CHAPTER 6 IMPACTS ON HEALTH OF CHILDREN DEPRIVED OF LIBERTY health.18 Second, the particular circumstances in which children are deprived of liberty may be harmful to health. For example, exposure to unsanitary conditions in justice-related detention may increase the risk of infection; concentration of people with infectious diseases such as tuberculosis and HIV in congregate settings such as immigration detention centres may promote the spread of infection; restrictions on movement and physical activity may adversely impact on physical development and increase the risk of obesity; inadequate diet may result in malnutrition; and experiences of trauma due to solitary confinement, abuse or neglect may produce or compound mental health problems.19 However, there are also some reasons to suspect that deprivation of liberty might be associated with improvements in some aspects of health, at least for some children, in some settings. Where children are deprived of liberty for therapeutic reasons, for example in response to acute mental illness or suicidal behaviour, appropriate psychiatric treatment in a least restrictive environment can be beneficial,20 although the evidence regarding when inpatient mental health care is most appropriate for children and adolescents is limited.21 In the context of extreme poverty and homelessness, children taken into institutional care may benefit from safe shelter, improved nutrition, and improved access to appropriate healthcare. Detention within the child justice system is, at least in most settings, inherently punitive, but even here there are some potentially positive health outcomes, such as delivery of overdue vaccinations,22 diagnosis and treatment of communicable diseases,23 and addressing social determinants of health through education and linkage to housing 18 Nicky Stanley, Siân Oram, Sharon Jakobowitz, Joanne Westwood, Rohan Borschmann, Cathy Zimmerman & Louise M. Howard C, ‘The health needs and healthcare experiences of young people trafficked into the UK’, Child Abuse and Neglect, Vol. 59, 2016, pp. 100-110. 19 Steven I. McLaughlin, Philip R. Spradling, Daniel Drociuk, Renée Ridzon, Carol Pozsik & Ida M. Onorato, ‘Extensive transmission of Mycobacterium tuberculosis among congregated, HIV-infected prison inmates in South Carolina, United States’, The International Journal of Tuberculosis and Lung Disease, Vol. 7(7), 2003, pp. 665-672; WHO, WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households, WHO/HTM/TB/2009.419, 2009; Kevin Whitley & John S. Rozel, ‘Mental Health Care of Detained Youth and Solitary Confinement and Restraint Within Juvenile Detention Facilities’, Child and Adolescent Psychiatric Clinics, Vol. 25(1), 2016, pp. 71-80. 20 Heather J. Hair, ‘Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003’, Journal of Child and Family Studies, Vol. 14(4), 2005, pp. 551-575; Marije Valenkamp, Kathleen Delaney & Fop Verheij, ‘Reducing Seclusion and Restraint During Child and Adolescent Inpatient Treatment: Still an Underdeveloped Area of Research’, Journal of Child and Adolescent Psychiatric Nursing, Vol. 27(4), 2014, pp. 169-174. 21 Devon Indig, Craig Gear & Ann York, ‘The role of inpatient care for children and adolescents with moderate-to-severe mental disorders: an Evidence Check rapid review brokered by the Sax Institute for the NSW Ministry of Health, September 2017, Available at https:// www.saxinstitute.org.au/wp-content/uploads/Inpatient-care-for-children-and-adolescents-with-moderate-to-severe-ment....pdf (Accessed 2 August 2019). 22 Emilien Jeannot, Tina Huber, Alejandra Casillas, Hans Wolff & Laurent Getaz, ‘Immunisation coverage among adolescents in a Swiss juvenile correctional facility’, Acta Paediatrica, 2016, pp. 1-3; Gregory L. Gaskin, Jason M. Glanz & Ingrid A. Binswanger, Arash Anoshiravani, ‘Immunization Coverage Among Juvenile Justice Detainees’, Journal of Correctional Health Care, Vol. 21(3), 2015, pp. 265-275. 23 David J. Templeton, ‘Sexually transmitted infection and blood-borne virus screening in juvenile correctional facilities: A review of the literature and recommendations for Australian centres’, Journal of Clinical Forensic Medicine, Vol. 13(1), 2006. pp. 30-36. Steven Belenko, Richard Dembo, Matthew Rollie, Kristina Childs & Christopher Salvatore, ‘Detecting, preventing, and treating sexually transmitted diseases among adolescent arrestees: An unmet public health need’, American Journal of Public Health, Vol. 99(6), 2009, pp. 1032-1041. 120