The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities Presenter:​ ​Gennady​ ​Baksheev Subdeacon,​ ​Holy​ ​Protection​ ​Cathedral​ ​-​ ​Melbourne Doctor​ ​of​ ​Philosophy​ ​(Forensic​ ​Psychology) [email protected]

Session:​ ​Saturday​ ​21​st​​ ​December​ ​2013,​ ​Morals​ ​and​ ​conscience Summary of talk: The brain is the most complex organ in the human body. It is involved in our thoughts, memories, feelings, actions and experiences of the world. The human brain undergoes constant growth and changes until the mid-20’s. Despite being an astonishing organ, it is however susceptible to damage. The focus of this talk is centred around understanding some of the common triggers that inflict damage on the brain. This includes some work that suggests that screen time, such as watching TV, has a negative effect on the brain. Substance misuse problems can also reshape the brain, and lead to undesired consequences. One such consequence may be offending, and I will present some findings from a research project that I undertook with police cell detainees. This point us in the direction to achieve the best possible upbringing for Orthodox youth, as Orthodox adolescent human​ ​brains​ ​are​ ​subject​ ​to​ ​the​ ​same​ ​influences​ ​as​ ​the​ ​rest​ ​of​ ​the​ ​population.

Transcript​ ​of​ ​talk Vladiko Blagoslovi. I am very pleased to be here this morning, and hope that you are enjoying your youth retreat so far. It wasn’t long ago that I used to attend these youth retreats, and I used to enjoy them very much. It is a good chance to meet new friends and see old friends. More importantly though, youth retreats are a wonderful opportunity to learn more about​ ​our​ ​Orthodox​ ​tradition,​ ​and​ ​spend​ ​time​ ​with​ ​our​ ​clergy. My talk is about the developing adolescent human brain. The human brain undergoes a lot of growth and changes from birth until the mid-20’s, and is a very complex and fascinating organ of the human body. We know however, that adolescence is a tumultuous transitional period from childhood to adulthood, and that engaging in risk taking behaviours is considered to be a normal characteristic of adolescence. These risk taking behaviours, and even some everyday behaviours, can reshape and damage the brain. The focus of this talk is centred around​ ​understanding​ ​some​ ​of​ ​the​ ​common​ ​triggers​ ​that​ ​inflict​ ​damage​ ​on​ ​the​ ​brain. This presentation is important for Orthodox youth for several reasons. Orthodox youth are subject to the same influences as non-Orthodox youth, making it imperative that we understand the effects of these influences, such as spending time in front of digital technologies and consuming alcohol. On a more substantive level, there are important lessons for us in terms of our psychological make-up, which is an important part of who we are (Christian​ ​anthropology​ ​teaches​ ​us​ ​that​ ​we​ ​are​ ​composed​ ​of​ ​a​ ​body,​ ​soul​ ​and​ ​spirit). Key​ ​features​ ​of​ ​today’s​ ​talk ● What​ ​is​ ​adolescence? The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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Watch​ ​a​ ​video​ ​of​ ​a​ ​lecture​ ​delivered​ ​by​ ​Baroness​ ​Susan​ ​Greenfield Summary​ ​of​ ​Susan​ ​Greenfield’s​ ​lecture Substance​ ​use​ ​problems Overview​ ​of​ ​my​ ​PhD​ ​research:​ ​Health-related​ ​burden​ ​among​ ​police​ ​cell​ ​detainees Conclusion

Adolescence You probably already know what adolescence is, given that you are right in the midst of it. However, I will provide a brief overview to set the scene for the talk. Adolescence is a developmental period in the life-cycle that equates approximately to the transition period from childhood to adulthood. This period is considered to be one of small transitions along numerous lines of development, rather than of an event, such as puberty. There is no generally agreed on age span to characterise adolescence, however, ages from 12-25 years are considered appropriate. Young people undergo many changes as they go through adolescence and increasingly take on adult roles and responsibilities. Adolescence is characterised by changes​ ​in: Physical development: this is often the most obvious set of changes in a young person as they​ ​grow​ ​and​ ​develop​ ​into​ ​their​ ​adult​ ​physical​ ​characteristics. Psychological development: some of the most significant psychological changes relate to the development of autonomy and independent identity. This often leads to the challenging of decisions and actions that they may have previously accepted, and often the discovering of new​ ​boundaries​ ​as​ ​they​ ​work​ ​to​ ​create​ ​their​ ​own​ ​identity. Cognitive development: the concrete thinking of childhood begins to move to more complex abstract thinking. Skills such as planning, prioritising, organising thoughts, suppressing impulses, problem solving and weighing consequences are developing and influencing the decision​ ​making​ ​process​ ​in​ ​young​ ​people. Emotional development: with lots of changes in thinking comes a range of emotions that the young person may not have experienced in the same way previously. While the young person is developing their own self-identity it is understandable that in this process they may experience more moodiness, irritability, and frustration. As these skills develop, their ability to manage these fluctuating emotions becomes more advanced. These changes also see the young person developing a greater sense of empathy, shifting from a focus of being self-centred​ ​to​ ​understanding​ ​more​ ​about​ ​the​ ​experiences​ ​of​ ​others. Social development​: while children generally see the family as an integral part of their life, many young people, while continuing to value the role of support of their family, begin to rely more on the support and guidance provided by their friends. In addition, they may also begin​ ​to​ ​seek​ ​out​ ​intimate​ ​relationships. Underlying a lot of these changes is the growth in the brain. I won’t go into what the brain is as​ ​Susan​ ​will​ ​cover​ ​this​ ​in​ ​the​ ​lecture.

