Isolation, segregation, separation, removal from association, single unlock: these names are used across detention settings to describe solitary confinement. Solitary confinement is where someone is physically and socially isolated from others for a period of time.
Its use is widespread in the youth justice system in the United Kingdom. It is estimated that up to 38% of boys in detention have spent time in solitary confinement, with stays of over 80 days being reported. There is also a growing practice of holding children in their own cells or rooms for upwards of 22 hours a day. This is largely due to staff shortages and increased violence in the youth justice system.
There is clear evidence that solitary confinement can have a profound, and lasting, adverse impact on health and wellbeing. As a result, we do not believe that its use can ever be sanctioned on children and young people.
It is clear that as long as the practice continues, the youth justice system must ensure that the health needs of those in solitary confinement are met.
When facing specific ethical dilemmas, doctors are strongly recommended to seek advice from the BMA medical ethics department, the General Medical Council, or their personal medico-legal defence body.
Core principles for doctors to keep in mind
Doctors working in the youth justice system are bound by the same principles of medical ethics as they would be in the community:
- doctors should not be involved, either formally or informally, in certifying a child or young person as ’fit‘ for solitary confinement
- doctors should raise concerns where they believe solitary confinement will be particularly damaging for a young person
- doctors should visit young people in solitary confinement regularly, and raise any concerns they might have about any deterioration in health and wellbeing
- doctors also have a more general duty to raise concerns about conditions which put patient safety at risk, or about practices which are abusive or negligent
- young people in solitary confinement have the same rights as other patients to confidentiality - however, they must be balanced against the risk of danger to the doctors involved in their care and the need for safeguarding
- young people at risk of suicide or self-harm should not be put into segregation units, other than when it has been deemed that it will reduce that risk
- if it is unavoidable, doctors working in these settings should seek to ensure regular interaction with the patient and raise concerns where they feel health is deteriorating.
The BMA’s position on solitary confinement
The BMA, along with our joint signatories, the Royal College of Psychiatrists (RCPsych) and Royal College of Paediatrics and Child Health (RCPCH) believe that children and young people detained in the youth justice system in the UK should never be subject to solitary confinement.
As children are still in the crucial stages of developing socially, psychologically, and neurologically, there are serious risks of solitary confinement causing long-term psychiatric and developmental harm.
There is also clear evidence that it is counter-productive. Rather than improving behaviour, solitary confinement fails to address the underlying causes, and creates problems with reintegration.
We have produced a full joint statement on our position, and recommendations to authorities on how to stop the use of solitary confinement.
Read the BMA joint position statement