The BMA has called on the government to take immediate steps to end the solitary confinement of children and young people in the youth justice system, a practice with serious risks of causing long-term psychiatric and developmental harm.
In a joint statement with The Royal College of Psychiatrists and The Royal College of Paediatrics and Child Health, the BMA recommends the use of solitary confinement should be abolished and prohibited.
The BMA is also calling for adequate resources and staff in the youth secure estate to develop systems to manage and meet the needs of detained children and young people without recourse to solitary confinement.
Known by several names in the UK including isolation, segregation and single-unlock, solitary confinement involves depriving individuals of meaningful contact, in physical isolation, for a prolonged period – often for upwards of 22 hours per day.
It’s estimated that 38 per cent of boys in detention have spent time in solitary confinement1, with some held in conditions akin to solitary confinement for up to 80 days at one time.
This is often a result of widespread staff shortages and increasing levels of violence in institutions.
Until solitary confinement is completely abolished, the youth secure estate must ensure that the health needs of those in solitary confinement are met.
To assist doctors working in these challenging circumstances, the BMA has produced guidance for doctors 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.
“Various studies suggest solitary confinement does little to improve a young person’s behaviour, 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.
“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.”
Notes to Editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
1 - HM Chief Inspector of Prisons for England and Wales (2017) Annual Report 2016-17. HM Inspectorate of Prisons: London. 63.
- Read the joint position statement here, and the BMA's guidance to doctors here.