Video​ ​of​ ​Susan​ ​Greenfield Susan Greenfield is a Professor of Synaptic Pharmacology at Oxford University. She is an influential neuroscientist, science communicator and policy adviser. Her research interests include: a. the impact of 21​st century technologies on the mind, b. how the brain generates

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consciousness, and c. novel approaches to neurodegenerative diseases, such as Alzheimer’s and​ ​Parkinson’s. The​ ​talk​ ​can​ ​be​ ​found​ ​via​ ​this​ ​link: http://www.abc.net.au/tv/bigideas/browse/speaker.htm?index=idx-big-ideas-speaker-susan-gr eenfield

Summary​ ​of​ ​Prof.​ ​Susan​ ​Greenfield’s​ ​talk Susan covered quite a lot of material, so it won’t be possible to go over everything that she spoke about. I will provide a summary of the first two aspects of the talk: a. the developing brain of a child / adolescent, and b. the environmental effects on the developing brain of a child​ ​/​ ​adolescent. The​ ​developing​ ​brain​ ​of​ ​a​ ​child​ ​/​ ​adolescent:​ ​the​ ​basics The brain of a child has a massive growth spurt. By the time children are six, their brains are already about 90-95% the size of an adult brain. But the brain still needs a lot of remodelling before it can function as an adult brain. The brain remodelling (plasticity) happens intensively during adolescence, continuing until a young person reaches their mid-20’s. This is what Susan spoke about as the process of a stimulating environment activating our brain cells to grow. This process creates more branches and connections between cells, giving related stimuli (such as the smell and touch of a special person) personal significance and uniqueness (e.g.,​ ​mother). Adolescence is a time of significant growth and development inside the brain. The main change that occurs is that unused connections in the thinking and processing part of our brains are ‘pruned’ away. At the same time, other connections are strengthened. This is the brain’s way of becoming more efficient, based on the ​‘use it or lose it’ principle​. This pruning process begins in the back of the brain. The front part of the brain, the prefrontal cortex, is remodelled last. The prefrontal cortex is the decision-making part of the brain, responsible for our ability to plan actions, solve problems and control impulses. Changes in this part continue into early adulthood. Given that the prefrontal cortex is still developing, teenagers might rely on a part of the brain called the amygdala (emotional brain) to make decisions and solve problems more than adults do. The amygdala is associated with emotions, impulses, aggression and instinctive behaviour. In effect this means that adolescents are working​ ​with​ ​brains​ ​that​ ​are​ ​still​ ​under​ ​construction. The​ ​other​ ​main​ ​point​ ​that​ ​I​ ​want​ ​to​ ​highlight​ ​from​ ​Susan’s​ ​lecture​ ​is​ ​that​ ​as​ ​our​ ​brains​ ​mature and establish greater connections, we make a transition from a sensory mode of functioning to a cognitive mode of functioning. Our sensory system is a part of the nervous system responsible for processing ​sensory information. Our sensory system consists of sensory receptors, neural pathways, and parts of the brain involved in sensory perception. Commonly recognized sensory systems are those for ​vision​, auditory (hearing), somatic sensation (somatic sensory system (including different parts of the body) - touch), gustatory (taste), olfaction (smell) and vestibular (balance/movement). In short, senses are transducers from the physical world to the realm of the mind / cognitive world, where we interpret the information, give​ ​information​ ​meaning,​ ​and​ ​create​ ​our​ ​perception​​ ​of​ ​the​ ​world​ ​around​ ​us. The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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As Susan mentioned, the prefrontal cortex is involved in planning complex cognitive behavior, personality expression, decision-making, and moderating social behavior. The prefrontal cortex lies in the frontal regions of the brain. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals. The most typical psychological term for functions carried out by the prefrontal cortex area is executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social control (that is, the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes). The prefrontal cortex is a region of the front part of the brain that is comprised of a collection of interconnected areas that sends and receives​ ​projections​ ​from​ ​virtually​ ​all​ ​parts​ ​of​ ​the​ ​brain. Digital​ ​technology:​ ​Effects​ ​on​ ​the​ ​adolescent​ ​brain? The aforementioned suggests that how adolescents spend their time is crucial to brain development. As such, it is worth thinking about the range of activities and experiences that adolescents are involved in. Susan described one such activity, the effects of a screen culture on the growing brain. By screen culture she meant sitting in front of any type of screen or digital​ ​techonology,​ ​such​ ​as​ ​a​ ​TV,​ ​video​ ​game,​ ​computer,​ ​smartphone,​ ​ipads,​ ​etc. Australian adolescents are no different from adolescents in the UK. They like to spend time in front of a screen. I dug up some quick statistics, and one source suggested that on average, young people consume almost 5 hours of media in a typical day (some tv time, internet time, etc).