Preventing Detention: Ethical and Legal Disputes Between Professionals in the Detention of Young People Who Present a Risk to Others
Main Article Content
Abstract
The detention of young people who pose a risk of harm to others can present major ethical and legal challenges to professionals. In this paper, we discuss those challenges with a particular focus on the causes of interprofessional disagreements that can seem intractable, and even lead to costly court proceedings. We use a clinically accurate composite case vignette to explore the commonest ethical dilemmas, which include (i) the costs of secure provision for young people and limits of resource provision (ii) the impact of professional anxiety about harmful outcomes, and (iii) the lack of attention to the voice of young people concerned. We discuss potential ways of improving ethical discussion between professionals in ways that are ethically coherent and respectful of different views.
Article Details
How to Cite
HALES, Dr Heidi et al.
Preventing Detention: Ethical and Legal Disputes Between Professionals in the Detention of Young People Who Present a Risk to Others.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6675>. Date accessed: 05 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6675.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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Adolescent Mental Health Practice. Journal of Medical Ethics. 1997; 23(1):26-31.
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26. Williams R, Fulford KW. Evidence-based and values-based policy, management and practice in child and adolescent mental health services. Clin Child Psychol Psychiatry. 2007; 12(2):223-42.
27. Kaltiala-Heino R, Eronen M. Ethical issues in child and adolescent forensic psychiatry: A review. Journal of Forensic Psychiatry & Psychology. 2015; 26(6):759-80.
28. Beyers W, Soenens B, Vansteenkiste M. Autonomy in adolescence: a conceptual, developmental and cross-cultural perspective. European Journal of Developmental Psychology. 2024;22(2):121-41.
29. Pope K, Luna B, Thomas CR. Developmental neuroscience and the courts: how science is influencing the disposition of juvenile offenders. J Am Acad Child Adolesc Psychiatry. 2012;51(4):341-2.
30. Smith JG, Bartlett A, Hales H. Exploration of adverse patterns of placement of young people in secure care: The unwanted child? Crim Behav Ment Health. 2022;32(3):212-26.
31. Ministry of Justice, HM Prison & Probation Service, Youth Custody Service. Safety in the Children and Young People Secure Estate: Update to Dec 2024. 2025 [Available from: https://www.gov.uk/government/statistics/safety-in-the-children-and-young-people-secure-estate-update-to-december-2024/safety-in-the-children-and-young-people-secure-estate-update-to-december-2024#:~:text=The%20rate%20of%20serious%20assaults,per%20100%20CYP%20per%20year. (accessed 05.06.25)]
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33. Fish S, Johnson F. Serious Case Review: “David”. Social Care Institute for Excellence; 2021. [Available at Serious Case Review 'David' (accessed 05.06.26)]
34. Shoesmith S. Learning From Baby P: The Politics of Blame, Fear and Denial: Jessica Kingsley Publishers; 2016.
35. Henriksen A-K. Locked up and safe – But for how long? Exploring how legitimising narratives shape decisions to sustain placement in secure institutions. European Journal of Social Work. 2021;26(1):148-59.
36. Roesch‐Marsh A. Risk Assessment and Secure Accommodation Decision‐Making in Scotland: Taking Account of Gender? Child Abuse Review. 2013;23(3):214-26.
37. Sabin JE, Daniels N. Allocation of mental health resources. 2009. In: Psychiatric Ethics [Internet]. Oxford University Press; [111-26]. Available from: https://doi.org/10.1093/med/9780199234318.003.0008.
38. Roesch‐Marsh A. Better together? Learning lessons for group decision‐making practice from a study of secure accommodation in Scotland. Child & Family Social Work. 2011;17(4):468-77.
39. Fulford KWM. The value of evidence and evidence of values: bringing together values-based and evidence-based practice in policy and service development in mental health. J Eval Clin Pract. 2011;17(5):976-87.
40. Fulford KWM. Ten principles of values-based medicine (VBM). Philosophy and psychiatry. Berlin; New York: De Gruyter; 2004. p. 50-80.
41. Cummins I. The Impact of Austerity on Mental Health Service Provision: A UK Perspective. Int J Environ Res Public Health. 2018;15(6).
42. Fahy K, Alexiou A, Daras K, Mason K, Bennett D, Taylor-Robinson D, et al. Mental health impact of cuts to local government spending on cultural, environmental and planning services in England: a longitudinal ecological study. BMC Public Health. 2023;23(1):1441.
43. Kahneman D. Thinking, fast and slow. London: Macmillan; 2011.
44. Conwy County Borough Council v PR & Ors. EWHC; 2024.
45. Henriksen A-K. “It’s my life they are talking about” – On children’s participation in decision-making for secure placement. Qualitative Social Work. 2021;21(4):783-99.
46. O’Neill O. A Question of Trust: The BBC Reith Lectures 2022: Cambridge University Press; 2002.
47. Panesar SS, Cleary K, Sheikh A, Donaldson L. The WHO checklist: a global tool to prevent errors in surgery. Patient Saf Surg. 2009;3(1):9.
