For young women caught up in the criminal justice system, their health needs throughout childhood will have been left unmet. Research indicates that young people in custody have disproportionate levels of anxiety, depression and psychosis; a 2008 report by the chief inspector of prisons identified that 89% of girls in custody had self-harmed. They do not develop mental ill-health in prison, although the experience may exasperate this; they are often there because their mental health needs have not been met beforehand.
Mental health problems are not the only issue young women in custody have in common – 89% have been excluded from school and one in three have experienced sexual abuse.
These concerns were articulated in the public health white paper published last week, which intends to improve public health across a range of areas including obesity, addiction, mental ill-health and pregnancy.
Many of these issues are particularly relevant for young women. The white paper recognises that "half of mental illness (excluding dementia) starts by the age of 14", that 15- to 24-year-olds are most likely to contract a sexually transmitted infection. Young people who are leaving care, homeless, excluded from school, children of teenage mothers or who are involved in crime are the most vulnerable to teenage pregnancy. And the levels of smoking, binge drinking and obesity among teenage girls is also worrying. So how does the government intend to improve public health for vulnerable young women?
It wants to give local authorities and communities a strong influence over health commissioning priorities; the assumption being that local decision-makers understand the needs of their area and so are best placed to make decisions about services. But for those who are most marginalised, it is unlikely that they will be able to engage in these decision-making structures without significant support from the voluntary sector.
Consider Jessica, a 14-year-old from the north of England. In a controlling and violent relationship with her 16-year-old boyfriend, she displays clear sexual and mental health needs. Her priority is keeping safe, so how will she manage to engage in the decisions regarding sexual health provision in her local area? But if those services aren't provided appropriately, her safety could be compromised and her ill-health increase.
Many voluntary sector organisations have developed service-user groups that influence which services are provided and how, and there is potential in this approach. Certainly, marginalised people, such as the girls I work with, need to be supported to speak for themselves. Unless we create mechanisms for them to engage and influence, the "big society" will become an exclusive society (to quote sociologist Jock Young), which only represents those who make the most noise or represents the most popular issues.
Tokenistic, one-off engagement of young women will not create an environment that includes them. What is the point of bringing a group of young people into a meeting to discuss "strategic commissioning frameworks", without taking the time to break down communication, jargon and statistical barriers and allow meaningful and equal participation? Simply inviting people to attend events doesn't engage them in the process.
We need a society in which young people are supported to make decisions and influence local policy and services from the outset. Many of the young women I work with who become increasingly excluded have no understanding of how decisions are made about their lives or the services that work with them.
If vulnerable girls are excluded from decision-making processes, we will continue to fund public services that fail to improve their health or protect them from harm. That cannot continue.
• Carlene Firmin is chief executive of the Gag Project and co-ordinator of the Female Voice in Violence project at social policy charity Race on the Agenda.