​ ​ ​However​ ​I​ ​think​ ​this​ ​is​ ​an​ ​underestimate,​ ​as​ ​this​ ​did​ ​not​ ​include​ ​the​ ​use​ ​of​ ​smartphones. I think Susan’s main point was that sensory experiences of the brain are over-riding the cognitive. The cognitive mode is concerned with content, understanding, contemplation, and deep thinking. She thought that the use of screen technologies might be skewing us towards a more sensory experience of life. The sensory experience of life is mostly concerned with process, that is, how to do something, the processing of information, without any deep level understanding. In this mode of existence, there is a lack of deep thinking involved and no attention is given to meaning and content. The over reliance on a sensory life can be detrimental​ ​as​ ​the​ ​cognitive​ ​mode​ ​of​ ​life​ ​is​ ​reduced. One apparent effect of the extended use of media technology is an increase in IQ (that is, levels of intelligence). It has been suggested that repetitively playing computer games may have increased people’s IQ. This is because as people use their hands more in these games, the connections responsible for controlling these movements (in the motor cortex part of the brain) are strengthened. These superior movements are then reflected in intelligence tests, as some​ ​of​ ​the​ ​tasks​ ​are​ ​motor-based​ ​tests. While there is no clear evidence to prove that an extended use of media technologies has a detrimental effect on the cognitive world, one line of evidence that Susan presented was Attention Deficit Hyperactivity Disorder (ADHD). ADHD is defined by impairing levels of inattention, disorganisation, and / or hyperactivity – impulsivity. Inattention / disorganisation entail difficulty staying on task, seeming not to listen. Hyperactivity entails over activity and fidgeting. This has resultant impairments in social, academic and occupational functioning.

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Susan suggests that the fast-paced media technology environment is making children susceptible to attention problems. That is, there is a constant need to seek out fast-paced stimulation, and that this in turn might have an impact on attention – creating shorter attention spans. There is certainly a lot of evidence to suggest that rates of ADHD are increasing, given the dramatic rise in the prescription of Ritalin (a medication prescribed for ADHD). Given that reading books is good for contemplation and developing deep thinking skills, I have​ ​listed​ ​some​ ​that​ ​you​ ​may​ ​be​ ​interested​ ​in: Reading​ ​resources​ ​for​ ​those​ ​that​ ​are​ ​interested http://www.susangreenfield.com http://thebrain.mcgill.ca/flash/d/d_04/d_04_cr/d_04_cr_peu/d_04_cr_peu.html#2 This​ ​is​ ​an​ ​example​ ​of​ ​what​ ​it​ ​means​ ​to​ ​use​ ​the​ ​amygdala​ ​to​ ​process​ ​information. http://thebrain.mcgill.ca/flash/d/d_05/d_05_cr/d_05_cr_her/d_05_cr_her.html This​ ​is​ ​an​ ​interesting​ ​hypothesis​ ​set​ ​forth​ ​by​ ​Paul​ ​McLean​ ​regarding​ ​the​ ​triune​ ​brain. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.sh tml Further​ ​information​ ​about​ ​ADHD​ ​can​ ​be​ ​found​ ​here. http://www.newscientist.com/article/dn9969-instant-expert-the-human-brain.html#.UtPb4_3J BuY This​ ​is​ ​an​ ​interesting​ ​website​ ​about​ ​the​ ​human​ ​brain. Books The​ ​private​ ​life​ ​of​ ​the​ ​brain,​ ​by​ ​Susan​ ​Greenfield The​ ​brain​ ​that​ ​changes​ ​itself,​ ​by​ ​Norman​ ​Doidge The​ ​shallows:​ ​what​ ​the​ ​internet​ ​is​ ​doing​ ​to​ ​our​ ​brains,​ ​Nicholas​ ​Carr Childhood​ ​under​ ​siege,​ ​by​ ​Joel​ ​Bakan Substance​ ​use​ ​problems The teenage brain is built to seek out new experiences, risks and sensations – it’s all part of refining those brain connections. But the self-monitoring, problem-solving and decision-making part of the brain – the prefrontal cortex – develops last. This means that young people don’t always have a lot of self-control or good judgment, and are more prone to risk-taking behaviours. Hormones are also thought to contribute to impulsive and risky behaviour​ ​in​ ​teens. Some common risk-taking behaviours among adolescents include fighting, truancy, alcohol use, illegal substance use (mainly smoking marijuana), tobacco smoking, dangerous driving and​ ​illegal​ ​activities​ ​such​ ​as​ ​trespassing​ ​or​ ​vandalism. The World Health Organisation have quantified the burden of disease and their associated

