Section 2. Background to the report enhancement unit (WADE) – a designated segregation unit – were held in separation conditions (on rule 49) with no access to education or gym, while others had more, albeit irregular, access to the regime. There was no plausible explanation for this discrepancy. At Wetherby, segregated children received daily outreach education and a weekly PE session supervised by gym staff. 2.12 Education provision for separated children also varied between units. In some units, education staff were able to run sessions for separated children but this was not always offered consistently as it depended on demand. For example, the segregation unit at Cookham Wood offered education every weekday morning but the frequency was determined by the numbers segregated, as education staff could only accommodate three children at each session. The prison’s Bridge unit ran education in groups where possible, although this was not available for children who were singly separated. Kinetic Youth (a youth work charity commissioned by the youth custody service) visited both units daily providing support and activity for the children, including activity packs and one-to-one sessions with those who requested it. Reviews and reintegration 2.13 We also found mixed practice on reviews and reintegration planning for separated children. At Feltham, regular review boards for separated children were better attended than we usually see, but targets set for children to reintegrate were often perfunctory and not adequately communicated to residential staff, who should have been instrumental in the reintegration of the children in their care. Cookham Wood held regular multi-agency rule 49 reviews for each child on the segregation unit, which were also well attended. We observed appropriate interactions with the children during reviews and all attendees were working to help them achieve their individual targets. The same was true for children separated on the Bridge unit, and conflict resolution staff also took part in the assessments to determine membership of the individual groups. At Wetherby, an excellent multidisciplinary meeting was well attended by key prison staff and managers to help direct and monitor reintegration work for all segregated children. This included those separated on normal location, for whom oversight had improved since the previous inspection. Individual management plans were raised for every child, and it was evident that staff supported individuals and addressed the issues that had led to their segregation. Multidisciplinary reviews were held for children separated under rule 49 and were well attended. However, plans for the child were not always agreed and documented at the review. Concerns about the use of separation 2.14 11 16 The Joint Committee on Human Rights published its report on solitary confinement and restraint in youth detention in April 2019.11 The report, citing evidence from the British Medical Association (BMA), stated that separation causes psychological harm with symptoms increasing with the length of confinement. The harmful effects include: ‘anxiety; depression; hostility, rage and aggression; cognitive disturbances; hypersensitivity to environmental stimulation; paranoia; and in the most extreme cases, hallucinations and psychosis.’ It also noted that children who are isolated even for short durations can experience ‘paranoia, anxiety and depression’, and that those isolated for extended durations ‘are more likely to attempt or commit suicide’. Joint Committee on Human Rights (2019). Youth detention: solitary confinement and restraint. Available at <https://publications.parliament.uk/pa/jt201719/jtselect/jtrights/994/99402.htm> accessed 24 October 2019. Separation of children in young offender institutions