In 2012/13 the average population of under-18s in custody in England and Wales was 1,544. Many came from chaotic backgrounds and were often victims of violence, abuse or neglect.

Long before they get into trouble and become caught up in the criminal justice system, very many young offenders are used to punishment – not as a measured, proportionate response to wrongdoing, but as random acts of cruelty or abuse often born of frustration and ignorance. What has not been part of their lives is consistent care, clear guidelines, a sense of wellbeing and an understanding of reparation and a means to make amends (BMA, 2014).

The BMA (2014) report makes 17 recommendations for doctors working in the community and in secure institutions. It also provides advice for commissioners and policy makers.

Doctors in the community should:

• Recognise and act upon risk factors: children and young people who enter the criminal justice system are an extremely disadvantaged group who present with multiple and complex health and social needs.
• Identify risk factors such as mental health problems and substance abuse among parents and carers.
• Have access to appropriate training and support to ensure they are confident in treating children and young people.

Doctors working with children and young people in secure settings should:

• Ensure their patients have the same rights around dignity, privacy, confidentiality and consent as patients in the community.
• Make it clear they are independent from prison officers and should not carry out custodial officer tasks or be directly involved in disciplinary proceedings. Doctors are in prison to act in a clinical and welfare capacity and acting outside this role can erode trust and damage the doctor-patient relationship.
• Ensure a summary record of a young person’s health, including recommendations for future treatment is sent to the young person’s GP, so that interventions that have yielded positive results in custody are not lost.

Ninety-five per cent of imprisoned young offenders have a diagnosed mental health disorder and this occurs in a place where optimal help may not always be available at the right time or by the right healthcare professionals (BMA, 2014 ).

In a 2013 survey on 1,435 prisoners in England and Wales, 29% of prisoners who reported recent drug use also indicated experiencing anxiety and depression, compared with 20% of prisoners who did not report recent drug use, it was found also that 26% of women and 16% of men said they had received treatment for a mental health problem in the year before custody.

Acceptance of sexuality is a key wellbeing indicator for children and what should be a safe journey into adulthood. Family acceptance of LGBT adolescents is associated with positive young adult mental and physical health and interventions which promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities (Russell et al., 2011).

Adolescent school victimisation in US due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment with insufficient studies currently available to develop knowledge and future direction. The US study ‘Family Acceptance Project’ included 245 LGBT young adults between the ages of 21 and 25 years and examined young adult suicide attempts, clinical levels of depression, heavy drinking and substance use .Reducing LGBT-related school victimisation is likely to result in significant long-term health gains and reduce health disparities for LGBT people.

Reducing these dramatic disparities for LGBT youth should be an educational and public health priority, with a global reach.

It is the responsibility of everyone who works with young people to foster a rights-based approach to their health and emotional wellbeing, a basic human right for all (Ryan et al. 2012).

It cannot be accurately predicted  which children and young people will develop a mental health problem, but there are factors which undermine healthy mental functioning and decrease resilience and there is still more to learn about how these factors impact on children and young people from black and minority groups.

It is recognised that there are a number of barriers which put young people from black and minority ethnic groups off accessing mental health services. Commissioners and service providers need to work with children and young people to develop evidence-based and culturally appropriate services that they will use which could be provided by a range of different agencies or organisations such as statutory sector services, including schools, and voluntary and community sector organisations, such as black and minority ethnic organisations, churches, temples and faith groups and so on.

It is known that children and young people from black and minority ethnic communities are less likely to engage with services which could intervene early to prevent mental health problems escalating. Health and wellbeing boards and local commissioners need to ensure that these services are prioritised within their local commissioning plans and that they develop culturally sensitive services that are appropriate and acceptable to children and young people.

While previous Government mental health policy specifically targeted the mental health of people from black and minority ethnic communities, and the current mental health policy covers all age ranges, there has been little specific focus on the mental health of black and minority ethnic children and young people evident in government policy.

BMA (2014) Child Detention – BMA Advises Doctors on How to Stop it. Available at: https://www.bma.org.uk/news/2014/november/child-detention-bma-advises-doctors-on-how-to-stop-it (last accessed 13 February 2018).

Ryan, C., Russell, S.T., Huebner, D. et al. (2012) ‘Family acceptance in adolescence and the health of LGBT young adults’, Journal of Child and Adolescent Psychiatric Nursing, 23 (4): 205–213.

Russell, S.T., Ryan, C., Toomey, R.B. et al. (2011) ‘Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment’, Journal of School Health, 81 (5): 223–30.