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leading risk factors. The burden of disease is measured as Disability adjusted life year (DALY). One DALY can be thought of as one lost year of ‘healthy’ life. The sum of these DALY’s across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal situation where the entire population lives to an advanced age, free of disease and disability. Alcohol and tobacco use are leading risk factors in accounting for a large proportion of the percentage of the global burden of disease.​ ​Alcohol​ ​and​ ​tobacco​ ​are​ ​the​ ​two​ ​most​ ​deadly​ ​drugs​ ​in​ ​Russia​ ​and​ ​globally. The World Health Organisation have completed a report regarding the level of alcohol consumption across different parts of the world. In this report, it was demonstrated that Russia​ ​is​ ​ranked​ ​as​ ​the​ ​highest​ ​in​ ​its​ ​level​ ​of​ ​alcohol​ ​consumption. Australians, however, are not too far behind. One only needs to look at recent news headlines: http://www.abc.net.au/news/2013-11-20/1-in-8-youth-deaths-linked-to-alcohol-ncd-report/51 05092 http://www.abc.net.au/news/2013-12-16/police-alone-will-not-stop-alcohol-violence/515837 6 I don’t want to spend to long talking about alcohol use problems, as I am sure that you have heard it all before. The reason that I wanted to bring it up here is that it illustrates the point made by Susan Greenfield, that we often engage in activities to have a good time or for a thrill,​ ​but​ ​don’t​ ​think​ ​about​ ​the​ ​consequences​ ​of​ ​our​ ​actions. Alcohol is a depressant drug, which means it slows down the messages travelling between the brain and the body. Suggested alcohol intake guidelines can be found here http://www.health.vic.gov.au/aod/alcohol/index.htm ​and http://www.druginfo.adf.org.au/drug-facts/alcohol Alcohol can enter the bloodstream very quickly. Unlike food, it doesn’t require digestion and once it is consumed it can reach the brain within minutes. Once alcohol is in the bloodstream it goes through to the liver, where it is estimated to take an hour to eliminate one drink – so if more alcohol is absorbed in the liver than what it can handle, excess alcohol will travel to all different parts of the body, circulating until the liver is finally able to process it. This will cause​ ​hangovers​ ​and​ ​leave​ ​you​ ​feeling​ ​tired​ ​and​ ​groggy. The risk of injury and disease increases the more you drink. Any drinking above recommended​ ​levels​ ​carries​ ​a​ ​higher​ ​risk​ ​than​ ​not​ ​drinking​ ​at​ ​all. There are a number of short-term and long-term effects of alcohol consumption – the extent of these effects will all depend on a few factors, such as the amount and manner in which people​ ​drink,​ ​and​ ​the​ ​size,​ ​weight​ ​and​ ​health​ ​of​ ​a​ ​person. Short-term​ ​effects​ ​of​ ​drinking​ ​to​ ​excess​ ​can​ ​be​ ​weight​ ​gain,​ ​hangovers​ ​and​ ​alcohol​ ​poisoning. The following may also be experienced: confusion, blurred vision, clumsiness, offensive and violent​ ​behaviour,​ ​memory​ ​loss,​ ​nausea,​ ​vomiting,​ ​passing​ ​out,​ ​coma​ ​and​ ​death. When drinking to excess people can also become more susceptible to other dangers, such as

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risk​ ​of​ ​injury,​ ​verbal​ ​or​ ​physical​ ​abuse​ ​and​ ​unsafe​ ​or​ ​unwanted​ ​sex. Long term effects / Regular use of alcohol may eventually cause: regular colds or flu, difficulty getting an erection (males), depression, brain damage, difficulty having children (males and females), liver disease, cancer, high blood pressure and heart disease, needing to drink more to get the same effect, dependence on alcohol, financial, work and social problems. Treatment​ ​options When alcohol use starts affecting health, family, relationships, work, school, financial or other​ ​life​ ​situation,​ ​then​ ​help​ ​may​ ​be​ ​required. There are a number of services available: withdrawal (detox), substitution pharmacotherapy, counselling (psychotherapy), rehabilitation, complimentary therapies (herbal / natural remedies), peer support (alcoholics anonymous), social support (housing / legal, etc), and family​ ​support. A​ ​good​ ​place​ ​to​ ​start​ ​is​ ​with​ ​your​ ​local​ ​doctor. Reading​ ​resources http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/ See Figure 7 in Report Part 2 for an illustration of the 19 leading risk factors that contribute to​ ​the​ ​burden​ ​of​ ​disease. http://www.who.int/substance_abuse/publications/global_alcohol_report/en/ The​ ​WHO​ ​report​ ​on​ ​alcohol​ ​and​ ​world​ ​consumption​ ​can​ ​be​ ​accessed​ ​via​ ​this​ ​link. www.turningpoint.org.au www.ysas.org.au PhD​ ​research:​ ​Health-related​ ​burden​ ​among​ ​police​ ​cell​ ​detainees I was involved in some research a few years ago now that investigated police responses to interactions with people with a mental illness. This was a joint project between Monash University and Victoria Police. There were a number of smaller projects within this broad topic, such as police interactions with victims of crime, and looking at use of force used by, and against, police. My contribution was an investigation of the health-related burden among police​ ​cell​ ​detainees. Plan​ ​for​ ​this​ ​part​ ​of​ ​the​ ​talk ● Background ● Methods ● Results ● Interpretation​ ​of​ ​findings​ ​/​ ​Implications Background

