Flat Earth News

The jailing of mentally disordered children

The Guardian, December 2004

Concluding his investigation into mentally-disordered prisoners, Nick Davies looks at the soaring number of children who have been locked up in prisons which cannot deal with their often alarming mental health problems.

We jail more children than almost any other country in the European Union. While politicians have been wringing their hands over the relentless increase in the number of adult prisoners, they have stayed almost silent on the fact that the number of children behind bars has been rising even faster.

During the 1990s, it just about doubled, with the sharpest increases among girls and children under 15. And now, while the adult prison population has fallen in the last six months, the number of children behind bars has risen again. We have obtained figures which show a dramatic surge in the number of children being jailed for breaching the government's Anti Social Behaviour Orders even though most of them have not been convicted of any criminal offence.

And since some 80% of children in custody suffer from at least two mental disorders - an even higher rate than among adult prisoners - the result is that young children with depression, anxiety, psychosis and severe personality disorders are now exposed to the same profound lack of effective treatment which afflicts adults behind bars. They are cut off from all psychotherapy and highly likely to be denied access to specialist child and adolescent psychiatrists.

And, just like adult prisoners, the most severely disordered children also suffer from the blockages which obstruct their transfer to secure hospitals. We have been told by psychiatrists who work in the system that there are at least a hundred children who are trapped in custody, often in punishment cells, even though their mental condition is so bad that they should be sectioned and sent to secure psychiatric beds.

These problems are particularly acute for mentally-disordered 15 and 16 year old boys. The surge of younger children into custody has pushed them out of the local authority secure homes and secure training centres, where the law allows them to be held in conditions designed for children, and into Young Offender Institutions, which are simply prisons for young adults up to 20 years old and which run a far tougher regime. There are up to 450 boys who are officially regarded as vulnerable being held in these prisons whose staff can only struggle to cope with the intensity of their problems.

Kevin Jacobs was 16 when he was sent to a Young Offenders Institution. By that time, he had been let down by the state for more than 14 years. He was less than 18 months old when he was first taken into care by Lambeth Social Services because his parents, who had learning disabilities, were failing to cope, yet he was not finally put on the register of children at risk for two-and-a-half more years; he was not presented to the fostering panel until he was eleven; even then, he was never placed with a foster family; and there is no evidence he was ever considered for adoption. Instead, he was shuttled between his family and various children's homes until, at the age of six, he was sent to a home outside London which was already being investigated for alleged abuse. Within two months of arriving, he complained that he had been sexually assaulted by an older boy and by a member of staff. Yet, he was left there for months still reporting more abuse and, when the police finally interviewed him six months later, they took no action.

When he was only four, Lambeth social workers asked for him to be assessed for special educational needs. It took nearly seven years for the education authority to do so and, in the meantime, he had been permanently excluded from three mainstream schools. Also when he was four, a paediatrician asked for him to be given a full psychiatric assessment. That was not done. When he was 15, another paediatrician made the same request - the community mental health team said they were too busy. His severe disorders and depression were never effectively treated.

From this childhood of institutional failure, abuse and confusion, Kevin stumbled into a criminal justice system which was geared to punish him but reluctant to help. He was eleven when he was first arrested, for setting fire to a barn. The police cautioned him and let him go. A Lambeth social worker who had been trying to help him and his four siblings, noted in his file: "We have wasted the best years of these children's lives already." When he was 12, the courts locked him up for two years for burglary, assault and more arson. Early in the sentence, a doctor recommended he be transferred from the secure children's home to a psychiatric unit, but they could not find him a bed. Later in the same sentence, another doctor found Kevin was a threat to himself and to others and urged that he be moved to the secure unit for adolescents at St Andrew's Hospital in Northampton, but St Andrew's said he was not ill enough and rejected him. During this two-year sentence, Kevin cut himself on some 40 occasions.

