Conclusions and recommendations
International human rights obligations
1.The UK has accepted international obligations, and incorporated certain obligations into domestic law, to ensure that children are not be subject to cruel, inhuman or degrading treatment. The Government must comply with its international and domestic obligations and ensure that children in detention are treated with appropriate care. (Paragraph 8)
Experiences and impact of restraint
2.There is substantial medical evidence of the physical and psychological impacts of restraint, particularly when used upon children. This evidence was brought into stark relief by the evidence of young people who had experienced these impacts, and parents who relayed the impacts upon their children. While restraint might seem to solve an immediate problem in custody or hospital, it causes harm in the short term and the longer term: it harms children, it harms staff, it undermines the objectives of detention, and contributes to a vicious circle of problems that can continue into the future including inhibiting life chances into adulthood. The use of restraint upon children can amount to inhuman or degrading treatment which is a breach of children’s rights. (Paragraph 17)
Rates of restraint of children
3.The data published about restraint in custodial settings and hospitals is not complete, and is hard to interpret. Each sector (health and custody) has datasets about restraint that are at once incomplete and also overlapping, making it difficult to obtain a clear picture of the issues. Furthermore, the different terminology used by each sector to describe essentially the same practices simply serves to complicate the making of comparisons. (Paragraph 20)
4.Despite the shortcomings in data collection, it is clear that in YOIs, STCs and hospitals a large minority of children experience restraints and separations; the average number of restraints and separations that these children experience is high. BAME children are particularly affected. From the evidence that we have heard, it is clear that some restraints are not justified on the grounds of ‘last resort’ to prevent harm. The available data about numbers of reported restraints suggest that potentially thousands of unjustified restraints are conducted each year. We conclude that rates of restraint of children in the custody estate and in hospitals are unacceptably high, and children’s rights are being commonly breached. (Paragraph 21)
5.We believe that the reported increases in the use of restraint in custody and hospitals are a combination of better reporting (showing that the problems are worse than previously thought) and actual increases (illustrating that the problems are becoming worse still). (Paragraph 23)
6.The issue must be tackled from both angles, with continued improvements in reporting in order to see the true scale of the issues, and action to reduce the need for restraint and separation, in all secure settings. (Paragraph 23)
Pain-inducing restraints in YOIs
7.There is clear evidence that the use of pain-inducing techniques (which are designed to cause pain and work by deliberately inflicting pain) on children inflicts physical distress and psychological harm in both the short and longer term, and it is clearly not compliant with human rights standards. (Paragraph 27)
8.We recommend that the use of specific pain-inducing techniques in Youth Offenders’ Institutes should be prohibited. We also recognise the right of prison officers to act in self-defence and we are aware that these issues are currently subject to review. (Paragraph 27)
Restraint for “good order and discipline” in YOIs
9.The use of restraint in YOIs for the purposes of ‘discipline and good order’ is not compliant with human rights standards, and is counterproductive for children’s rehabilitation and the development of beneficial relationships with staff.(Paragraph 31)
10.We recommend that the use of restraint for the purposes of ‘discipline and good order’ in Young Offenders’ Institutes be prohibited in all but the most exceptional circumstances, and that the guidelines produced by the Ministry of Justice and its agencies be updated accordingly. (Paragraph 31)
Prone (face-down) restraint
11.The use of prone (face-down) restraint is distressing and can be dangerous, and its use as anything but a last resort is not compliant with human rights standards for children. We believe that prone restraint is used too often. (Paragraph 34)
12.While we acknowledge that there may be exceptional circumstances in which prone restraint is preferable to alternatives, it must be more rigorously regulated by governing health bodies and regulators, including by annual publication of statistics for each institution (broken down by patients’ diagnoses, age and justification for not using an alternative method). (Paragraph 34)
Experiences and impacts of separation
13.We acknowledge that short-term separation has a role to play in allowing ‘cooling off’ after difficult incidents, and longer-term separation is sometimes necessary for medical observations and treatment, although it poses risks. Separation is not appropriate for other purposes. We conclude that the use of separation from human contact is harmful to children if used for more than a few hours at a time and, beyond that, it can amount to inhuman or degrading treatment that is a breach of children’s rights. (Paragraph 45)
Prevalence of separation
14.We are concerned that the data published about separation in custodial settings and hospitals is not complete, and is hard to interpret. Each sector (health and custody) has datasets about restraint that are at once incomplete and also overlapping, making it difficult to obtain a clear picture of the issues. Furthermore, the different terminology used by each sector to describe essentially the same practices simply serve to complicate the making of comparisons. (Paragraph 49)
