Management and care guidelines for youth with mental health challenges at Child and Youth Care centres, for the multi-disciplinary teams

Abstract

Overcrowding remains a severe problem in South African prisons. Also, mentally ill inmates’ welfare has become of dire importance in light of the recent spike in deaths (Etheridge 2018:10-15). According to the Judicial Inspectorate for Correctional Services (JICS) ’s latest annual report, an estimate of 1200 (approx. 1%) inmates has been diagnosed with some form of mental illness. The report also revealed that a large proportion of the mentally ill inmates were treated at the prison and were kept with the general population. The report provides evidence that numerous inmates have a mental illness, and the Department of Correctional Services is not equipped to cater to the needs of mentally ill prisoners. The Inspecting Judge, Johann van der Westhuizen, strongly believes that mentally ill inmates’ welfare has become an urgent matter because, over the period 2016-2017, the number of unnatural deaths rose from 52 to 82 (the correctional services provided this information). Once a child aged between 16 and 18 commits a crime, regardless of their mental illness status, they are detained in the various Child and Youth Care Centres in the country, either in a diversion program or a sentenced program or awaiting trial. However, most of these detention facilities do not have proper systems to cater to the needs and the safety of these mentally ill youth. There is a vicious cycle where the youth with mental health disorders continue to enter and remain involved with the Justice System; they tend not to be just one-time offenders. There is evidence that the rate of mental health disorders is higher among youth in juvenile justice than the general population. The Child and Youth Care Centres, where young people are detained for various crimes, are not adequately equipped to deal with the challenges presented by mentally ill youth. The staff ratio within these facilities has been designated to meet the general population’s needs within the secure centre, and no provision is made for young people with mental health challenges. Moreover, there are no guidelines, policies and procedures to assist the multi-disciplinary team (MDT) with the management of these young people. Child and Youth Care Centres are not mental health hospitals; mentally ill children need to be placed in mental health facilities because such facilities employ full-time licensed professionals formally trained in mental health and are on call daily to attend to the children’s needs. This study aims to develop management and care guidelines that can be referred to by the multi-disciplinary team when they have to work with mentally challenged youth. Although the MDT tasked with the Child and Youth Care centres’ management usually consists of professionals such as nurses, their mandate is to provide services to the general population within the facility and not the mentally challenged. This study also addresses the challenges faced by the MDT when managing young people who have a mental illness. The study used qualitative research methodology and the intervention design and development model developed by Rothman and Thomas (1994). Data was collected through focus groups with MDT and peer councillors and also through semi-structured interviews. Purposive sampling was employed to select a sample of professional practitioners rendering these services. Data analysis was done using the framework designed by Tesch (in Creswell 2014:189) and verified using Guba’s model of Trustworthiness (in Krefting, 1991:214-222), as well as the TAPUPAS framework (Pawson, Boaz, Grayson, Long & Barnes, 2003). Ethical considerations were upheld when conducting this study. Based on the research findings, recommendations were formulated in the form of guidelines for the management and care for young people with mental illness in Child and Youth Care Centres.