By the time he turned 16, he was locked into a pattern of crime and self-harm, often at the same time. He burgled a doctor's office to try to inject himself with insulin; stole a knife to cut himself; stole another knife to cut himself and some paracetemol for an overdose. Twice, he was taken to hospital and resuscitated. The police arrested him for trying to rob an old lady in front of his own social worker. In the cells, he cut his arms with cutlery and swallowed an overdose of ibuprofen. At court, a doctor and a worker from the local Youth Offending Team produced reports on him. Both agreed he was at serious risk of harming himself. Both said he needed a full psychiatric assessment, but it did not happen. Both said he needed secure accommodation, not prison; the magistrates agreed; but the secure accommodation was all full. The Youth Justice Board, to whom the local YOT worker reports, might have pushed and got him onto a waiting list, but vital paperwork which might have persuaded them to do so never reached them. So Kevin was sent to await trial at the Young Offenders Institution at Feltham, in Middlesex. That was when the trouble really started.

In his first two weeks in Feltham, Kevin was interviewed by a prison officer on reception, a prison GP, a prison psychiatrist and a psychiatrist preparing a report for the court. None of them was a specialist in child psychiatry, and all of them were working blind: the Youth Justice Board report on his history, which included his self-harm, was misfiled and never made it to the prison; nor did his medical records and other history. Kevin himself, like many prisoners, chose to conceal his history of disorder, claiming that he had not harmed himself recently nor ever tried to kill himself. Nevertheless, it was clear he was at risk. He was placed in the health care centre but, after three days, he was moved to a standard cell on the juvenile wing. The prison opened a F2052SH form to ensure he was checked regularly to stop him harming himself, but, after ten days, the form was closed.

When he went back to court to be sentenced a couple of weeks later, he was given a six-month detention order, three months to be served in custody, three in the community. There is no evidence that the court made any effort to ensure that he served the three months in a secure childrens home. He went back to Feltham, where he embarked on an erratic journey of self-harm and suicide attempts while the prison struggled and failed first to treat him and then to transfer him to a secure hospital bed. The sixteen-year-old boy began to slide into despair.

He was bullied, smashed the light bulb in his cell and was found lying on his back bleeding from both arms. The prison re-opened the F2052SH form on him and sent him to the health care centre. Twenty-four hours later, he was back in a standard cell where he was spotted with equipment to make a noose. So he went back to the Health Care Centre for another 24 hours.

The pattern was clear. Kevin would harm himself. Prison officers, one of whom described him as "a timebomb waiting to explode", would try to move him to health care, who would house him for a short time or turn him away because they were short of staff and/or had no suitable cell available. Sometimes, he was held in solitary confinement in the segregation unit; often he was held in a standard cell whose bars and fittings are not made safe against self-harm and suicide. The prison psychiatrist reviewed him four times and each time, still working blind without Kevin's missing paperwork, he accepted Kevin's assurances and concluded that he was at no immediate risk of suicide or self-harm: he advised that Kevin needed "no further psychiatric input" and referred him on a non-urgent basis to be seen by a trainee psychologist who was working in the prison.

Ten weeks into his sentence, two prison officers were leaving Feltham at the end of their shift on a day when Kevin had cut his arm with a broken cup and been told there was no room for him in health care. The officers were so anxious about him that they turned around and went back to tell the governor that Kevin must have a nurse to tend to his injury and special clothing which could not be turned into a noose. When they reached the wing, they asked another officer to check on him: Kevin was squatting beneath his window with a sheet tied around his neck, pulled tight against the bars above him, drifting into unconsciousness. They saved his life, walked him over to health care, insisted he be given a bed and finally left for the night. The suicide attempt was not recorded in his medical notes. Nor were his family told. The incident was not investigated.

During his first week on remand in Feltham, the psychiatrist who prepared his court report had recommended that he be transferred to a secure bed at the Bethlem Royal Hospital in Beckenham, Kent. This psychiatrist warned that, if he remained untreated, Kevin's behaviour would remain criminal and destructive. But the Bethlem wanted a consultant's opinion. The prison provided it. The Bethlem then said they would have to assess him themselves and said it could be four weeks before they did so. Four weeks later, they offered to assess him after a further four weeks - on the very day Kevin was due to be released from prison. In the background, the Youth Justice Board made no move to transfer him to a secure children's home.

