Among the small number of girls detained in secure accommodation, severe and repetitive self-injurious behaviour (SIB) appears to be a significant problem. Effective management programmes must consider access to objects used for SIB, staff supervision, use of physical restraint and search procedures, consent to medical treatment, and effects on the peer group. Intervention programmes should be based on an analysis of the meaning and function of self-injury in individual cases, using information obtained through behavioural observation and interview. The effect on staff team behaviour and the extent to which SIB provides rewarding consequences require particular attention. Interventions to address associated emotional and psychological problems, such as the effects of childhood sexual abuse, are often not feasible within secure settings due to time factors and the reluctance of some girls to engage in therapy. Progress that is made in secure settings is often not maintained upon transfer to open settings due to insufficient service integration and a lack of time available for the generalization of behavioural change. Research is needed into outcomes and into the effectiveness of intervention programmes in secure settings. Only then will it be possible to make a realistic cost-benefit analysis of placing self injurious girls in secure settings.
Adshead, G.
(1997). `Written on the body': Deliberate self-harm and violence. In E.V. Welldon & C. Van Velsen (Eds.), A practical guide to forensic psychotherapy. London: Jessica Kingsley.
2.
Blackman, D.E.
(1985). Contemporary behaviourism: A brief overview. In C.F. Lowe, M. Richelle, D.E. Blackman, & C.M. Bradshaw (Eds.), Behaviour analysis and contemporary psychology. London: Erlbaum.
3.
Boswell, G.
(1997). The backgrounds of violent young offenders: The present picture. In V. Varma (Ed.), Violence in children and adolescents. London: Jessica Kingsley.
4.
Brooksbank, D.J.
(1985). Suicide and parasuicide in childhood and early adolescence. British Journal of Psychiatry, 146, 459-463.
5.
Browne, K.
, Falshaw, L., & Hamilton, C. (1995). The characteristics of young persons resident at the Glenthorne Centre during the first half of 1995. Youth Treatment Service Journal, 1, 52-71.
6.
Burrow, S.
(1992). The deliberate self-harming behaviour of patients within a British special hospital. Journal of Advanced Nursing, 17, 138-148.
7.
Carr, E.G.
(1977). The motivation of self-injurious behaviour: A review of some hypotheses. Psychological Bulletin, 84, 800-816.
8.
Carr, E.G.
, & Durand, V.M. (1985). The social-communicative basis of severe behaviour problems in children. In S. Reiss & R. Bootzin (Eds.), Theoretical issues in behaviour therapy. New York: Academic.
9.
Coid, J.
, & Wilkins, J. (1991). Self-mutilation in female remanded prisoners: I. An indicator of severe psychopathology. Criminal Behaviour and Mental Health, 1, 247-267.
10.
Cookson, H.M.
(1977). A survey of self-injury in a closed prison for women. British Journal of Criminology, 17, 332-347.
11.
Department of Health
(1991). The Children Act 1989 Guidance and Regulations. Volume 4: Residential Care. London: HMSO.
12.
Department of Health
(1996). Children accommodated in secure units: Year ending 31 March 1996 England. London: DoH Government Statistical Service.
13.
Edelson, S.M.
, Taubman, M.T., & Lovaas, 0.I. (1983). Some social contexts of self-destructive behaviour. Journal of Abnormal Child Psychology, 11, 299-312.
Goddard, N.
, Subotsky, F., & Fombonne, E. (1996). Ethnicity and adolescent deliberate self-harm. Journal of Adolescence, 19, 513-521.
16.
Harris, R.
, & Timms, N. (1993). Secure accommodation in child care: Between hospital and prison or thereabouts?London: Routledge.
17.
Hatfield, B.
, Harrington, R., & Mohamad, H. (1996). Staff looking after children in local authority residential units: The interface with child mental health professionals. Journal of Adolescence, 19, 127-139.
18.
Hawton, K.
(1986). Suicide and attempted suicide among children and adolescents. Beverly Hills, CA: Sage.
19.
Hawton K.
(1990). Self-cutting: Can it be prevented? In K. Hawton & P. Cowen (Eds.), Dilemmas and difficulties in the management of psychiatric patients. Oxford: Oxford University Press.
20.
Hawton, K.
, & Catalan, J. (1982). Attempted suicide: A practical guide to its nature and management. Oxford: Oxford University Press.
21.
Hillbound, M.
, Krystal, J.H., Sharpe, K.S., & Foster, H.G. (1994). Clinical prediction of self-mutilation in hospitalised forensic patients. Journal of Nervous and Mental Disease, 182, 9-13.
