Growing up inside Understanding the key health care issues for young people in young offender institutions and prisons

By Miranda Davies, Rachel Hutchings and Eilís Keeble

There were 11,494 people under 25 years of age in young offender institutions and prisons in England and Wales as of 31 December 2022, representing 14% of the total population in custody. While the number of children (under 18) in secure settings has fallen sharply over the past 15 years, very serious challenges remain over the use of force in the children’s secure estate, with ongoing concern over children being held in solitary confinement, some for extended periods. From a legal perspective, young people are treated as adults from the age of 18 within the criminal justice system, but there is recognition of the needs of 18- to 25-year-olds as ‘young adults’ (see the work of t2a.org.uk), distinct from the needs of children or other adults. This analysis uses routinely collected hospital data to look at the service-use patterns of children and young adults aged 25 and under in young offender institutions and prisons in England. We engaged with experts and looked at the literature to consider this in the context of the key health care needs of young people. Looking across the children’s secure estate as well as the adult estate provides a novel perspective on the key health care issues for young people, allowing us to compare experiences in the so-called ‘children and young people secure estate’, which caters for those aged 18 and under and is run as a distinct part of the custodial estate, with those in the adult estate, which manages young adults alongside prisoners in older age groups. Understanding how health care access and needs differ is important, because the distinction between the two parts of the system is becoming increasingly blurred. Recently, population pressures in the adult estate have led to an increase in the number of young people aged 18 or over in the children’s secure estate, which will drastically alter the age profile of the children’s secure estate population.

A summary of the key findings and some considerations for policy-makers are provided below. We found that some of the biggest problems affecting the adult prison estate – violence and self-harm – have a disproportionate impact on young adults. We consider how the prison service can meet the needs of young people in custodial settings, and the benefits of providing tailored support for young adults in particular.

London: Nuffield Trust, 2023. 55p.