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An offender is someone who commits an illegal act. There are crimes against the law making responsibilities of the Commonwealth or the Federal Government, such as aircraft crimes and people smuggling. There are also crimes against the law making responsibilities of the States and Territory governments. These include abduction, assault, and drink driving, among others. Depending on the nature and severity of the crime, and taking into account other factors,​ ​such​ ​as​ ​prior​ ​offending,​ ​a​ ​person​ ​may​ ​be​ ​sentenced​ ​to​ ​imprisonment. According to some recent estimates, there are 10.1 million people held in criminal institutions throughout the world, mostly as pretrial / remand prisoners or as sentenced prisoners. In terms of pure numbers, almost half of the world’s prison population is held in the United States (2.29m), China (1.65m) and Russia (0.81m). In terms of prison population rates (per 100,000 of a national population), the United States is ranked highest, followed by Rwanda and​ ​Russia. What​ ​makes​ ​an​ ​offender? When we talk about why some people engage in offending behaviours, psychological research refers to this in terms of risk and protective factors. Risk factors are characteristics that indicate an increase probability of offending. They may be causally related to offending, or simply correlated with such behaviour. One risk factor alone is unlikely to lead to offending. Risk factors interact and accumulate in complex ways over time and at key life stages. Also, risk factors that have been identified at a population level may operate differently at the level of the individual. Protective factors are factors that mitigate the effect of​ ​risk​ ​factors,​ ​reducing​ ​the​ ​likelihood​ ​of​ ​future​ ​offending. Risk and protective factors tend to fall into one of two inter-related categories: social – environmental context, and individual development. It is important to know about risk and protective factors because it helps in targeting interventions, and the design of interventions that focus on the things that matter, such as building resilience, thereby tackling the underlying​ ​causes​ ​of​ ​offending. According to a dominant theory, called the Psychology of criminal conduct, there are eight central risk factors for offending. This work has been mostly done with adults. The central eight risk factors are: history of antisocial behaviour, antisocial personality pattern, antisocial cognition, antisocial peers, family and / or marital, school and / or work, leisure / recreation, and​ ​substance​ ​abuse. These risk factors are largely similar as those that have been found for violence perpetrated by youth. Some protective factors against violence perpetration include prosocial involvement,​ ​strong​ ​social​ ​support,​ ​and​ ​strong​ ​attachments​ ​and​ ​bonds,​ ​among​ ​others. Of those people in jails and prisons, we know that a large proportion of them are afflicted with a mental illness. Since the 1970’s, a large body of evidence has accumulated regarding the plight of those with a mental illness in the criminal justice system. Results from a large study that compiled all of this evidence together found that about 4% of prisoners are afflicted with a psychotic illness, 12% with major depression, 21% with antisocial personality disorder, 10-30% alcohol abuse and dependence, and 10-60% drug abuse and dependence. The rates of these illnesses are between 3 and 5 times higher among prisoners compared with people​ ​in​ ​the​ ​general​ ​community. The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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Mental illness is important to consider in the criminal justice system for many reasons. Some of these include: psychiatric disorders are a risk factor for suicide; there are high rates of mortality associated with psychiatric disorders; deleterious impact of the prison environment on mental well-being; and public safety considerations, to the extent that these disorders are related​ ​to​ ​future​ ​offending​ ​behaviours. The extant literature base however has focussed mainly on the back end of the criminal justice system, in jails and prisons, probably because this is a largely captive population. It is important to understand what is happening in police cells as police services are the first point of detention in the criminal justice system, following the alleged commission of an offence and arrest by the police. This means that the number of people passing through police cells are greater, with most individuals spending time in a police cell before imprisonment. However not all people in a police cell make their way through to prison, as some are released back into the community at this point. It is likely that the mental health related burden is greater in the police cell context. This is because some people may be diverted at this​ ​point,​ ​and​ ​some​ ​may​ ​receive​ ​treatment​ ​in​ ​police​ ​cells. The handful of studies that have been conducted in police