Section 2. Background to the report 2.15 Separation can also reinforce existing mental health problems. Evidence in the report from the Royal College of Psychiatrists (RCP) looking at child and adolescent mental health services (CAMHS) and custody explained that: ‘When a young person with mental health and/or emotional difficulties is denied two hours of meaningful contact and so enters a state of solitary confinement, their mental health problems and/or emotional difficulties are likely to be significantly exacerbated’.12 The RCP stated that this risk is particularly acute due to the high prevalence of pre-existing issues for young people in secure settings. 2.16 Finally, the Joint Committee’s report described how separation can in itself undermine the aims of detention. For example, children in YOIs who are separated from others will miss out on the usual routines, such as the weekly planned 30 hours of education and two hours of physical exercise. The Children’s Commissioner’s evidence to the report noted that isolation can contribute to reoffending: ‘Children often come to the secure estate establishments from very complex backgrounds, which means that they have previously lacked structure and guidance in their lives and that emotional regulation is difficult for them to grasp. Prolonged or frequent isolation can often serve to worsen these problems as the children fail to learn the important lessons of social order and interaction which they will need when they leave the establishment. In that sense, isolation can have a long-term negative impact on a vulnerable child and can contribute to the perpetual vicious cycle of release and re-offending. This would also explain an earlier finding of this study, that the children who were isolated once are likely to be isolated again.’13 2.17 The BMA had previously recognised the profound impact that solitary confinement can have on children in its guidance for doctors working in the youth justice system. The guidance reiterates the key role played by doctors when children are separated. BMA Guidance for doctors working in the youth justice system14 - 12 13 14 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 child or young person Doctors should visit children and 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 Children and young people in solitary confinement retain the same rights as other patients to privacy and confidentiality, but these rights are not absolute. They must be balanced against the risk of danger to the doctors involved in their care, and the need to share information in order to safeguard children and young people Ibid. <https://publications.parliament.uk/pa/jt201719/jtselect/jtrights/994/99402.htm> Ibid. <https://publications.parliament.uk/pa/jt201719/jtselect/jtrights/994/99402.htm> British Medical Association (2018). The medical role in solitary confinement: Guidance for doctors working in the youth justice system. Available at <https://www.bma.org.uk/collective-voice/policy-and-research/equality/the-medical-role-in-solitaryconfinement> accessed 9 December 2019. Separation of children in young offender institutions 17