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Responding to Violence, Suicide, Psychosis and Trauma

Physical restraint of volatile young offenders

Physical restraint of volatile young offenders is both controversial and risky. So why are ministers keen on rule changes that could see it used more widely?

Jon Scott, Wednesday November 28 2007, The Guardian

 

 

Watching CCTV footage during a visit to one of England’s four privately run secure training centres (STCs) for young offenders, I see a girl who, I am told, had grabbed the duty manager by the collar as he was sitting on her bed talking to her. A female officer, also in the room, raises the alarm. On the laptop screen, I see responding staff go into the girl’s room, then emerge a couple of minutes later with the girl, using what is known as Phase 3 restraint.

 

That’s when I recognise her: a quiet girl I had talked to earlier in my visit. Six staff are involved in restraining her: two on the legs, one on each arm, one with a hand under the back, and one holding the head. It’s not pretty.

 

Unsurprisingly, the Youth Justice Board (YJB) was nervous about my visit to the STC; a prerequisite for access was that I did not reveal which one. STCs have been stung by criticism after two youngsters in their care died within three months in 2004. Fifteen-year-old Gareth Myatt choked to death at Rainsbrook STC, near Rugby, while under restraint by staff, and 14-year-old Adam Rickwood hanged himself by his shoelaces hours after being restrained at Hassockfield STC, near Durham. Both cases attracted widespread press attention.

 

A damning investigation by Liberal Democrat peer Lord Carlile, on behalf of the Howard League for Penal Reform, into physical restraint, solitary confinement and forcible strip-searching, and a subsequent debate in the House of Lords, have helped keep up the pressure for an accurate picture of how such practices are carried out.

 

According to the Howard League, getting across the seriousness of issues around restraint, such as when it is used inappropriately and its long-term consequences, is an uphill struggle. “I think people don’t understand why this is such a big issue,” a spokesman says. “One of the things we are really concerned about when it comes to restraint in STCs is that these are troubled kids who have often experienced neglect and abuse – sexual or emotional – and they may provoke restraint to get attention.

 

“They are used to the language of abuse. One girl [told us] that, for her, it was a way of getting her anger out. It was a kind of catharsis. What often happens is restraint [reinforces] behaviour and they end up leaving the STC more resentful. It perpetuates the language of violence, which is all a lot of them know.”

 

In July, the government announced a review of restraint across all juvenile secure settings. Its two co-chairs, nominated last month, will examine the medical safety and “operational efficacy” of restraint techniques, and better ways to manage volatile children. The 2,574 recorded incidences of restraint of children in STCs between February 2006 and March 2007 (there are around 250 young people in STCs at any time) suggest there is plenty of scope.

 

When I meet the director of the STC, he explains that of the 58 children in his care, two-thirds are boys, most aged 14 to 16; the girls, on average, are slightly older. He is keen to establish that his staff-to-trainee ratio (trainee is the name given to young people in the youth justice system) is three times higher than in a young offender institution (YOI) – hence triple the cost per head – but lower than in a secure children’s home. Children sent to STCs tend to be more vulnerable, although their offences may still be serious, he says. At the time of the visit, his staff were caring for three murderers and a serious sex offender.

 

Justified scrutiny

 

During lunch, the director fields questions from boys crowding round the table, who address him by his first name as he vents frustration at what he terms “this myth” about STCs. “Obviously, the tragedies were horrendous,” he says, “and it’s right we are scrutinised. But we’ve had thousands of young people through the doors, from the tiny 13-year-old boy with ADHD [attention deficit hyperactivity disorder] who fights with absolutely everyone, to the 16-year-old girl who has been on the streets. Almost all come from chaotic backgrounds, many have not been to school for years, have suffered violent or sexual abuse, and arrive here with a chronic drug or alcohol habit. That’s why all our senior team here are qualified social workers.”

 

Much of the afternoon is spent in the STC’s healthcare facility talking to one of five full-time nurses, and in the substance-misuse department, where I learn that some recent arrivals had been downing a litre of vodka a day. It’s then on to education, where we drop in to a “beauty clinic”, then craft, design and technology, and a catering class. In an information and communication technology class, I notice a boy learning to use a spreadsheet. He tells me he’d been excluded from school in year 5 [aged 9-10] and that he had not been back since.

 

The buildings, none more than eight years old, are in good order, and the site – the size of a secondary school – is clean enough for my guide to be embarrassed about scuff marks made when pushing a trampoline into the sports hall. We also walk past two artificial football pitches, just relaid, on our way to the “Champions” unit, for boys whose good behaviour has earned them extra privileges. There, five adolescents are slouched on the sofa in front of a gigantic TV, half-shouting to each other over a blaring pop video.

 

A care officer asks the boys if I can see their rooms, then unlocks two. Larger than their YOI equivalents, the rooms are also more homely, helped by large, barless windows and rugs on the utilitarian, checked carpets. In common with a YOI, posters of women in bikinis and the odd photo plaster the walls.