cells support the notion of high levels of psychopathology. For example, one study conducted in the Netherlands found high levels of psychiatric symptoms, such as depression, were much higher among police cell detainees compared to the general population. This is all in the context of substandard conditions that detainees must spend their time in while awaiting their court hearing. Some of these conditions include poor quality of sleeping accommodation, uncleanliness of cells and lengthy​ ​time​ ​periods​ ​required​ ​to​ ​access​ ​health​ ​care,​ ​etc. It is therefore important that detainees with mental illnesses are accurately identified in the police cell context. The aims of mental health screening are: a. to identify those with a mental illness to provide timely access to treatment and improve their subjective well-being; b. to prevent violence and disruptive incidents in such settings; c. to allocate limited resources to those most in need; and d. to reduce cycles of admission between health, social and criminal justice systems. However, limited work has been conducted regarding the accuracy of screening​ ​tools​ ​in​ ​the​ ​police​ ​cell​ ​context. Aims: ​The aims of the project were to measure the health-related burden among police cell detainees,​ ​and​ ​to​ ​test​ ​the​ ​predictive​ ​utility​ ​of​ ​screening​ ​tools​ ​for​ ​mental​ ​illness. Methods Participants I conducted interviews with 150 police cell detainees across two police stations in metropolitan​ ​Melbourne. Procedure Custodial nurses offer all newly admitted detainees a health screen. These health screens are detailed yet non-standardised, and consist of questions regarding physical and mental health, use of medications and drugs/alcohol. Potential participants were approached by the researcher immediately following the completion of this health screen. Given that the health screening assessments with the custodial nurse were voluntary, some detainees refused this assessment. Attempts to approach this group to invite them to participate in the research were The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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made in one of two ways: (1) immediately following a visit from a professional, such as a lawyer, or (2) asking a police officer to transfer the detainee from the cell block to the secure interview room at a time when the interview room and the police officers were available. Potential participants were fully informed of study requirements, and the limits to confidentiality. If consent was provided, an interview was conducted and measures were administered in a secure interview room. Questionnaires were read out to all participants, and were​ ​reverse-ordered​ ​to​ ​control​ ​for​ ​interview​ ​fatigue. Measures Psychopathology The Structured Clinical Interview for DSM-IV-TR (Patient Edition) (SCID-IV) was used to assess mental disorders in the past month (current). The disorders evaluated were: mood, psychotic,​ ​substance​ ​use,​ ​anxiety,​ ​and​ ​eating​ ​disorders. Psychiatric​ ​symptoms​ ​were​ ​measured​ ​using​ ​the​ ​Brief​ ​Psychiatric​ ​Rating​ ​Scale.​ ​The​ ​measure is comprised of 24 items (e.g., suicidality, depression) rated on a 3-point scale, with higher scores​ ​indicating​ ​higher​ ​levels​ ​of​ ​psychiatric​ ​symptomatology. Standardised​ ​mental​ ​health​ ​screening​ ​tools Brief Jail Mental Health screen: This is comprised of 8 yes / no questions. Eg, ‘Do you currently feel that other people know your thoughts and can read your mind?’ This tool is designed​ ​to​ ​identify​ ​those​ ​with​ ​mood​ ​and​ ​psychotic​ ​disorders. Jail Screening Assessment Tool (JSAT). This is made up of various sections, including demographic, legal situation, suicide/self-harm issues and mental health. Referral criteria comprised self-harm ideation, suicide intent, current use of psychiatric medication(s) and previous psychiatric hospitalisations amongst others, and were scored simply as ‘yes’ or ‘no’. This​ ​tool​ ​is​ ​designed​ ​to​ ​identify​ ​all​ ​Axis-I​ ​disorders​ ​excluding​ ​substance​ ​use​ ​disorders. Situational​ ​factors​ ​measures Levels of satisfaction with physical conditions and services provided in police cells were measured using the Checklist of Physical Conditions in Police Cells. ​This was designed specifically for use in this study. It contains 24 items, including overcrowding, sleeping accommodation, cleanliness of the cells, lighting, heating, food, access to drinking water, access​ ​to​ ​health​ ​care,​ ​and​ ​access​ ​to​ ​fresh​ ​air​ ​and​ ​sunlight. The Camberwell Assessment of Need – Forensic Short Version (CANFOR-S) was used to measure individual needs across 25 common domains, considering both needs that are met by current interventions and those that remain unmet and ongoing problems despite any help being​ ​received. Results Sample​ ​characteristics The group of participants looks like most offender groups. They are mostly male, aged around​ ​30​ ​years,​ ​mostly​ ​unemployed​ ​single​ ​and​ ​born​ ​in​ ​Australia.