22.
Hollin, C.R.
, Epps, K.J., & Kendrick, D.J. (1995). Managing behavioural treatment. Policy and practice with delinquent adolescents. London: Routledge.
23.
Iwata, B.A.
, Dorsey, M.F., Slifer, K.J., Bauman, K.E., & Richman, G.S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2, 3-20.
24.
Kerfoot, M.
(1987). Suicidal behaviour in adolescence. In J.C. Coleman (Ed.), Working with troubled adolescents: A handbook. London: Academic.
25.
Kiernan, C.
(1991). Professional ethics: Behaviour analysis and normalization. In B. Remington (Ed.), The challenge of severe mental handicap: A behaviour analytic approach. Chichester: Wiley.
26.
Kosky, R.
(1983). Childhood suicidal behaviour. Journal of Child Psychology and Psychiatry, 24, 457-468.
27.
Lovaas, O.I.
, & Simmons, J.Q. (1969). Manipulation of self-destruction in three retarded children. Journal of Applied Behaviour Analysis, 2, 143-157.
28.
McLaughlin, J.
, Miller, P., & Warwick, H. (1996). Deliberate self-harm in adolescents: Hopelessness, depression, problems and problem-solving. Journal of Adolescence, 19, 523-532.
29.
McKerracher, D.W.
, Loughnane, T., & Watson, R.A. (1968). Self-mutilation in female psychopaths. British Journal of Psychiatry, 114, 829-832.
30.
Morgan, H.
(1979). Death wishes? The understanding and management of deliberate self-harm. New York: Wiley.
31.
National Children's Bureau
(1995). Safe to be let out?: The current and future use of secure accommodation for children and young people. London: author.
32.
O'Dwyer, F.G.
, D'Alton, A., & Pearce, J.B. (1991). Adolescent self-harm patients: Assessment in an accident and emergency department. British Medical Journal, 303, 629-630.
33.
Oliver, C.
(1995). Annotation: Self-injurious behaviour in children with learning disabilities: Recent advances in assessment and intervention. Journal of Child Psychology and Psychiatry, 36, 909-927.
34.
Pattison, E.M.
, & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
35.
Pierce, D.
(1986). Deliberate self-harm: How do patients view their treatment? British Journal of Psychiatry, 149, 624-626.
36.
Reder, P.
, Lucey, C., & Fredman, G. (1991). The challenge of deliberate self-harm by young adolescents. Journal of Adolescence, 14, 135-148.
37.
Rickles, N.
(1971). The angry woman syndrome. Archives of General Psychiatry, 24, 91-94.
Scott, S.W.
, & Powell, J.C. (1993). Brief report: Adolescent self-mutilation in a rural area. Journal of Adolescence, 16, 101-110.
40.
Secretary of State for Health
. (1991). The health of the nation. London: HMSO.
41.
Shaffer, D.
, Gould, M.S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339-348.
42.
Simpson, C.A.
, & Porter, G.L. (1981). Self-mutilation in children and adolescents. Bulletin of the Menninger Clinic, 45, 428-438.
43.
Simpson, M.A.
(1975). Self-injury: The phenomenology of self-mutilation in a general hospital setting. Canadian Psychiatric Association Journal, 20, 429-434.
44.
Solomon, Y.
, & Farrand, J. (1996). `Why don't you do it properly': Young women who self-injure. Journal of Adolescence, 19, 111-119.
45.
Swinton, M.
, & Hopkins, R. (1996). Violence and self-injury. Journal of Forensic Psychiatry, 7, 563-569.
46.
Tantam, D.
, & Whittaker, J. (1992). Personality disorder and self-wounding. British Journal of Psychiatry, 161, 451-464.
47.
Tate, B.G.
, & Baroff, G.S. (1966). Aversive control of self-injurious behaviour in a psychotic boy. Behaviour Research and Therapy, 4, 281-287.
48.
Taylor, E.
(1987). Adolescent suicide. British Journal of Hospital Medicine, 37, 481.
49.
Taylor, E.A.
, & Stansfield, S.A. (1984). Children who poison themselves. I. A clinical comparison with controls. British Journal of Psychiatry, 145, 127-135.
50.
van der Kolk, B.A.
(1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389-411.
51.
Walsh, B.W.
, & Rosen, P.M. (1988). Self-mutilation: Theory, research and treatment. London: Guilford.
52.
Winchel, R.M.
, & Stanley, M. (1991). Self-injurious behaviour: A review of the behaviour and biology of self-mutilation. American Journal of Psychiatry, 148, 306-317.
