Mental health and therapeutic support recommendations

The Review made 83 recommendations. These have been sorted into work programs for implementation.

Our objectives

To provide young people in detention with mental health and therapeutic services that support:

  • safety
  • wellbeing
  • rehabilitation.

The way forward

To achieve this we will:

  • strengthen and expand our health and therapeutic services
  • build staff capacity to identify and respond to emotional/psychological harm and mental health issues
  • communicate better with families about their child’s suicide risk, and emotional/psychological harm
  • establish governance arrangements to collaborate and coordinate health and therapeutic services at the local level.

Recommendations

Recommendation 21 (status: closed)

The Review recommends that consultation with external stakeholders should be undertaken in the development of programs for young people with disabilities and/or learning difficulties. (9.R5)

We now employ speech and language pathologists in youth detention centres in Queensland, as part of the multi-disciplinary team. They undertake a range of assessments and help develop intervention plans for young people. They also deliver tailored individual and group programs to young people. A range of external experts and organisations worked with us to develop the youth detention speech and language practice framework, including Professor Pamela Snow (LaTrobe University) and Mary Woodward (Speech Pathology Australia).

We have established an Aboriginal and Torres Strait Islander working group to support speech and language practice and make sure that:

  • it is culturally appropriate
  • staff understand the differences between Australian Aboriginal English and standard Australian English.

We continue to embed speech and language practices and upskill staff to modify their communication when working with young people who may have a disability or learning difficulty. A review of the Changing habits and reaching targets program has also started, to adapt it to the needs of young people with a disability or learning difficulty.

The Emotional regulation and impulse control program has been trialled across Youth Justice. Deakin University has completed a trial evaluation report on the project and we are now considering options for implementation.

Psychologists and speech and language pathologists in our behaviour support team now have the clinical capacity to assess for Foetal Alcohol Spectrum Disorders (FASD). They completed formal training to identify and diagnose FASD with Dr Doug Shelton and Susan Astley.

The Neurodevelopmental impairment assessment and support framework for Youth Justice was endorsed in February 2019. It will help idnetify young people who need assessment, more intensive services and programs.

Recommendation 44 (status: complete)

The Review recommends that there should be commonality between the definition of harm under the Child Protection Act 1999 and the Youth Justice Act 1992 and it should include an unacceptable risk of harm. (15.R1)

We have amended the relevant policy to ensure commonality with the Child Protection Act 1999.

We have improved our harm identification processes. This includes the involvement of professional staff in identifying and managing suspected emotional and psychological harm.

The addition of child safety officers at each youth detention centre also supports these processes.

Recommendation 45 (status: in progress)

The Review recommends that there should be specialised, ongoing training to youth detention staff to assist them in identifying signs of emotional and psychological harm of a young person, as well as how institutionalised practices can cause or trigger significant harm to a young person.

The training should be provided by representatives from the Mental Health, Alcohol, Tobacco, and Other Drugs Services (MHATODS). (It is understood there is currently no ongoing training on this issue). (15.R2)

We are committed to ensuring that youth detention staff are able to identify and report suspected harm to young people in detention. We recognise that the factors and issues that contribute to emotional and psychological harm are wide-ranging and may be related to:

  • a single traumatic event
  • chronic trauma
  • intergenerational trauma
  • a series of traumatic events.

We recently introduced trauma informed practice as the underlying philosophy for youth detention services to strengthen staff's ability to identify harm that impacts on a young person's psychological or emotional wellbeing.

As noted in recommendation 44, we are actively exploring options to improve the identification and reporting of harm. Implementing the Youth Justice Practice Framework will also help.

We will work with Queensland Health to develop a specialised training program for youth detention staff when all policy work has been completed. This will help staff to identify signs of emotional and psychological harm, and enhance their understanding of how institutionalised practices can cause or trigger harm.

This recommendation is scheuled for completion by 30 June 2020.

Recommendation 46 (status: in progress)

The Review recommends that harm reporting obligations should be subject to annual refresher training for all youth detention centre staff. (15.R3)

See recommendations 44 and 45. We also provide extensive and comprehensive training to youth detention staff, including annual suicide and self-harm prevention training.

This recommendation is scheduled for completion by 30 June 2020.

Recommendation 47 (status: in progress)

The Review recommends that all records of SR1 in ICMS should provide detailed information of the specific management of suicide risk and behaviour, detailing specific pro-active interventions, as a means of ensuring transparency and accountability between relevant government departments. (15.R4)

Regular and comprehensive information is exchanged between detention and community based caseworkers. Child safety caseworkers are including in this if relevant. Newly established on-centre child safety officers also support this process.