The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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Health-related​ ​burden The rate of mood disorders (e.g., depression) in this sample was 40%. Psychotic disorders were 7%, anxiety disorders 27%, and substance use disorders 59%. The rates are much higher among​ ​police​ ​cell​ ​detainees​ ​as​ ​compared​ ​with​ ​the​ ​general​ ​population. According to the needs assessment measure (CANFOR), participants reported having an average of 5 needs of a possible 25 need domains; a large proportion of these were considered​ ​to​ ​be​ ​unmet,​ ​thus​ ​representing​ ​ongoing​ ​difficulties​ ​for​ ​the​ ​participants. The most common unmet needs were in the area of insufficient money, limited friends / company,​ ​ongoing​ ​drug​ ​and​ ​alcohol​ ​use,​ ​and​ ​psychological​ ​distress. Screening​ ​accuracy The Brief Jail Mental Health Screen and the Jail Screening Assessment Tool were tested for their ability to detecting mental illnesses. The main point here is that the tools did reasonably well at picking up cases, but not so well at screening out cases without a mental illness. This can be a problem for service providers before it would over select people for further assessments. It is a problem in the context of under-resourced services. These results provide compelling evidence that increased accuracy in the detection of detainees with a current mental​ ​illness​ ​may​ ​be​ ​possible​ ​by​ ​using​ ​a​ ​standardised​ ​screening​ ​tool. We also demonstrated that personal factors, namely current psychiatric disorder (excluding substance use disorders) and history of psychiatric hospitalization were significant predictors of psychiatric symptomatology among detainees. Situational factors and the interaction between​ ​person​ ​and​ ​environment​ ​did​ ​not​ ​account​ ​for​ ​high​ ​levels​ ​of​ ​psychiatric​ ​symptoms. Implications Study​ ​findings​ ​have​ ​implications​ ​for​ ​the​ ​provision​ ​of​ ​medical​ ​services​ ​in​ ​police​ ​custody. Firstly, there is a real need to implement standardised mental health screening tools in custody. Regarding this, there are a number of practical implications with the implementation of such a tool that will need to be considered. In my view, while police officers may assist in observing behaviour among police cell detainees, it is healthcare professionals who should ultimately hold responsibility for the delivery of effective screening tools in police cells. This is because they are most able to build rapport with detainees due to their specific training in healthcare and their ability to assist detainees with their varied healthcare needs. Furthermore, detainees may not be willing to disclose personal health information to police officers, given that a police officer recently arrested the person and brought them into the police station. Other practical complexities include having the staffing levels and resources to complete the assessments, knowledge and expertise of mental illness is important, and ascertaining as much​ ​information​ ​in​ ​a​ ​limited​ ​amount​ ​of​ ​time. There is also a real opportunity to connect detainees with services if released back into the community with relevant services. This reintegration process of detainees back into the community does not occur currently. We know that the majority of police cell detainees will be released back into the community, depending on the nature of their crime. They are faced with many challenges when returning back into the community, and will most likely return to disadvantaged communities and situations that are crime producing. Their contact with police cell services may be an opportunity to change their trajectory, and link them in with services

The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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and treatment in order to help them not only cease their reoffending, but also to integrate into the​ ​life​ ​and​ ​activities​ ​of​ ​mainstream​ ​society. Perhaps one way to achieve this is to have an assessment of a person’s clinical and social needs, and public safety risks. This will help inform a plan for the treatment and services required to address the person’s needs. We could then identify required community programs responsible for the provision of services and then coordinate the transition plan to ensure implementation​ ​and​ ​avoid​ ​gaps​ ​in​ ​care​ ​with​ ​community-based​ ​services. To conclude this section on my PhD research, we can see that a lot of work is still needed in the​ ​police​ ​cell​ ​context​ ​to​ ​assist​ ​detainees​ ​reintegrate​ ​back​ ​into​ ​the​ ​community. Summary of talk so far: ​An excessive consumption of media technologies has an adverse effect​ ​on​ ​people,​ ​as​ ​does​ ​an​ ​excessive​ ​consumption​ ​of​ ​alcohol. General​ ​Conclusion An astute observer might notice that there was no Orthodox components in this presentation, so what relevance does all of this have for a young Orthodox person? This sounds like a university lecture on neuropsychology and forensic psychology! Indeed, you would be correct​ ​in​ ​thinking​ ​this. Orthodox adolescents and young people are subject to the same influences as the rest of the population. Therefore, the brains of Orthodox and non-Orthodox youth are subject to the same influences. This makes it imperative that we understand what these influences are, and the effect that they have on us. This is important as it points us in the direction to achieve the best possible upbringing for Orthodox youth, to encourage positive behaviour and promote good​ ​thinking​ ​skills. What do secular writers suggest? To encourage positive behaviour, we could consider: a. finding creative and expressive outlets for emotions: sport, music, writing, various art-forms, science, b. talking through decisions with parent(s) / guardians, c. structure and routines around school / family timetables, d. being praised for desired behaviours, e. having a positive role model, and f. having a warm and approachable relationship with parent(s) / guardian. To promote thinking skills we could a. talk about feelings. By sharing our feelings and thoughts we could learn from other people who may have a different perspective to share. b. consider immediate consequences of actions: thinking about the distant future may not be helpful, and c. develop decision making and problem solving skills. One way to achieve this is via role modelling (e.g., practicing a difficult social situation with a parent). And d. get lots of​ ​sleep. Role​ ​of​ ​Orthodoxy It may be clear from our previous discussion that human nature, as we know it, has got some serious problems. I have covered some secular approaches to these problems, such as treatments for alcohol use disorders. But, being Orthodox Christians, we also have at our disposal​ ​spiritual​ ​treatments. The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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First, let’s remind ourselves what Orthodoxy means. I quote from a sermon by Archbishop Averky of Syracuse and Holy Trinity Monastery: ‘Orthodoxy is the true, undistorted, unperverted by any human sophistry or invention, genuine teaching of Christ in all its purity and fullness – the teaching of faith and piety which is life according to the Faith.’ The Archbishop explains to us that Orthodoxy is the ​life according to the Faith in Jesus Christ. As such, it is not a once a week thing that we do to come to Church and put up a candle. Neither is it a theory. Orthodoxy is a life, an everyday direction that agrees with everything in the Faith. Again I quote from the Archbishop: ‘The true Orthodox Christian is not only he who thinks in an Orthodox manner, but who feels according to Orthodoxy and lives Orthodoxy, who​ ​strives​ ​to​ ​embody​ ​the​ ​true​ ​Orthodox​ ​teaching​ ​of​ ​Christ​ ​in​ ​his​ ​life.’ What then are the spiritual remedies to our corrupt human nature? These include prayer (both private prayer at home and also communal prayer in Church), keeping the fasts, attending Vigils, participating in frequent Confession and Communion, and reading the lives of the Saints. I think these things are the building blocks that we need to establish a spiritual life, these things will draw us closer to God, and through God, draw us closer to each other. Young people can also enhance their Orthodox lives by socialising with other Orthodox youth. Youth conventions, like this one, go a long way to establishing lasting and meaningful relationships. Participating in local Church activities, such as sporting events (e.g., playing table tennis, billiards), group outings, movie nights, theology classes, and even working bees, create friendships and encourage active participation in the broader Church community. Given that Orthodox youth are not immune to the influences in the world (you may recall that on page 10 it was mentioned that police cell detainees presented with many unmet needs, such as insufficient money, limited friends / company, ongoing drug and alcohol use, and psychological distress), participating in Church-based social activities can mitigate against these​ ​issues. I think adolescence is a wonderful time to learn more about the Orthodox Faith, and practice these remedies as they will strengthen us to fight the many temptations that come along our way​ ​in​ ​the​ ​modern​ ​world.

The​ ​developing​ ​adolescent​ ​human​ ​brain:​ ​a​ ​period​ ​of​ ​vulnerabilities​ ​and​ ​opportunities​ ​Gennady​ ​Baksheev

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