US states should ban solitary confinement for kids, doctors say

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What You Need to Know About Obama's Restrictions on Solitary Confinement

(Reuters Health) - Too many incarcerated U.S. children serve time in solitary confinement even though the United Nations and many physician groups believe this form of punishment amounts to torture and should be banned, some doctors argue.

U.S. President Barack Obama recently banned solitary confinement for juvenile offenders in the federal prison system, but most incarcerated kids are housed in state and local facilities that aren't covered by this ban, Dr. Mikah Owen and Dr. Jeffrey Goldhagen of the University of Florida note in an article in the journal Pediatrics.

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Extended periods of isolation are linked to a wide range of problems in adults including depression, anxiety, panic attacks, social withdrawal, insomnia, impaired vision, headaches and joint pain, Owen said by email.

While the effects in children aren't as clearly understood, they, too likely suffer from depression and other mental health problems resulting from solitary confinement.

"It's not really a developmentally appropriate way to discipline youth," Owen added. "The primary goal of the juvenile justice system should be to rehabilitate."

Precise statistics on youth in solitary confinement are hard to come by, but one report in 2010 found 35 percent of juvenile prisoners reported being held in some type of isolation, Owen and Goldhagen note.

More than half of kids in solitary confinement report being held in these conditions for more than 24 hours at a time, they also note.

Children are even more emotionally vulnerable to the negative effects of solitary confinement than adults because they are still developing and have less resilience to draw on, said Dr. Ian Lambie, a clinical psychologist at the University of Auckland in New Zealand who wasn't involved in the article.

"Put bluntly, they experience a sense of hopelessness and complete vulnerability, and a lack of sensory stimulation from the outside world," Lambie said by email.

"Any confinement needs to be for as limited a period of time as possible, allowing the young person to reintegrate into their surroundings," Lambie added. "If possible, it is important that they are let out for recreation, meals, etc."

The American Academy of Child and Adolescent Psychiatry recommends against solitary confinement for these reasons, and also notes that suicide risk is much higher for young inmates who are kept in isolation than for their peers who are in the general prison population.

But the leading group for U.S. doctors treating children, the American Academy of Pediatrics, has not issued recommendations on solitary confinement.

The AAP should call for a ban on the practice in the U.S. and worldwide, the authors argue. In the absence of an outright ban, correctional facilities should be required to report data on the use of solitary confinement and any adverse health effects.

Even when it's necessary to separate youth from adult prisoners to keep kids safe, solitary confinement and isolation aren't the right way to accomplish this, said Dr. John Rozel, a researcher in psychiatry and law at the University of Pittsburgh who wasn't involved in the article.