48. Anna Freud. What is AMBIT? [Available from: https://www.annafreud.org/training/health-and-social-care/adaptive-mentalization-based-integrative-treatment-ambit/what-is-ambit/. (accessed 05.06.25)
2. Department for Education. Children looked after in England including adoptions. 2024 [Available from: https://explore-education-statistics.service.gov.uk/find-statistics/children-looked-after-in-england-including-adoptions/2024. (accessed 05.06.25)]
3. Warner L, Hales H, Smith J, Bartlett A: Secure settings for young people: a national scoping exercise. St George’s University of London; Central and North West London NHS Foundation Trust. 2018. [Available from: secure-settings-for-young-people-a-national-scoping-exercise-paper-1-scoping-analysis.pdf (accessed 05.06.25)]
4. Children’s Commissioner. Who are they? Where are they? Children Locked Up. 2019. [Available from: https://assets.childrenscommissioner.gov.uk/wpuploads/2019/05/cco-who-are-they-where-are-they-may-2019.pdf. (accessed 05.06.25)]
5. Souverein F, Hales H, Anderson P, Argent SE, Bartlett A, Blower A, et al. Mental health, welfare or justice: An introductory global overview of differences between countries in the scale and approach to secure placements of children and young people. Crim Behav Ment Health. 2022; 32(3):238-47.
6. Hales H, Warner L, Smith J, Bartlett A. Census of young people in secure settings on 14 September 2016: characteristics, needs and pathways of care. St George’s University of London; Central and North West London NHS Foundation Trust. 2018. [Available from: secure-settings-for-young-people-a-national-scoping-exercise-paper-2-census-report.pdf (accessed 05.06.25)]
7. Hales H, Warner L, Smith JG, Bartlett A. Primary neurodevelopmental disorders in detained adolescents: point prevalence and patterns of care. The Journal of Forensic Psychiatry & Psychology. 2022; 33(3):354-70.
8. Hart D, Valle LI. Secure children’s homes: placing welfare and justice children together. In: Department for Education, editor.: Social Socience in Government. 2021. [Available from Secure children’s homes: placing welfare and justice children together (accessed 05.06.25)]
9. Department of Health. Mental Health Act 1983: Code of Practice. 2015.
10. Department for Education. Guidance: Secure children’s homes: how to place a child aged under 13. 2015 [Available from: https://www.gov.uk/guidance/secure-childrens-homes-how-to-place-a-child-aged-under-13#criteria. (accessed 05.06.25)]
11. HM Prison, Probation Service. Guidance: Placing young people in custody: guide for youth justice practitioners. 2014. [Available from: https://www.gov.uk/guidance/placing-young-people-in-custody-guide-for-youth-justice-practitioners. (accessed 05.06.25)
12. Beard J, Sturge G. UK Parliament, House of Commons Library, Research Briefing, Youth Custody. 2022 [Available from: https://commonslibrary.parliament.uk/research-briefings/cbp-8557/#:~:text=According%20to%20the%20Ministry%20of%20Justice%2C%20in%202020%2F21%2C,than%20five%20time%20that%20number%20in%202008%2F09%20%282%2C881%29. (accessed 05.06.25)]
13. Williams A, Cummings A, Forrester D, Hodges H, Warner N, Wood S. Even Secure Children’s Homes Won’t Take Me. Children Placed in Alternative Accommodation. Residential Treatment for Children & Youth. 2022; 39(4):370-86.
14. Accredited official statistics. Youth Justice Statistics: 2023 to 2024. 2025 [Available from: https://www.gov.uk/government/statistics/youth-justice-statistics-2023-to-2024/youth-justice-statistics-2023-to-2024. (accessed 05.06.25)]
15. Roe A. What do we know about children deprived of their liberty? An evidence review. Nuffield Family Justice Observatory; 2022. [Available at What do we know about children and young people deprived of their liberty in England and Wales? An evidence review - Nuffield Family Justice Observatory (accessed 05.06.25)]
16. Balasubramaniam S, Smith JG, Hales H, Bartlett A. Medium secure mental health care for young people: decisions to detain. The Journal of Forensic Psychiatry & Psychology. 2023; 34(3-4):401-15.
17. Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University Press; 2001.
18. Fielding J, Swain R, Emmanuel J, Behr G. Engage? Disengage? Discharge? Ethical approaches to fraught questions. BJPsych Bull:1-5. 2025. doi:10.1192/bjb.2025.4
19. Mental Capacity Act c.9. 2005 [Available from: https://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_20050009_en.pdf. (accessed 05.06.25)]
20. Graham PJ, Foreman DM. An ethical dilemma in child and adolescent psychiatry. Psychiatric Bulletin. 1995;19(2):84-6.
21. Gillon R. Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. Journal of Medical Ethics. 2003;29:307-12.
22. Alderson P. Competent children? Minors’ consent to health care treatment and research. Social Science & Medicine. 2007; 65(11):2272-83.
