Do secure units punish or protect?

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Ellen Maloney questions society's approach to care when it uses secure units against the young 

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24th August 2017 by TFN Guest 0 Comments

I’m easily distracted these days. My mind constantly revisiting parts of my past that serve as a drag anchor, pulling me back to then. But this is now. This is now. I know this, yet my mind is elsewhere.

My thoughts are pulled back to the eight months I spent in a secure unit when I was 15. Who I was when I went in, who I was when I left, the many ways I’ve tried to make sense of those months.

The details of my experience aren’t relevant to share. What is relevant is that the definition of “secure” is: “certain to remain safe and unthreatened” and I felt neither safe nor unthreatened.

When we discuss secure units, often the conversation is shut down because, “In an ideal world, would we be putting young people in secure units?” That, I think, denies the complexity of the reality of many young people’s lives.

What have we done to the meaning of “secure”? 

Isn’t somewhere secure to live what we want for all our children? A place of safety; a place free from danger; a place where young people, whatever obstacles they may be facing at that moment in time, can be helped through them so they can move towards a better life than the one they left behind?

When we think about secure units, we think about locking a young person up, taking away their freedom, putting them in a place that, inevitably, we associate with punishment.

The threat of being sent to a secure unit is used to force young people to behave better, as if going to a secure unit is the worst thing that can happen to them.

Why is that? What is the purpose of secure units? To punish or protect? What is happening in secure units that “being secured” is a threat rather than somewhere that young people who most need it go to get intensive support to overcome the difficulties that are creating a situation where a secure unit is an option for them? What is a secure unit for? To contain a problem or to confront the challenges that young people are facing in their lives at that time?

I spent two eight-month periods in secure units when I was a teenager and both left indelible impressions on me. One because it was traumatic for me and undermined my sense that life was reasonably safe and I was protected; the other because it broke a six-year-long cycle of institutional care, overdosing, self-harm, and emergency admissions to hospitals.

My second admission was to, what should more appropriately be described as a “high-intensity therapeutic unit.” Not because I received much formal therapy but the staff were aware that if a young person needed to be in a secure unit, they needed help, and substantive work needed to be done before they would be ready to leave.

There was a high staff ratio (2:1). Locking a vulnerable young person alone in their room was unthinkable. 

The threat of being sent to a secure unit is used to force young people to behave better

There was school in the morning and groups in the afternoon - not intensive therapeutic groups because the needs of the young people were so varied - but a range of daily activities from volleyball to Tai-Chi to bingo.  

The staff recognised the importance of the relationship between young people and staff. If someone was showing signs of being agitated or distressed, a staff member would take them aside and chat to them or take them outside to kick a football around until they calmed down.

Most importantly, we were treated like humans. We were listened to, we were heard, and our difficulties were never dismissed as being unimportant or irrelevant.

If they were causing us problems, they mattered. We mattered. The focus was on relationships and empowering young people to make changes in their behaviour.

That sat in stark contrast to the behavioural modification regime which prevailed in my previous unit where vague and arbitrary long-term goals were set that were neither measurable nor realistic.

The only intervention was the containment that the unit itself provided, but I’d been placed there because of the risk I posed to myself and I needed help.

I needed to be kept safe, but safety of walls around a person can only do so much. Whether it is for a month, or two months, or six months, at what point do we say, “Okay, that’s enough now?”

We can’t, because the passage of time alone does not reduce the risk to self or others. There needs to be proactive therapeutic interventions alongside the containment that a secure unit provides if the time is to be used effectively. Otherwise, who benefits? Who feels secure for those months? The young person? Or the people who decided to place them there?

Two different secure units, two wildly different experiences.

I think there’s a need for secure units. I also think there’s enormous potential for the transformative experience that such a high-intensity unit can and should provide and we need to maximise the support that’s provided within those walls.

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