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US states should ban solitary confinement for kids, doctors say
Prisoners stand while being processed for intake at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. They arrive by the busload each Tuesday and Thursday, dozens of new inmates entering Georgiaâs prison system. Most stay only a week or two. But for those sentenced to die, this is their last stop. (AP Photo/David Goldman)
Frederick Harris, right, cuts the hair of Josh Harris, no relation, as he is processed for intake at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. When inmates arrive, their possessions are inventoried. Then they shower and don white jumpsuits. They sit in barber chairs while permanent inmates give them close haircuts, then pose for an ID photo. (AP Photo/David Goldman)
A motivational poster hangs on the wall as prisoners stand at attention while being processed for intake at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. The prison, the stateâs biggest, houses about 2,100 male inmates on a wooded, 900-acre campus about 50 miles south of Atlanta. A warden and three deputy wardens oversee more than 600 employees. (AP Photo/David Goldman)
Prisoner Ricky Wheat looks out from his cell at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. Inside the prison itâs loud and busy. Heavy metal gates clank open and shut. Inmates shuffle in single-file lines, guided by just a few guards. Chatter, shouts and the crackling of radios echo with nothing soft in sight to absorb the sound. (AP Photo/David Goldman)
A prisoner faces a mural painted by inmates on a cinderblock wall inside the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. When visitors approach, inmates in the hallways turn their backs and stand close to the walls. That makes it easy for guards to spot a guy who steps out of line. (AP Photo/David Goldman)
Capt. Dwain Williams checks on a prisoner in the the Special Management Unit, known as high-max at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. Face-to-face interaction is rare. The cells are only 7 by 13½ feet, and inmates canât see out unless guards slide back a metal cover over the grated opening on the door. Meals slide through an opening like a mail slot. (AP Photo/David Goldman)
An inmate looks out of his cell in the the Special Management Unit, known as high-max at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. A select few have glass instead of sliding metal doors as windows because theyâre known to hurt themselves and need extra supervision. Theyâre on the same row as others whose cells are behind a glass partition because they have a history of throwing things, including bodily fluids, from their cells. (AP Photo/David Goldman)
An inmate takes a GED exam at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. While many in high-max wonât ever be free, some will eventually get out. The GED program aims to help a relatively small number of inmates who will eventually get out be better prepared for release. (AP Photo/David Goldman)
Sgt. Michael Stovall looks through a set of security gates on death row at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. The inmates on death row have been convicted of horrific crimes, but they generally cause few problems according to prison Warden Bruce Chatman. Possibly because many still have appeals pending and donât want to risk jeopardizing a chance, however slim, that their lives could be spared, he said. (AP Photo/David Goldman)
Personal items sit on shelves of a prisoner's cell on death row at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. The 76 death row inmates live in four âpodsâ of neatly kept single-inmate cells measuring just 6½ by 9 feet and feature a bed, sink, toilet and shelves. (AP Photo/David Goldman)
Shoes sit under a prisoner's bed in his cell on death row at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. Georgia has executed inmates by injection since October 2001, when the state Supreme Court ruled electrocution violated the stateâs ban on cruel and unusual punishment. (AP Photo/David Goldman)
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A cell sits empty on death row at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. Once a judge signs an execution order, the warden meets with the inmate to read him the order, give him a copy and ask if he has any questions. The inmate doesnât return to death row but instead is held in the prisonâs medical area under 24-hour watch by two guards for the roughly two weeks until his execution date. (AP Photo/David Goldman)
A calendar hangs inside a prisoner's cell on death row at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. On the day of the execution, the condemned inmate can receive visitors until about 3 p.m., when heâs given a medical checkup and then brought to a holding cell near the execution chamber around 5 p.m. Heâs given his final meal and has an opportunity to record a final statement. (AP Photo/David Goldman)
Sgt. Andrew Archie walks through death row at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. The 76 death row inmates live in four âpodsâ of neatly kept single-inmate cells measuring just 6½ by 9 feet and feature a bed, sink, toilet and shelves. (AP Photo/David Goldman)
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Correctional officers are reflected in a puddle as they stand guard outside a yard for death row inmates at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. Inmates are allowed into the common area or into the outside yard in small groups of men who are known to get along. (AP Photo/David Goldman)
Deputy Warden of Security Keith Eutsey, left, and Warden Bruce Chatman walk to the execution chamber along rows of barbed wire at the Georgia Diagnostic and Classification Prison, Tuesday, Dec. 1, 2015, in Jackson, Ga. Death row inmates donât have far to go when their appeals run out. The chamber where lethal injections take place, a small room with a gurney, separated by a large pane of glass from the observation area, is on the grounds. (AP Photo/David Goldman)
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"The use of isolation and solitary confinement is often proffered as a stop-gap intervention," Rozel, who wasn't involved in the study, said by email. "But juvenile crime is neither new nor rare."

With advance planning, the practice shouldn't be necessary, said Dr. David Fassler, a psychiatry researcher at the University of Vermont College of Medicine in Burlington who wasn't involved in the article.

"The use of solitary confinement can and should be eliminated through adequate staffing, appropriate training and access to comprehensive assessment and treatment services for mental health and substance use disorders," Fassler said by email.

"President Obama's decision to end the use of solitary confinement for juveniles in the federal system sends a timely and important message," Fassler added. "Hopefully, it will encourage state legislators and correctional administrators to institute similar reforms."

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