As the prison struggled to protect the boy from himself, Lambeth Social Services held a series of meetings about his future and decided that it was too expensive to keep him at the children's home in Guildford, Surrey where he had been living for 20 months before his arrest. Since this was one of the few places where he had ever settled, Kevin was distressed by the news. Since Lambeth were then unable to come up with any other plan for him, and with his release date approaching, he became morose and anxious.

An outreach worker from the health centre recorded that Kevin was frightened and angry about the lack of a release plan and contacted Lambeth social services, the YOT worker and two prison governors to alert them to the crisis. The social worker and the YOT worker were both urging the prison to organise a full psychiatric assessment because of the risk that he would harm himself. A week later, Kevin was caught trying to break his cell light and tearing up sheets to make a noose. He said he had no real intention of killing himself. The psychiatrist judged he was at no immediate risk of self-harm. The health centre said their unit was too noisy for him. He was put in an ordinary cell, where officers checked on him every hour. Kevin told staff he was having flashbacks to being sexually assaulted as a child in care.

Two days later, his social worker came in to see him and told him there was still no sign of anywhere for him to live after his release, which was now just three weeks away. That afternoon and evening, Kevin sat in his cell watching television: there was a shortage of staff, and so he was not unlocked and, for five hours nobody spoke to him at all. The trainee psychologist visited him, he asked her to stay, she said she would come back the next day. By 10.45 that night he was asleep. At 2.15 in the morning, an officer looked through his hatch and found him still asleep. At 2.35, he was found hanging from his window bars. At three o'clock, the ambulance crew instructed staff to stop attempts to resuscitate him: Kevin Jacobs was dead.

It is three years now since the prison service and the department of health declared: "The government is very clear that the needs of juveniles and young offenders have to be a priority. It is therefore important to ensure that services for young offenders take account of the special and often very complex needs of this group." Those words have not been translated into reality.

An inquest into Kevin Jacobs' death found his death was "suicide to which neglect contributed". Most of those who dealt with him in prison were clearly worried about his welfare and often went beyond the call of duty in trying to protect him. The neglect to which the inquest jury referred was, in their own words, the result of "gross deficiencies within the system."

This systemic failure has a familiar shape. On the one hand, just about everybody who deals with young offenders knows that the best way to stop them committing crimes is to keep them out of custody and to attack the problems which are pitching them into crime in the first place. The government knows it too. Four years ago, they created the Youth Justice Board with a network of local Youth Offending Teams with the precise aim of pulling together different agencies to tackle the individual roots of any child's crime. And yet, the same government has sabotaged the YJB's work.

Relentlessly, this government has joined its immediate predecessors in driving more and more children into custody. Dr Barry Goldson, senior lecturer at the University of Liverpool, analysed crime figures and found that between 1992 and 2001, the number of children being jailed each year soared by 90%, from 4,000 to 7,600, while those held on remand jumped by 142%. The number of children under 15 sent to custody increased by 800%, the number of girls by 400%. The average length of their sentences also increased, by 16%, for example, for boys aged 15 to 17. And yet, he found, there had been no significant change in the number or seriousness of the offences children were committing; and no impact on re-offending. This was all about a politically-led drive to jail more children.

This government came to power in 1997 with a prominent pledge to "fast-track the punishment of persistent young offenders". Since then they have kept up the rhetorical pressure on courts and reinforced it with: the 1998 Crime and Disorder Act which specifically extended the powers of the courts to impose longer sentences on children aged 15 to 17 and made it easier to impose custody on children aged 12 to 14; and the 2001 Criminal Justice and Police Act which gave magistrates power to remand children as young as 12 for minor repeat offences whereas previously that had been done only for the most serious crimes.

