Question: Do locked-up youth deserve behavioral healthcare? If so, who should pay for it?
Dr. Adam Sagot: It is essential that youth in juvenile detention centers receive healthcare in all domains. These individuals are at increased risk for symptoms associated with trauma and other psychiatric conditions. As they are being housed in state and federal facilities, the governmental level that manages the facility should be required to provide for all medical care to these individuals. Inmates of both adult and juvenile carceral settings are required by law to receive adequate medical healthcare, and behavioral healthcare is no different.
Juvenile detention facilities have the ability to subcontract with different pediatric subspecialists if they do not have providers in the facility with the adequate experience or knowledge to address specific concerns. As both a child/adolescent and forensic psychiatrist, individuals with similar training are uniquely qualified to provide psychiatric care in these settings.
Q: What does solitary confinement do to existing mental health issues in youth? Can it create mental health issues that weren’t there before?
AS: What we understand about solitary confinement is that it does not have a positive impact on anyone’s mental health, adults or juveniles. This is, of course, significantly worse for those with pre-existing mental health issues. The developing brain is vulnerable, and experiences in solitary could be the difference between the development of a mental illness that rises to the level of diagnosis versus simply experiencing less than ideal environmental stress. Individuals with risk factors, be they genetic or adverse childhood experiences are at risk of developing mental illness. We consider things such as solitary confinement to be a “threshold event,” one that might cause symptoms to be expressed in individuals that may never have hit the level of illness that reached criteria for a diagnosis to be established.
Q: In what situations is putting youth in solitary justified?
AS: There are situations in which “cool down” periods or “quiet rooms” are used in medical settings in the acute psychiatric hospitals with good effect. These instances still have significant components of monitoring, interaction with staff and do not typically last an entire day, let alone days at a time. While solitary confinement, which has many names that are not quite as eloquent or inoffensive, could play an effective role to reduce tensions surrounding an acute incident, it is not an appropriate solution when used for days on end.