On-site Queensland Health staff work with us to ensure young people can access appropriate mental health services and that these continue when they leave the centre. Access to our information systm helps with information sharing.

We are updating our information sharing service level agreements with Queensland Health, our suicide and self-harm risk management policies and procedures.

This recommendation is scheduled for completion by 31 March 2020.

Recommendation 48 (status: in progress)

The Review recommends that the SR1 in ICMS should be relayed to CHQ Statewide MHS to ensure that appropriately skilled mental health practitioners are aware of the incident and risk alert and can assist where appropriate. (15.R5)

Queensland Health provides essential care and support for young people in detention who present with suspected mental health issues via on-site services. Their multi-disciplinary teams include:

  • psychologists
  • speech pathologists
  • occupational therapists
  • social workers
  • Indigenous health workers
  • psychiatrists.

After-hours access to psychiatrists is also available to assist youth detention and primary health care staff with any urgent and significant mental health incidents.

We are updating our service level agreements with Queensland Health to support this.

This recommendation is scheduled for completion by 31 March 2020.

Recommendation 49 (status: complete)

The Review recommends that Queensland Health staff responsible for conducting mental health assessments on young people in response to a serious suicide attempt should be trained (if not qualified) in mental health assessment specific to young people (particularly those with complex needs). (15.R6)

Queensland Health has established on-site mental health teams to ensure that young people in youth detention receive appropriate and high quality mental health services. Their multi-disciplinary teams include:

  • psychologists
  • speech pathologists
  • occupational therapists
  • social workers
  • Indigenous health workers
  • psychiatrists.

After-hours access to psychiatrists is also available to assist youth detention and primary health care staff with any urgent and significant mental health incidents.

On-site mental health staff now also provide advice and support to the behaviour support team in relation to any young person in detention assessed as high risk of suicide or self-harm.

It should be noted that primary health care staff working in youth detention do not conduct mental health assessments (as this is outside their scope of practice).

Recommendation 50 (status: complete)

The Review recommends that parents and guardians should be advised of all significant incidents occurring in the centre for which children may have suffered harm as defined in the Youth Justice Act 1992, section 268 as soon as there is a recognition that harm has been suffered. (15.R7)

Existing policies require parents/guardians to be notified in the event their child may have been harmed while in youth detention. We have amended procedures and created factsheets to improve these processes. These documents also clarify timeframes and thresholds for contact with families.

Recommendation 76 (status: complete)

The Review recommends that further investigation should be undertaken as to the concerning allegation of the misuse of Individual THHS-12’s electronic signature and accuracy of meeting minutes. (19.R1)

Youth Justice does not have electronic signatures. Our information system (DCOIS) provides notifications to staff members to alert them to items for their information or action. We are reviewing records relevant to the recommendation to identify where we can achieve greater clarity.

Recommendation 80 (status: in progress)

The Review recommends that youth detention centre employees should receive more training in identification, treatment and management of young people with mental health issues. (19.R5)

We are working with the Queensland Centre for Mental Health Learning to deliver specialised mental health training and therapeutic upskilling in the identification, treatment and management of young people with mental health issues.

Our on-centre client services teams will also support and build the capacity of operational staff. Staff will work together to develop practical and effective operational support plans that best meet the needs of individual young people.

This recommendation is scheduled for completion by 30 March 2020.

Recommendation 81 (status: in progress)

The Review recommends that Youth Justice policies and risk assessment tools should:

  • distinguish between suicide risk and self-harm risk
  • reflect the research undertaken by Youth Justice that physical restraints escalate self-harming behaviour. (19.R6)

We have amended relevant policies to further differentiate between suicide risk and self-harm risk. We continue to update our risk assessment tools. This work will reflect contemporary research regarding the impact of physical restraints on young people at risk of suicide or self-harm.

This recommendation is scheduled for completion by 30 June 2020.

Recommendation 82 (status: closed)

The Review recommends that consideration should be given to creating a 0.5 FTE consultant psychiatrist and a 1.0 FTE psychiatry registrar to be based at each youth detention centre. (19.R7)

Onsite mental health services provide essential care and supports for young people in detention who present with suspected mental health issues. The teams are multi-disciplinary. After-hours access to psychiatrists is also available to help with urgent and significant mental health incidents.

Recommendation 83 (status: closed)

The Review recommends that a consultant psychiatrist should be available on call after hours and on weekends. (19.R8)

See recommendation 82.