They launched their new Detention and Training Orders for juveniles, which were seized on by magistrates, causing another spike in the jailing of children. In 2002, they launched their Street Crime Iniatitive. The inquest into the death of Joseph Scholes, who hanged himself, aged 16, in Stoke Heath YOI two years ago, heard evidence that the government put direct and arguably improper pressure on the Youth Justice Board to make sure that children picked up under the initiative were sent to prison.

More recently, the government have campaigned noisily to persuade police and courts to make more use of Anti-Social Behaviour Orders, which are civil measures which usually restrain their subjects from visiting named places or people but which can yield prison sentences of up to five years for those who breach them, even if they have not been convicted of a crime.

We have obtained figures which show a sharp surge in the jailing of children for breaching ASBOs: in the first four years of their use, some 255 children were sent to custody for breaching their ASBOs. The government were disappointed. Downing Street and the Home Office demanded they be used more often. The result was that in only four months this summer, 195 more children were jailed in ASBO hearings. (see panel). Some are only 12 years old. Often, these children had not even been charged with breaking the law. And 80% of them suffer from at least two mental disorders.

The result of all this incarceration is that the Youth Justice Board has been left struggling to fulfill its purpose. It now finds itself having to spend 74% of its budget buying places in custody with the prospect of spending another 1.6% just to keep pace with the new rate of ASBO jailings, all of which cuts the money which the board has left to spend on crime prevention. And these children cannot fit into the institutions which are designed to house them.

All of the local authority secure childrens' homes and all of the new private secure training centres between them hold fewer than 500 child offenders. Almost all 15 and 16 year old boys now end up in Young Offender Institutions, which have much lower staffing, much higher rates of self harm and suicide, far less education and far more chance of being locked up for 22 hours a day. They are prisons. And it is not just that these are children, but that significant numbers of them are officially regarded as 'vulnerable', like Kevin Jacobs.

When the YJB started work in 2000, it told the Home Secretary: "Young people should be placed in accommodation which most effectively meets their needs and the risk of harm that they pose to themselves and others. The accommodation should be appropriate for their age, emotional maturity and level of vulnerability." But YJB officials told the Joseph Scholes inquest in April this year that each day they can handle a hundred booking forms for children who have been sentenced to custody of whom 30 or 40 will be officially described as vulnerable and, if they are boys over 14, almost all of them will end up in a YOI. At any one time, they said, there are some 450 vulnerable children in YOIs.

Earlier this year, the board's new head, Prof Rod Morgan, opened a new building at a YOI and told his audience frankly that he hoped he could return soon with a wrecking hammer to knock the place down. But, inundated with child prisoners and short of funds, the board is being forced into reverse gear. Places in local authority secure homes are expensive, and the board has been cutting the number of beds it buys in them. As a result, two local authority security homes closed last year and two more are about to close. This means that the new private secure training centre which opened this year and two others which are due to follow in the next few years will end up largely replacing the homes which have closed instead of diverting children from prison.

For the mass of jailed children like Kevin Jacobs who suffer from mental disorder, this is a disaster. The Youth Justice Board, like the Prison Service, has genuinely tried to improve health care behind bars, but neither of them pretends that they have been able to do enough. In particular, there is a dire shortage of child and adolescent psychiatrists for juvenile prisoners. "What they get is other general psychiatrists or nothing," a senior forensic psychiatrist told us. A survey of psychiatrists working with young offenders in Scotland three years ago found that only three of them had forensic training and few even knew of a specialist child psychiatrist they could consult.

The process of finding a psychiatric bed for the most severely disordered children is even worse than that for adult prisoners, which we described yesterday. In the whole of England and Wales, there are only 44 secure psychiatric beds for children. They cannot cope with the surge of jailed children with severe mental illness. As a senior executive from the YJB told the Joseph Scholes inquest in April: "It's the view of the Board that about a hundred of these children should be sectioned and they should be kept in secure mental health accommodation, but I am afraid that does not exist." Even those who do get a bed can experience long delays - "three, six, nine months" according to a senior source - as first the specialist hospitals and then the local Primary Care Trust conduct their assessments and hold meetings.

