Section two Focus on detention issues external scrutiny where isolation goes on for long periods or where it is informal, such as they currently do in relation to other safeguarding issues in prisons (such as use of force or complaints). Health and social care detention NPM members monitoring health and social care settings examined isolation practices in adult mental health and intellectual disability hospital wards. Evidence was contributed by MWCS, CSSIW, HIW and CQC.77 MWCS can review all records of incidents of seclusion and policies and procedures, and has its own guidance for staff on use of seclusion.78 CSSIW reviews a random selection of files on annual inspections of care homes, looking at all incidents occurring in the previous 12 months for each file, including isolation. CSSIW may also become aware of isolation occurring in complaints about other issues, or in relation to applications for deprivation of liberty safeguards under its regulatory powers. HIW reviews seclusion rooms as part of regulatory inspections in independent hospitals and looks at seclusion rooms as part of inspection visits to NHS services. CQC looks at isolation practices on visits conducted under the Mental Health Act and as part of its regulatory inspections. It has undertaken monitoring visits with a specific focus on isolation, and can also investigate and receive complaints related to these practices. Background Health and social care detention is not punitive in nature, so practices within detention such as isolation should not have a punitive purpose. Isolation should not be used as a punishment, threat or active behaviour modification tool, or solely as a means of managing self‑harming behaviour, but rather as a reactive, last resort measure to contain actually dangerous behaviour. It can only be justified for as long as it necessary to contain such behaviour. Where isolation and solitary confinement occur Case study: isolation on a ward In one instance a detained patient was kept in a locked area of a secure ward on a continuous basis for over five years. The hospital defined this practice as ‘low stimulus’. Although the patient was isolated, efforts had been made to ensure regular contact with staff who attended to his personal care and meals, and encouraged him to leave the area and join other patients on the ward. The NPM member was satisfied that the patient was able to do this on request, and noted that his case was subject to regular review by multidisciplinary teams and regular risk assessments. The nature of the person and the situation and oversight meant that the seclusion was deemed appropriate and considered to be used as a last resort. Isolation in health and social care settings is more commonly known as ‘seclusion’. In their monitoring, NPM members found detainees isolated in a range of ways, both formal and informal. 77 The Care Inspectorate has begun monitoring in 2015. 78 Mental Welfare Commission for Scotland (2014), Good practice guide, the use of seclusion. At: http://www.mwcscot.org.uk/ media/191573/final_use_of_seclusion.pdf (accessed 14/10/15). 35