Two themes have emerged which are familiar to those working with adults. The first is that individuals in residential accommodation, secure or otherwise, exhibit more psychiatric disorders and gross neurological and behavioral disturbances than individuals did 20 years ago. The second is that inadequate provisions exist for those who are not in physical institutions. The author criticizes the national tendency in the United Kingdom to provide simplistic, reactive solutions to each new problem as it arises and emphasizes the importance of recapturing the total range, extent, and development of problem careers and the need to consider the complexity of individual needs rather than overemphasizing philosophical and theoretical management models. Specifically, child and adolescent health services are important, and the tendency to deny the extent of health problems among young people in favor of family and social explanations of deviancy has led to a dearth of trained specialists. The surge of recent deaths of young people in custody is viewed as an indication of the failure of physical institutions for juveniles. Health issues in institutions for young people are addressed, as well as the the importance of mental health services, costs of mental health care for disturbed adolescents, and juvenile suicide. 33 references