The Joseph Scholes inquest heard from a former medical officer at the YOI where he hanged himself, who had personal experience of trying to transfer severely disordered children to secure hospital beds. Dr Jane Bright said: "My experience was that when we did have inmates who had gross psychiatric disturbance, and I'm talking about a psychosis rather than a non-psychotic patient, it was very difficult to get a forensic psychiatrist to see them, very difficult to get an appropriate bed for them. We had to wait weeks and weeks, spend hours and hours and hours making phone calls, very, very difficult. The resources just weren't there to back us up."

Kevin Jacobs' family are now suing the London borough of Lambeth, the Home Office and the Youth Justice Board. Their lawyer, Fiona Murphy of Bhatt Murphy, has told Treasury solicitors: "Imprisoning such a vulnerable and damaged boy was humiliating, debasing and degrading and had the effect of undermining his will to cope with his feelings of helplessness. His will to resist the suicidal ideation from which he suffered, was cumulatively undermined by the failure to plan for his release and address his medical needs."

Additional research by Roxanne Escobales

See below for statistics and case histories

Anti Social Behaviour Orders -

Average number of children jailed each month for breaches of ASBOs

April 00 to Dec 02 2.3
Jan 03 to Mar 04 6.8 (estimate)
May 04 to Aug 04 48.75

Source: Home Office and Youth Justice Board

Children in custody -

  Secure homes/centres Prison
Oct 02 471 2704
Jan 04 473 2194
April 04 459 2345

Source: Youth Justice Board

Mental disorder among children in custody -

  Male Remand Male Sentenced Female All
84% 88% N/A
Psychosis 8% 10% 9%
52% 41% 67%
(life time)
20% N/A 33%

Source: Office of National Statistics

Case histories -

Toni aged 17 assault YOI prison

Toni used to watch her mother trying to hang herself and taking overdoses and using drugs. Her mother used to batter her with her fists or a hammer or anything else that came to hand. Eventually, she threw Toni downstairs, so Toni put herself into care. Her father was never around much. In fact, her mother told her he was not her father, and so she is not sure who he is. She remembers once he said there were dead people buried under the floor, so she and her mother pulled up all the floorboards and found a dog's head. It still had its collar on. Toni says she understands life: "My view of the world is that we are living in hell and we are all ghosts."

She has thoughts she can't control and voices in her head. She has been in trouble with the police since she was eleven - stealing, terrorising the neighbours, setting fire to things. Recently, she cut a girl: "Sometimes I feel I have to cut people up if I don't like them. Sometimes it only takes them to do one thing and, if I don't like it, then I'll have to have a go at them." So now, she is in prison, in a Young Offenders Institution. She is 17.

She wants help for her mental problems but, as far as she remembers, nobody has ever treated her. It's the same in the prison. Sometimes, doctors come to the cell. "Everyone comes to your door at once and they just stare at you." So she doesn't talk to them. When she was first in prison, they put her on self-harm watch, but then she told somebody she'd like to attack another prisoner, so the next thing she knew she was hauled out of her cell and taken down to segregation.

She spent 20 days there, locked up alone for 23 hours a day day. She could hear people screaming and smashing up their cells. One night, two people tried to hang themselves. Toni thought she could hear people crying, but she wasn't sure if she was imagining it. A 60-year-old woman in the next cell had got hold of some glass and was cutting her arm. Being on the seg made her feel low, her thoughts started to get the better of her, and so she took to banging her head against the wall. She felt paranoid, she was sure there were ghosts in the cell and then, one time, all the books fell off her shelf, so she knew the ghost was there.

Jink 17 assault and threats to kill YOI prison

A lawyer from the Howard League for Penal Reform found Jink in a prison cell - a 17-year-old boy who weighed 22 stone and who was suffering from a congenital heart disease as well as mental impairment. Almost as soon as Jink arrived in prison, the prison doctors had said he needed to be sent to a secure psychiatric unit, but seven months later, he was still in his cell. When the lawyer found him, Jink was eating faeces and urine.