 

As we walk to the adjoining unit, a tall boy is playfully slapping a much smaller lad on the head. “He started it,” shouts the tall one, pointing to another boy, who begins running around wielding a pool cue, half shrieking, half laughing. Two circuits later, plus many staff requests to “stop it!”, he is running at the tall boy, cue raised, when a care officer grabs the weapon, put her arm round the back of the small boy and ushers him towards a residential manager five yards away, who takes him by his forearm into another room.

 

The small number of boys on the unit meant it never felt unsafe, but the director says to me afterwards that the boy does actually hit people with cues, and he could have resisted the manager’s arm. “Even so, that ‘caring gesture’ – to use children’s homes terminology – is what we call a Phase 1. It counts as a restraint statistic and requires paperwork to be filled in.”

 

Back in his office, the director reminds me that physical control in care, known as PCC, is used only in STCs, and comprises three phases in all. The first two essentially mean taking a young person by the hand or arm, but the third is an escalated response, involving multiple staff. PCC is also meant to be “non-pain compliant”, meaning that pain should be inflicted only if the behaviour puts people in danger.

 

The director shows me the restraint statistics for last month. Out of a total of 57 incidents, 38 concern only three boys. “September was higher than normal, and it only takes a few characters to really escalate our figures,” he explains. Of those 57 restraints, 16 were Phase 1, and 12 were Phase 2. No child is restrained using Phase 3 during my day-long visit.

 

The director admits that he has concerns about the lack of consistency across secure juvenile facilities. And he does not object when I suggest that the six-month government review of restraint is long overdue. “The YJB have got to be brave about the restraint issue,” he says. “They’re looking for other people to make the decisions for them. For instance, we had to go and find our own de-escalation tool ourselves, and came up with therapeutic crisis intervention, which has halved our restraint figures since we introduced it 18 months ago. Normally, though, we don’t have time to be creative because we’re busy meeting targets.

 

Action plans

 

“We have two full-time YJB monitors on site who produce a monthly report, we’re due a two-and-a-half-day unannounced Ofsted inspection some time after Christmas, and then an announced five-day one in July,” says the director. “Sometimes, it seems all we do is implement action plans – so if we’re told to do things differently, we will.”

 

According to the Howard League, the YJB responded to recent criticism of deaths involving restraint by widening the conditions under which restraint can be used. This, they say, puts even greater responsibility on the forthcoming government review to identify improvements. Inquests had found that restraint was being used inappropriately to force young people to comply with orders from staff. “Rather than deal with this, the YJB changed the rules,” the Howard League spokesman says. “The original rules around restraint were very clear, but then the YJB added that it could also be used to maintain ‘good order and discipline’. The YJB argued that it clarified things, but what it actually means is more vagueness.”

 

To see this story with its related links on the Guardian Unlimited site, go to http://www.guardian.co.uk/society/2007/nov/28/guardiansocietysupplement.youthjustice

 

Copyright Guardian Newspapers Limited 2007

 

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Filed under: Uncategorized, Violence, , , ,

‘Speed Of Thought’ Guides Brain’s Memory Consolidation

This could be important in understanding the processing of traumatic mmemories

ScienceDaily (Nov. 16, 2007) — Scientists at The University of Arizona have added another piece of the puzzle of how the brain processes memory.

Bruce McNaughton, a professor of psychology and physiology, and his colleague David Euston have shown that, during sleep, the reactivated memories of real-time experiences are processed within the brain at a higher rate of speed. That rate can be as much as six or seven times faster, and what McNaughton calls “thought speed.”

Memory stores patterns of activity in modular form in the brain’s cortex. Different modules in the cortex process different kinds of information – sounds, sights, tastes, smells, etc. The cortex sends these networks of activity to a region called the hippocampus. The hippocampus then creates and assigns a tag, a kind of temporary bar code, that is unique to every memory and sends that signal back to the cortex.

Each module in the cortex uses the tag to retrieve its own part of the activity. A memory of having lunch, for example, would involve a number of modules, each of which might record where the diner sat, what was served, the noise level in the restaurant or the financial transaction to pay for the meal.

But while an actual dining experience might have taken up an hour of actual time, replaying the memory of it would only take 8 to 10 minutes. The reason, McNaughton said, is that the speed of the consolidation process isn’t constrained by the real world physical laws that regulate activity in time and space.

The brain uses this biological trick because there is no way for all of its neurons to connect with and interact with every other neuron. It is still an expensive task for the hippocampus to make all of those connections. The retrieval tags the hippocampus generates are only temporary until the cortex can carry a given memory on its own.

“It’s a slow process,” said McNaughton.

“The initial creation of the tag is made through existing connections. In order to do the rewiring necessary to have the intermodular connections carry the burden takes time. What you have to do is reinstate those memories multiple times. Every time you reinstate the memory, the modules make a little shift in the connection . . . something grows this way, grows that way, a connection gets made here, gets broken there. And eventually, after you do this multiple times, then an optimal set of connections gets constructed,” Mc Naughton said.

The brain is generally thought to do all of this during sleep, specifically slow-wave sleep, when the brain is not busy with processing real-time inputs. McNaughton has developed the technology to record from multiple probes, each of which can track the activity of a dozen or more brain cells.

