Seclusion in young offenders' institutions - only as a last resort, say staff
Researchers working on a study of young offenders' institutions in Belgium, the Netherlands, Finland and the United Kingdom have found that secluding young offenders with psychiatric disorders after an aggressive incident is always a last-resort option for the staff responsible for their welfare. The study focused on forensic units ranging from 8 to 12 beds, treating young offenders with problems such as severe mental health disorders, delinquent, violent and non-compliant behaviour and impulse control problems. 'Adolescent aggressive behaviour poses a challenge for staff working in forensic units, which cater for 12-to-18-year-olds who have been in trouble with the law, because it occurs so frequently,' says lead study author Johanna Berg from the University of Turku, Finland. 'Our study of units in Belgium, Finland, the Netherlands and United Kingdom found that while the principles of dealing with aggression were fairly similar, there were some differences in the practical solutions.' Their findings, presented in the Journal of Psychiatric and Mental Health Nursing, are based on one-to-one interviews with 58 staff members including nurses, doctors, psychologists, social workers, sports instructors, educators, support workers, and occupational, art and family therapists. The team found that across the board, verbal intervention was the preferred course of action and was most effective when it was clear, structured and used in the early stages of aggression. Talking about the incident afterwards was also very important, so that both the young person and the staff member could reflect on what had triggered the incident and how a repeat could be prevented in future. Seclusion, which is banned by legislation in Finland, remains legal in Belgium, the United Kingdom and the Netherlands. Yet in these countries, putting adolescents in a bare, locked room was still viewed as the least favoured option. Isolation techniques ranged from separating the aggressive youngster from peers for 5 to 15 minutes so they could calm down, to seclusion, which was only used when less restrictive interventions had failed. The team found that when it came to medication, the staff member and the young person jointly took the decision on whether it should be taken. Forced medication was used on rare occasions and only where safety was seriously compromised by aggressive behaviour. 'Staff in all four units displayed high ethical standards when it came to the use of restrictive treatment measures,' explains Johanna Berg. 'They endeavoured to cooperate with the adolescent as long as possible and avoid coercive measures, while still maintaining the safety of others.' Factors at play when determining the appropriate level of response included the level of aggression involved, how well staff were acquainted with the individual's behaviour, and what had proved effective in the past. The staff who took part in the study also emphasised the importance of teamwork, and that all members of the multidisciplinary team needed to be committed to therapeutic aggression management. Based on their observations, the researchers put together some clinical practice recommendations. They believe that continual education is necessary to make sure staff members know how to evaluate incidents and implement the safest and most effective practices when intervening in aggressive situations. They also recommend that sufficient resources be made readily available so that the needs of adolescents can be met without compromising the safety and well-being of the staff that care for them. Such a strategy helps retain skilled staff in a challenging working environment.For more information, please visit:Journal of Psychiatric and Mental Health Nursing:http://www.wiley.com/bw/journal.asp?ref=1351-0126&site=1
Countries
Belgium, Finland, United Kingdom