When the lawyer asked why this deeply disturbed boy had not been moved immediately to a psychiatric hospital, he found that Jink had simply got lost in the system. The prison were extremely worried about him but they could not give him the care he needed. One day, Jink used his clothes bag to hang himself from the bars of his cell. They cut him down, he was still alive and one of the governors went and had a cup of tea with him, and Jink told him how his dad had started buggering him when he was six years old and used to keep him locked up in the bedroom. The governor said he seemed very low.

Straight after that, the prison called together all the agencies who had an interest in the boy - social services, youth offending team, Welsh health commissioner, prison doctors, hospital psychiatrists, defence lawyer. But they still could not sort out where to send him and how to pay for it. And all the time he waited, Jink was being bullied mercilessly. If ever he left his cell, he clung to a prison officer for protection.

Jink had assaulted his mother and threatened to kill her. From time to time, they would take him to court for a remand hearing. It was the first time he had been in trouble. He hated going to court: the cubicle in the van was too small for him; he suffers from claustrophobia; once, the door got jammed and they couldn't get him out; he had a panic attack in the van.

The lawyer from the Howard League said it was simply unacceptable that Jink had been wating seven months for a hospital bed and so he got onto his computer and Googled psychiatric units and rapidly found one which was suitable. He called the unit, who agreed to assess Jink. Two weeks later, he was moved. He is much better now.

Henry 16 arson with intent to endanger life Secure Training Centre

Henry was severely sexually abused as a young boy. He has had mental health problems since he was nine. He hears voices, has blackouts and flashbacks, sets fires, harms himself, drinks to the point of hazard. The government says no prisoner with a severe mental illness should wait more than three months to be transferred to a secure psychiatric bed. Henry waited fourteen months.

The first six months were spent simply waiting for a local community psychiatrist to assess him. Finally, the psychiatrist declared that there was no suitable placement in the Primary Care Trust's area, so he had no remit to do the job. In the background, the local youth offending team had asked another psychiatrist to asses him, but that never happened and the YOT lost interest. Henry's lawyers appealed to the local director of public health, but he was off sick.

In the seventh month, the judge who was waiting to preside over Henry's trial said he was 'extremely concerned' by the delay. The lawyers wrote to the head of the local YOT and threatened to summons him as a witness before the judge if he did not take responsibility within two weeks. The YOT replied that it was really up to the PCT. The PCT said they would consider a non-local placement, but it was up to the community psychiatrist to arrange an assessment. The community psychiatrist said he would refer Henry to the Gardener unit in Manchester. The doctor who was advising the lawyers said it was the wrong sort of unit: Henry needed to be in St Andrew's in Northampton. The community psychiatrist said St Andrew's was private and too expensive and he could not refer him there. The lawyers thought the best thing would be for both units to assess Henry. It was the ninth month before they discovered that nobody had actually referred Henry to either place.

The lawyers then got an independent psychiatrist to assess Henry, and he agreed that the Gardener unit was wrong for him but suggested the Proudhoe in Northumberland. But the Proudhoe had no beds and said they could not even assess him for two more months. The lawyers wrote to the local MP who wrote to the PCT who said they still wanted the Gardener unit because it was cheaper. The Gardener unit also had no beds. Then Henry got lucky. The Proudhoe brought forward their assessment and agreed to take him - but not until the twelfth month, when a bed was due to come free. In the meantime, St Andrew's also assessed him, agreed to take him but failed to tell the lawyers. And they also had no beds.

The MP wrote more letters. The lawyers made a formal complaint to local social services, who started a dispute about how to proceed. They also lodged a complaint with the local PCT, who failed to reply. By now, it was the twelfth month and the Proudhoe bed was due to come free. It didn't - the patient they were expecting to leave had needed to stay. Then the lawyers finally heard from St Andrew's that they had been willing to take Henry, that they had had two free beds in the past couple of months but had said nothing because they thought he was going to the Proudhoe, and now both beds were filled again. They agreed to put Henry back on their waiting list, but only if they had a new referral from the community psychiatrist, who was still saying he should go to the Gardener unit. In the fourteenth month, after four assessments involving three units and seven doctors, Henry finally was given a bed at the Proudhoe. During all that time, he received no effective treatment for his illness.