“We need groups of cells because in order to identify a pattern, you have to look at the collected activity of many neurons,” McNaughton said. His previous research has show that cells that fired during activity prior to sleep, also fired in the same sequential patterns during sleep. During sleep, the hippocampus sends little, 100-millisecond bursts of activity to the cortex as much as three times per second.

What remains is finding an experiment that will enable researchers to demonstrate that changes in the memory reactivation process would affect memory consolidation but not damage the brain in the process.

“The more practical point, I think, is that this methodology, the ability to measure how fast the brain is processing at the level of changing the state of the brain from one 10- millisecond epoch to the next, how fast the internal state is sweeping through its memories or its allowable patterns is, I think, a model for thought speed,” McNaughton said.

Knowing the determinants for the speed of thought, he said, might allow studies of the effects of drugs, developmental anomalies and the behavioral therapies that might improve them.

Adapted from materials provided by University of Arizona.

 University of Arizona (2007, November 16). ‘Speed Of Thought’ Guides Brain’s Memory Consolidation. ScienceDaily. Retrieved November 17, 2007, from http://www.sciencedaily.com­ /releases/2007/11/071115164450.htm

Filed under: trauma, Uncategorized, ,

Difficult, Disturbing and Dangerous Behaviour Course – London

Just a note to say that there are still places on the Homeless Link course in London on 22 November 2007. If you are interested, please contact Kaite Welsh [kaite.welsh@homelesslink.org.uk].

Filed under: Impact Training, , , , ,

Suicide and Personality Disorder – a breakthrough?

 
The Wallingford Group, which is part of the Thames Valley Personality Disorder Initiative, has led to 100 per cent reduction in the number of suicide attempts, a 97 per cent fall in psychiatric admissions, a 70 percent fall in the GP attendance and an 88 per cent decrease in the number of self harm incidents.Meanwhile, the Haven in Colchester believes that there has been a significant reduction in service usage among the 110 registered clients who were treated.

Police, probation and prison intervention was reduced by 84 per cent, debt agencies were contacted almost 86 per cent less, A&E usage dropped by 45 percent and there was an 81 per cent reduction in contact with housing and homelessness organisations.

Although these results are preliminary, independent evaluation of all the pilot services is in progress through the Institute of Psychiatry and Imperial College, and will be completed in 2008.

The programme was part of a scheme, initiated through partnership between the Department of Health, Ministry of Justice and the National Institute for Mental Health which developed specialist therapeutic services for people with personality disorders.

Personality disorders affect 10-13 percent of the adult population, are more common in younger age groups (25-44 yrs) and are equally distributed between males and females.

They are a result of abuse, neglect or a traumatic experience, which results in people behaving in ways that others find unusual.

As part of the programme, 11 community pilot services were introduced throughout the country which provided varying treatment and support for adults diagnosable with personality disorders.

The scheme ran from 2003 until March 2007, when responsibility for funding the pilots was passed to their local PCTs.

Maria Duggan, National Personality Disorder Team, Department of Health says:

“These initial results are very encouraging and are a great credit to the individuals who have put so much time and effort into helping those with personality disorders.

In a relatively short space of time, we now have a much better understanding of the services that should be available to those with personality disorders and the benefits these can reap.

We now need to ensure that there is uniform support across the country rather than the patchy provision available at present.

However, what is most heartening is that there is now a greater hopefulness that personality disorder need no longer be a diagnosis of despair.”

All treatments were tailored to the client group and were relatively long term. Breakthrough approaches in this programme included crisis services, respite beds, centres being open 24 hours a day, group analytic approaches, informal outreach and engagement, assessment and therapeutic interventions and a very comprehensive day time therapy which included art therapy.

Art therapy is an important element of the treatments used and very popular with personality disorder clients who are known to be particularly creative.

In recognition of this creative impact, a group of service users and carers from the National Personality Disorder programme steering group formed Personality Plus, a community interest company designed to raise awareness of personality disorder through the arts and other creative media.

In celebration of the completion of the pilot phase of the National Personality Disorder Programme, Personality Plus will hold an exhibition and interactive event at the Tate Modern on 29 October.

This event, supported by an Arts Council Grant and the Tate Modern, will provide a platform for artistic and creative materials, produced by people who have personality disorders or are closely involved with people who have the diagnosis.

The exhibition will then move around the country.

Rex Haigh, psychiatrist with the Thames Valley initiative, says:

“Although personality disorder affects around one in ten of us, everybody has a personality, and nobody is perfect. People can be very unsympathetic to any behaviour they see as ‘different’, but it’s important to understand that personality disorder often stems from some sort of trauma – so what people really need is our acceptance and understanding.

Many people find that art is a really useful way to get to grips with difficult emotions, and we hope that exhibiting some of this artwork will demonstrate that people with personality disorder are not so different from anyone else.”

Reg McKenna, Chairman of The Haven said:

“For many people with personality disorder, the lack of understanding they encounter from others – including family, friends and professional services – means that they become even more isolated.

However, many organisations are leading the way in working with people to prove that it is possible to overcome the difficulties associated with personality disorder, and lead a satisfying and successful life.”

Filed under: Suicide, , , ,