Annual Report of the Chief Medical Officer 2012 - Population Health and Improvement Science

Chapter 5

Offending behaviour in young adults

We have highlighted frequently the importance of a safe, nurturing environment in ensuring children have the opportunity to grow and achieve their potential in life. Where such salutogenic environments are not present, harm can come to the child in the form of behavioural problems and physical and mental health issues. We have considered the problems of looked after children and the sad fact is that many of them will come to the notice of the criminal justice system at some point in their lives. It is important to see offending behaviour in the context of adverse events in early life. As the Early Years Collaborative takes effect, we should see a reduction in offending behaviour in young people. This will take some years to become apparent. We can, however, suggest approaches which reduce the impact of adversity in early life already experienced by today's teenagers. An improvement approach to offending and reoffending could reduce significantly such behaviour in Scottish society

The prison population

The prison population in Scotland has been increasing by around 4 per cent per annum over the past decade and, in 2012, it reached a daily average of 8,178. During 2011-12, the average daily population increased by 4 per cent to 7,710 for men, while the female population increased by 8 per cent to 468. The young offender sentenced population showed a marked drop of 8 per cent to 556 ^[11].

The current increase is driven by an increase of 11 per cent in the adult remand population and a somewhat smaller increase of 4 per cent for the adult direct sentenced population.

The total sentenced population (including recalls) has increased, primarily due to marked increases in the length of sentences of between 3 months and 2 years (9 per cent overall), and more modest increases for the life sentence and recall populations which have increased by 5 and 3 per cent respectively.

The evidence for intervention

The Justice Directorate of the Scottish Government is leading a programme to reduce reoffending in young people ^[12]. It has produced a review of the evidence of the effectiveness of different approaches to reduce reoffending or, in other, more technical words, promote desistance from crime among young people and adults. The document provides compelling evidence for the determinants of offending and reoffending to be similar to the determinants of poor health.

The authors found evidence that offending begins in early adolescence, peaks during the late teens and tapers off in young adulthood. A key feature of this reduction in offending behaviour is a growth of connections with others. The parallels with the problems of childhood are striking. Failure of attachment in the first few years of life is significantly associated with behavioural problems and mental and physical health issues.

Inadequate attachment increases the risk of failure and alienation as a young person goes through school and, it appears that the risk of offending behaviour reduces as ties with family, friends and the wider community are rebuilt. Connectedness with others in positive social relationships seems to be a powerful motivator to desist from offending.

It is a consistent finding in the literature that the occurrence of key life events such as obtaining and remaining in suitable employment, acquiring a stable partner and completing education increase the likelihood of desistance from offending by adding structure to offenders' lives and acting as a source of informal monitoring and emotional support. The same effect has been observed when offenders move away from criminal peers. Women, for example, are more likely to desist from offending once they develop attachments to a law-abiding husband and enter a good-quality marriage.

Predictably, therefore, it appears that offenders who feel a welcomed part of society are less likely to reoffend compared to those who feel stigmatised. Discussions with young offenders highlight this issue. "How will I ever get a job when I'm competing with others who have qualifications and work experience and have a Disclosure certificate?" This comment highlights the hopelessness felt by many young people who have offended and it calls for action to ensure that mechanisms for positive reintegration into society are strengthened. The economic benefits of effective rehabilitation are significant but more important are the human consequences of putting a young life back together.

Therefore, evidence stresses the importance of work not only with offenders but also with their family, friends and the wider community of employers and organisations that support reintegration into community in the development and sustaining of positive relationships.

Other approaches to supporting offenders include specific therapeutic interventions such as cognitive behaviour therapy (CBT). The report points out that antisocial attitudes are among the strongest predictors of reoffending and there is good evidence from experiments conducted in the United States that programmes of CBT that aim to change offenders' thinking styles and attitudes can result in modest reductions in reoffending when rigorously implemented. Evidence from the UK is more mixed, with some studies reporting modest reductions in reconviction rates and frequency of reoffending among programme participants and others no significant effects. However, differences in results of American and UK studies may reflect variations in the quality and rigour of programme implementation rather than genuine differences in effectiveness. Programmes may work better in the U.S. simply because they are implemented better, though differences in the characteristics of programme participants may also account for some of the variation in outcomes.

In Scotland, no outcome evaluations of therapeutic programmes have been conducted as yet but a recent review of the quality of interventions argued that such programmes cannot operate effectively if they do not simultaneously address the broader context in which offending takes place and the multiplicity of offenders' needs.

The role of improvement science

Reading the evidence for what works in terms of encouraging desistence, one is struck by how similar the themes are to the issues faced by chaotic families in bringing up children and by looked after children as they emerge into adolescence. Alienation and lack of connectedness with others are recurring themes.

The authors of this report produce a series of key messages that emerge from their review of the literature on how offenders desist from offending. Viewed from an improvement science perspective, they look like a series of drivers of change that might produce a consistent societal response to the problem of repeat offending and reconnection with society. They concluded that:

• Key events in offenders' lives such as parenthood and re-integration in the local community impact on their motivation to stop reoffending.
• Desistance is a highly individualised process and one-size-fits-all interventions do not work.
• Compared to recidivists, desisters show higher levels of self-efficacy and commitment to change, and have stronger social support networks.
• Offenders value getting support to solve practical problems, being listened to and believed in. Supervision is unhelpful when it amounts to simply reporting at social work offices.
• Interventions that help offenders find employment, develop positive social networks, enhance family bonds and increase levels of self-efficacy and motivation to change are those more likely to have the strongest positive impact on the risk of reoffending.
• Rehabilitative interventions with the strongest evidence base are cognitive-behavioural programmes and supportive and interpersonally skilled supervision.
• Intensive supervision that is not accompanied by some form of support in addressing the drivers of offending behaviour is unlikely to lead to reductions in reoffending.

The basis of change in complex systems is accumulating small gains across many parts of the system and seeing them add up to large gains. There is evidence that the interventions identified in the report, done consistently and at scale, could influence significantly the risk of reoffending. It is also clear that those working in Scotland with offenders in the prison service, social work, health and the voluntary sector are highly motivated and skilled in these ways of working.

Improvement science offers a method for change and Scotland could lead the world in its application in this setting.