatment process that might benefit young people by offering them a chance to speak up about their emotions without being judged by their fellow inmates. This will help therapists understand the client problems in a more relaxed way. These methods are widely used in urban area where youngster use rap music to escape street gangs and speak up about their problems. Art, sport, music will benefit young offenders with coping skill, might even help them boost their finance when leaving prison. Moreover, all these factors will help the youngsters to form an identity which is very important during adolescence. (3251 words)
Reference
Gussak, D (2013) Art Behind Bars: The trials of providing therapy in prison—is art the key? Psychology Today Online. Available at https://www.psychologytoday.com/us/blog/art-trial/201310/art-behind-bars Accessed on 28/05/18Madden, V (2013) Understanding the Mental Health Needs of Young People involved in Gangs. online Available at http://www.mac-uk./Handlers/Dowload.ashx?IDMF=52660ab9-9de2-429d-bafa-1f9c741fc71b accessed 10/05/18
Ministry of justice, (2010) Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders Online Available at http://webarchive.nationalarchives.gov.uk/20111206103817/http://www.justice.gov.uk/consultations/docs/breaking-the-cycle.pdf Accessed on 25/05/18
Newman et al., (2010/2011) young lives around: How health and justice services can respond to children with mental health problems and learning disabilities who offend Online available at http://www.prisonreformtrust.org.uk/Portals/0/Documents/turningyounglivesaroundFINAL.pdfOpen University, (2017) Week 2 Tensions between therapeutic and forensic settings available online athttps://learn2.open.ac.uk/mod/oucontent/view.php?id=976542
Open University, (2017) Week 3 The historical context. online Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=976544
Open University, (2017) Week 5 Diagnosis and categorisation. Online Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=976549
Open University, (2017) Week 9 Age. Online available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1048231
Open University, (2017) Week 18 Attachment-based approaches Online Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1152609
Open University, (2017) Week 19 Cognitive behavioural therapy Online Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1152618
Open University, (2017) Week 20 Systemic approaches Online Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1152689
Open University, (2017) Week 21 Mindfulness Online Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1152716
Vossler et al., (2017) Chapter 1: working therapeutically in forensic settings. The Open University. ISBN 978-1-4739-6351-1. Page 18-21
Vossler et al., (2017) Unit 7: Age. The Open University. ISBN 978-1-4739-6351-1. Page 103-107
Vossler et al., (2017) Unit 13 Attachment-Based Approaches. The Open University. ISBN 978-1-4739-6351-1. 191-200
Vossler et al., (2017) Unit 14: Cognitive Behaviour Therapy. The Open University. ISBN 978-1-4739-6351-1. Page 206-221
Vossler et al., (2017) Unit 15 Systemic Approaches. The Open University. ISBN 978-1-4739-6351-1. Page 225-235

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