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Ban solitary confinement of teens to protect their mental health, health leaders urge

BMA and royal colleges call for immediate changes to be made to youth justice system

Caroline White

Thursday, 19 April 2018

The solitary confinement of children and young people in the youth justice system should be banned, with immediate effect, say health leaders.

In a joint statement, The Royal College of Psychiatrists, The Royal College of Paediatrics and Child Health, and the BMA say the practice poses serious risks of causing long-term psychiatric and developmental harm.

They call on the government to take prompt action to impose a ban on solitary confinement, also known as isolation, segregation and single-unlock.

The practice involves depriving individuals of meaningful contact, in physical isolation, for up to 22 hours a day.

It’s estimated that 38% of boys in detention have spent time in solitary confinement, with some held in similar conditions for up to 80 days at one time, which is often prompted by widespread staff shortages and increasing levels of violence in institutions, says the BMA.

It is also calling for adequate resources and staff to develop systems to manage and meet the needs of detained children and young people without recourse to solitary confinement.

To assist doctors working in these challenging circumstances, the BMA has produced guidance for those working in the youth justice system to maintain the highest ethical and professional standards.

The guidance maintains that a doctor must never certify individuals ‘fit’ for solitary confinement when assessing a patient’s health and wellbeing.

BMA medical ethics committee chair, Dr John Chisholm, said: “Solitary confinement has no place in the youth secure estate and must be immediately replaced with alternatives which can better provide for young people’s health needs.

“Until this harmful practice is abolished, there is a duty for authorities to ensure the health needs of those being detained are met and doctors aren’t obstructed in their ethical duty to put their patient’s needs above others.”

The evidence shows that the practice doesn’t improve young people’s behaviour, he insisted.

“It makes it more difficult for them to reintegrate into communities and is counter-productive. What’s even more concerning, is the increased risk of suicide and self-harm in those placed in solitary confinement.” 

He added: “Doctors working in these institutions are acutely affected by the competing aims of the secure environment and healthcare, and it’s at the heart of the difficulties our members report to us when working in close proximity to solitary confinement.”

Dr Alison Steele, Child Protection Officer for the Royal College of Paediatrics and Child Health, said the effects of solitary confinement on children and young people were “profound” and left underlying issues unaddressed with potentially “devastating consequences.”

She added: “Children and young people held in secure settings have three times the prevalence of mental health disorders compared to the general population, with depression and anxiety being the most common. A large number – over 50% – also have learning disabilities.”

Dr Heidi Hales, chair of the Forensic Adolescent Special Interest Group, Royal College of Psychiatrists, said the effects of solitary confinement were even more damaging for children and young people than they were for adults.

“Banning this process in our youth justice establishments is an important step in the right direction. Punishment of young people for punishment’s sake brings out the worst in some young people and does nothing to help them become a positive member of society.

“Keeping them busy and active and helping them to value themselves, will reduce their risk of violent behaviour. Solitary confinement, meanwhile, will likely make them worse.”

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