The Split System of Secure Mental Health Care for young people

By Dr Mindy Reeves, ST8 Dual Forensics CAMHS Psychiatry Trainee and
Dr Holly Wolton, ST8 Dual Forensics CAMHS Psychiatry Trainee

This article appears in our latest newsletter (Summer 2023) which can be downloaded here.

The 60 secure units for children and young people in Great Britain are not distributed
equally across England, Scotland, and Wales which can lead to young people being detained in locations that are far from home. These distances cause challenges for family members and professionals that want to visit the young person. The inability to have contact with family often causes a negative impact on the young person and their family. There can also be difficulties when making arrangements for the young person to attend Court. The units are run by different organisations including the NHS, private hospitals, local authorities, and charities which can led to each service providing a different package of care.

There are different acceptance criteria dependent on the unit. Some units have mixed gender populations but there is still variation in the arrangements of shared living spaces and educational areas. There is not currently a national policy regarding the placement of young people who identify as transgender or pregnant females.

There is a lack of secure beds available for young people with neurodevelopmental disorders and eating disorders.

Young people in secure settings deserve to receive the same care and treatment that they would receive in the community or general adolescent psychiatric units. They should also have access to education. The differences in secure settings across the United Kingdom make it challenging to offer equitable care planning for each child or young person as not every unit will be able to provide the indicated treatment or intervention.

Research will help to identify the gaps in the system. An international group of professionals has gathered information from 10 different countries to compare secure placements around the world (Souverein et al., 2022). The data which was comparable to UK findings showed multiple variances in these services. Further research is needed to promote discussions between provider collaboratives to ensure that the appropriate services are provided for children and young people within the secure setting.

Children, young people, and their carers should be given a voice so that they can advocate for themselves, in order to achieve optimal care and outcomes.

Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.

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Souverein, F., Hales, H., Anderson,P., Argent, S.E., Bartlett, A., Blower, A., Delmage, E., Enell, S., Eske Henrikseon, A.-K., Koomen, K., and Oostermeijer, S. (2022) ” Mental health, welfare, or justice: An introductory global overview of differences between countries in the scale and approach to secure placements of children and young people” Criminal Behaviour & Mental Health, 1-10.