23. Josselson R. Narrative, identity, and identity statuses: Reflections on the kaleidoscopic self. Handbook of personality development. New York, NY, US: The Guilford Press; 2019. p. 448-64.
24. Sutton A. Authority, Autonomy, Responsibility and Authorisation: With Specific Reference to
Adolescent Mental Health Practice. Journal of Medical Ethics. 1997; 23(1):26-31.
25. McElhaney KB, Allen JP, Stephenson JC, Hare AL. Attachment and autonomy during adolescence. Handbook of adolescent psychology: Individual bases of adolescent development, Vol 1, 3rd ed. Hoboken, NJ, US: John Wiley & Sons, Inc.; 2009. p. 358-403.
26. Williams R, Fulford KW. Evidence-based and values-based policy, management and practice in child and adolescent mental health services. Clin Child Psychol Psychiatry. 2007; 12(2):223-42.
27. Kaltiala-Heino R, Eronen M. Ethical issues in child and adolescent forensic psychiatry: A review. Journal of Forensic Psychiatry & Psychology. 2015; 26(6):759-80.
28. Beyers W, Soenens B, Vansteenkiste M. Autonomy in adolescence: a conceptual, developmental and cross-cultural perspective. European Journal of Developmental Psychology. 2024;22(2):121-41.
29. Pope K, Luna B, Thomas CR. Developmental neuroscience and the courts: how science is influencing the disposition of juvenile offenders. J Am Acad Child Adolesc Psychiatry. 2012;51(4):341-2.
30. Smith JG, Bartlett A, Hales H. Exploration of adverse patterns of placement of young people in secure care: The unwanted child? Crim Behav Ment Health. 2022;32(3):212-26.
31. Ministry of Justice, HM Prison & Probation Service, Youth Custody Service. Safety in the Children and Young People Secure Estate: Update to Dec 2024. 2025 [Available from: https://www.gov.uk/government/statistics/safety-in-the-children-and-young-people-secure-estate-update-to-december-2024/safety-in-the-children-and-young-people-secure-estate-update-to-december-2024#:~:text=The%20rate%20of%20serious%20assaults,per%20100%20CYP%20per%20year. (accessed 05.06.25)]
32. Cooper A, Whittaker A. History as tragedy, never as farce: tracing the long cultural narrative of child protection in England. Journal of Social Work Practice. 2014;28(3):251-66.
33. Fish S, Johnson F. Serious Case Review: “David”. Social Care Institute for Excellence; 2021. [Available at Serious Case Review 'David' (accessed 05.06.26)]
34. Shoesmith S. Learning From Baby P: The Politics of Blame, Fear and Denial: Jessica Kingsley Publishers; 2016.
35. Henriksen A-K. Locked up and safe – But for how long? Exploring how legitimising narratives shape decisions to sustain placement in secure institutions. European Journal of Social Work. 2021;26(1):148-59.
36. Roesch‐Marsh A. Risk Assessment and Secure Accommodation Decision‐Making in Scotland: Taking Account of Gender? Child Abuse Review. 2013;23(3):214-26.
37. Sabin JE, Daniels N. Allocation of mental health resources. 2009. In: Psychiatric Ethics [Internet]. Oxford University Press; [111-26]. Available from: https://doi.org/10.1093/med/9780199234318.003.0008.
38. Roesch‐Marsh A. Better together? Learning lessons for group decision‐making practice from a study of secure accommodation in Scotland. Child & Family Social Work. 2011;17(4):468-77.
39. Fulford KWM. The value of evidence and evidence of values: bringing together values-based and evidence-based practice in policy and service development in mental health. J Eval Clin Pract. 2011;17(5):976-87.
40. Fulford KWM. Ten principles of values-based medicine (VBM). Philosophy and psychiatry. Berlin; New York: De Gruyter; 2004. p. 50-80.
41. Cummins I. The Impact of Austerity on Mental Health Service Provision: A UK Perspective. Int J Environ Res Public Health. 2018;15(6).
42. Fahy K, Alexiou A, Daras K, Mason K, Bennett D, Taylor-Robinson D, et al. Mental health impact of cuts to local government spending on cultural, environmental and planning services in England: a longitudinal ecological study. BMC Public Health. 2023;23(1):1441.
43. Kahneman D. Thinking, fast and slow. London: Macmillan; 2011.
44. Conwy County Borough Council v PR & Ors. EWHC; 2024.
45. Henriksen A-K. “It’s my life they are talking about” – On children’s participation in decision-making for secure placement. Qualitative Social Work. 2021;21(4):783-99.
46. O’Neill O. A Question of Trust: The BBC Reith Lectures 2022: Cambridge University Press; 2002.
47. Panesar SS, Cleary K, Sheikh A, Donaldson L. The WHO checklist: a global tool to prevent errors in surgery. Patient Saf Surg. 2009;3(1):9.
48. Anna Freud. What is AMBIT? [Available from: https://www.annafreud.org/training/health-and-social-care/adaptive-mentalization-based-integrative-treatment-ambit/what-is-ambit/. (accessed 05.06.25)