Babs 17 affray and arson with intent YOI prison

As a little girl, Babs was abused sexually, physically and emotionally and spent years going in and out of care. In one foster family, she was sexually abused again. She also saw her young brother die. As an adolescent, she tried to get help but was told she was just being manipulative. She often committed offences.

When she was 17, she set fire to her bed, was taken to court and pleaded to be sent to a psychiatric hospital. When they refused, she ran from the court, met up with two friends, who were both schizophrenics, got drunk and swallowed all their medication with them, was indecently assaulted by one of them, trashed the house, set fire to the sofa, was subdued by police using CS gas and still not sent to a hospital. Instead, she was remanded in custody to await trial.

There, a prison doctor learned about her two personalities (Andy who she liked and Andrea who she didn't) and diagnosed personality disorder, mood disorder and post traumatic stress disorder. The doctor said she must be transferred to a secure hospital. But that took eleven months, during which time her condition careered downhill and the prison alternated between desperately trying to protect her and punishing her.

She made her her most serious suicide attempt when she hanged herself with a cable from her cell window. Officers cut her down and left her in the cell under constant observation. When she recovered, she wanted to leave and tried to shove her way past the officer in the doorway. Other officers were called. She was handcuffed, stripped, put into a strip gown and placed in the punishment block where one of her friends had hanged herself.

During her eleven-month wait for a hospital bed, Babs tried to hang herself using cables, laces, torn shirts and sheets. She cut and burned her legs, hair, face, hands and tried to cut off her thumb. She also tried to throw herself off the wing landing. On several occasions, she dug a wound in her arm and buried a pen in it. The pens had to be removed at a local hospital and she was warned that if she continued to damage her arms or hands, they might have to be removed.

Margie 17 breaking and entering and assault YOI prison

Margie has had trouble with mental illness all her adolescence. She has been sectioned twice and held in hospital for psychiatric care and she has been been prescribed anti-psychotic medication. She hears voices. Given the chance, she will drink eight cans of beer a day and a bottle of vodka a week.

The reason is not hard to find: she spent the first eight years of her life being beaten up by her father and watching him do the same to her mother; when she was eight, her mother fled to a refuge taking Margie and her four siblings with her; but, one night, the father found them and broke into the room and Margie hid and watched while he stabbed her mother 17 times and then kidnapped her brothers and sisters, leaving her alone with the corpse.

At first when she was arrested - for breaking into another girl's home and forcibly shaving her head - it looked as though she would be moved from prison to hospital without much trouble. The judge said her transfer was 'extremely urgent' and, within two months of her arrest, a psychiatrist assessed her and diagnosed schizoaffective disorder with post-traumatic stress and borderline personality traits. He not only recommended that she be transferred to a secure hospital but pointed out that she wanted to kill babies and added: "Formal therapeutic interventions are vital. It would be impossible to contain her behaviours and provide such intensive interventions, if she were not to be managed in a secure psychiatric unit.... Failure to implement such provisions at this opportune time can potentially result in far more serious consequences to property and people in the future."

But the primary care trust, who were going to have to pick up the bill, were not so sure. They sent another psychiatrist to assess her, and she concluded that the first psychiatrist's diagnosis was wrong, that Margie would not respond to treatment and would not mix well with other patients in the unit and might be malingering. The PCT refused to fund the transfer.

Margie was given a long sentence and no visible prospect of a hospital place. The last time she was heard of, she was extremely anxious: she had just heard her father was due to be released from the sentence he was serving for murdering her mother. She said: "My brain thinks that if I throw a stone in a pot then I won't die, and I don't throw a stone in a pot."

* the names of all children have been changed

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