Young men and young women in secure care: gender differences in the placement of those with mental health needs

Bartlett, Annie; Smith, Jared G.; Warner, Louise; Hales, Heidi

doi:10.1186/s12888-021-03440-7

Cited by 5 publications

(1 citation statement)

References 17 publications

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“…A considerable body of research exists on the gendered aspects of life in adult acute mental health facilities (3,4,(7)(8)(9)(10)(11)(12)(13). This literature is supplemented by research in specialized forensic (14)(15)(16)(17)(18), general hospital (19)(20)(21)(22), and outpatient mental health (23)(24)(25)(26) settings. Many papers examine the experiences of women (6, 7,11,12,15,18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46], while the perspectives of men are notably absent in much of the qualitative research.…”

Section: Introductionmentioning

confidence: 99%

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

et al. 2022

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BackgroundGender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, including how to ensure emotional and physical safety of those living and working in them.MethodsThis paper draws on a large study of the lived experiences of 42 staff and 43 service users from different acute mental health units in New Zealand. We conducted thematic analysis of interview data from four units with diverse architectural layouts to identify key themes central to decisions around gender and spatial design.ResultsKey themes emerged around gender-related trauma histories, safety perceptions and vulnerabilities, accommodation of gender-diverse and non-binary mental health service users, and gender-specific needs and differences. A further theme, of it goes beyond gender emphasized that there are many other non-gender attributes that influence vulnerability on the unit.ConclusionsWhile findings emphasize the need for safe places for vulnerable people, trauma-informed care, access to staff who “understand,” and recreation that is meaningful to the individual, we question if the dilemma of gender-separation vs. gender-mixing is an outmoded design consideration. Instead, we argue that a flexible, person-centered approach to provision of care, which values autonomy, privacy, and safety as defined by each service user, and that promotes choice-making, obviates a model where gender accommodations are fore. We found that a gender-exclusive narrative of vulnerability understates the role of other identifiers in dynamics of risk and vulnerability, including age, physicality, past violence, trauma history, mental unwellness, and substance use. We conclude gender need not be a central factor in decisions around design of prospective built unit environments or in occupational and clinical decisions. Instead, we suggest flexible spatial layouts that accommodate multiple vulnerabilities.

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Section: Introductionmentioning

confidence: 99%

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

et al. 2022

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Bringing ‘care’ back into locked residential institutions: What can we learn from adolescents' experiences of secure care?

Turcotte,

Fenchel

2024

Child Abuse Review

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In Canada and elsewhere, efforts have been made to regulate the use of secure care on welfare grounds. Yet, studies raise questions about its usefulness as a psychosocial intervention since it appears to be mostly experienced as a punishment. The main objective of the current study was therefore to explore adolescents' experiences of secure care. We conducted qualitative interviews with 25 adolescents aged 14 to 17 years old while they were placed in secure care units in the province of Quebec, Canada. Uncertainty regarding how to exit secure care was the most important theme that emerged. Participants did not always understand the words used by practitioners to frame their expectations. Adolescents were also uncertain about how to prove they no longer presented a risk to others or themselves while being in locked settings. This uncertainty generated a lot of anger and distress. To get some control back, adolescents chose to just comply and pretend to agree with practitioners. The present paper questions the utility and even legitimacy of secure care as it is currently used. However, we argue that if an ethic of care predominated our conceptualisation of secure care, rather than an ethic of justice, adolescents could feel both secure and cared for.

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Exploration of adverse patterns of placement of young people in secure care: The unwanted child?

Smith

Bartlett

Hales

2022

Criminal Behav Ment Health

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Background Emerging evidence suggests that distant placements and multiple moves may be detrimental to young people in care settings. Less is known about the characteristics of young people in secure care most affected by these processes. Aims This study examined distance from home and number of previous placements in English young people detained in secure care and their relationships with organisational and individual characteristics. Methods Data were derived from the (2016) cross‐sectional National Adolescent Study census of English young people in secure care, which included 1322 young people across secure mental health, welfare and Youth Justice establishments. Associations were described with odds ratios/95% confidence intervals (OR/CI). Results Overall, 285 young people (26.4%) were in secure placements over 100 miles from their family/local authority while 54 (5.6%) had 10 or more previous placements. These rates were higher in secure welfare than other settings (73.8%; OR (CI) = 9.62 (5.72, 16.18), 12.7%; OR (CI) = 2.76 (1.29, 5.91) respectively), and there was significant overlap between long‐distance placement and multiple placements (n = 22; OR (CI) = 2.26 (1.27, 4.04)). Younger age and presence of neurodevelopmental disorder were also associated with long‐distance placements while psychiatric diagnosis, previous secure placement, and previous service contact were linked to multiple placements. Conclusions Distant and/or multiple placements in young people in secure care appear common, particularly for those who are placed in secure welfare and who are younger and/or present with a psychiatric disorder. Multi‐agency evaluations that capture the longitudinal experience of these vulnerable young people are needed to understand how undesirable patterns of placement in secure care occur and prevent future instances.

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Young men and young women in secure care: gender differences in the placement of those with mental health needs

Cited by 5 publications

References 17 publications

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

Bringing ‘care’ back into locked residential institutions: What can we learn from adolescents' experiences of secure care?

Exploration of adverse patterns of placement of young people in secure care: The unwanted child?

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