New Standards Set To Ensure ‘Consistency And Clarity’ In Care For Vulnerable Children

Drawn up by a group of Royal Medical Colleges led by the Royal College of Paediatrics and Child Health and backed by the Children’s Commissioners of all four UK nations, the Healthcare Standards for Children and Young People in Secure Settings (CYPSS) are designed to help plan, deliver and quality assure the provision of children and young people’s health services in secure settings.

There are 69 standards in total, which include the need for every child and young person to:


Undergo an initial health screening and risk assessment before the first night and ideally within two hours of their arrival.


Have a comprehensive healthcare plan including physical health, mental health, neurodisabilities and substance misuse within 10 days of their arrival in the secure setting.


Have all health assessments reviewed annually and mental health assessments reviewed within 3 months of admission to ascertain if needs have changed.


Have a named lead healthcare professional.

The coalition of health bodies who authored the standards, including the Royal College of Psychiatrists, Royal College of Nursing, Royal College of GPs, Faculty of Forensic and Legal Medicine and Faculty of Public health, are calling on secure settings to adopt the standards – which should be regularly audited with the results made publicly available.


Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, said:


“Children in young offenders institutions and secure children’s homes have some of the most complex health needs. The fact that there is currently no specific guidance on how these children’s health needs should be met – and no consistent standards – is simply not good enough.


“In putting together these standards and talking to young people, we came across worrying variations in healthcare standards depending on geographical location and the individuals involved.  What these standards aim to do is ensure consistency in care so that health needs are addressed and not neglected”.

Children in secure settings are some of the most vulnerable, often suffering poor physical and mental health.   Evidence presented in the report shows young people in secure settings:

Are more likely to be victims of crime, have a parent in prison, have been exposed to bullying and be a young parent.


Are twice as likely as the general population  to have experienced serious maltreatment, with many having been in contact with children’s social care or have been looked after.

Have three times the prevalence of mental health disorders compared to the general population, with depression and anxiety being the most common disorders.


In addition:


Over a quarter of young men and a third of young women in secure settings have a long standing physical complaint including respiratory problems, dental health problems, blood-borne viruses, sexually transmitted infections and epilepsy.

An estimated 50% have learning disabilities


A high proportion of young people in secure settings have a history of substance misuse. Before they entered custody 83% were regular smokers, over 60% drank alcohol daily or weekly and over 80% used an illegal drug at least once a month.  

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:


“The prevalence of mental illness among children and young people in secure settings is high and, if not addressed, can lead to even greater long-term complications. This isn’t good for the children themselves or for society as a whole.


“I’ve worked in this field for over 30 years, and these new standards are long overdue. I believe they will play a critical role in enabling the mental health needs of these young people to be identified, and appropriate interventions to be carried out. This will make a real difference to their health, and their ability to learn and respond to offender programmes – making both young offenders and communities safer.”