15.In hospitals and custodial settings, children are separated from human contact (whether in their own room or in a particular unit) too often and for too long, where other options would be less harmful and more effective. The problem is even worse than is reported, due to some data not being collected fully and some data not being collected at all in particular for the separation of children in their own cells in YOIs. (Paragraph 50)
16.We recommend that all use of separation in all institutions is regulated and monitored, with data published annually by institution. (Paragraph 50)
Solitary confinement
17.Evidence over several years shows that incidents of separation can ‘drift’, so that children end up in what amounts to solitary confinement (at least 22 hours per day without meaningful contact) which may be prolonged (at least 15 days’ duration). This breach of children’s rights is not a policy decision by the Government, but it is within the power of Government to prevent it. (Paragraph 55)
18.We recommend that every decision, or review of a decision, by YOIs to extend a period of separation beyond 72 hours is reported to the responsible Minister on a monthly basis, who will certify the information and lay it before each House for publication. The information provided to the Minister should specifically highlight any separations that extend beyond 21 days. These figures should be simultaneously copied to the Independent Monitoring Board. (Paragraph 56)
19.We acknowledge that there are cases of children in custody who are so unwell, violent or afraid that it is difficult to know how to treat them. (Paragraph 58)
20.They should be moved to an institution that is equipped to look after them, or the institutions in which they reside should be reconfigured to enable them to adopt responses other than solitary confinement. (Paragraph 58)
21.The use of separation from human contact for medical observation and treatment must be weighed against the risks of distress and harm to the child. Some cases in hospitals amount to solitary confinement, which is not compliant with human rights standards for children. (Paragraph 61)
22.We recommend that the use of separation in hospitals be more rigorously regulated. Each institution in the health sector must report data on extension of separations to the responsible Minister on a monthly basis, who will certify the information and lay it before each House for publication. (Paragraph 61)
Availability and suitability of placements
23.The detention of children in institutions that are inappropriate to their needs contributes to the unacceptably high rates of restraint and separation. This includes children who have mental health issues but are detained in custody for criminal convictions, and children who are autistic or have learning difficulties who could be better cared for in community settings. (Paragraph 69)
24.The Ministry of Justice, the Department of Health and Social Security, and the Department for Education all have responsibilities for children in detention, and must increase their efforts to coordinate and reconfigure resources, to ensure that there are enough specialised placements (including in SCHs and CAMHS), so that each child can be placed in the most appropriate setting and as near as possible to home.(Paragraph 69)
Staffing levels, training and specialisms
25.Staffing levels are too low in YOIs, CAMHS and ATUs, and the mix of skills is insufficient, preventing the appropriate care of children and the optimal management of difficult situations, and contributing to the unacceptably high rates of restraint and separation. (Paragraph 75)
26.We urge the Government and agencies to take steps to increase the numbers of staff qualified to manage children across the Youth Custody Service, NHS England and their respective estates and contractors. The objective should be to ensure that there is an appropriate mix of skills, so that staff can manage difficult situations without recourse to restraint and separation. (Paragraph 75)
Rights, appeals and redress
27.We have heard compelling evidence that institutions are not doing enough to ensure that children in detention are made sufficiently aware of (and understand) their rights; or to ensure that children can have trust in the complaints system and the staff disciplinary system; or to ensure that parents and other representatives are made aware of the problems faced by children in detention. Even when children, their parents and representatives are made aware of their rights, they face obstacles when challenging decisions. (Paragraph 81)
28.We recommend that parents or other representatives should be informed of incidents and consulted about the appropriateness of interventions; that independent advocates should be given responsibility for proactively helping children to understand their rights; that debriefs about restraints and separation should allow the child to discuss the incidents with the staff who were involved; and that staff who have acted in breach of the rules must face disciplinary action that must be communicated to the child. There must be annual publication of statistics for each institution about appeals and their outcomes, including about disciplinary action against staff. (Paragraph 81)
29.This is an area in which the Independent Monitoring Boards are well placed to play a role. Any concerns they raise with respect to these issues should be seriously considered (Paragraph 82)
Published: 18 April 2019