Section two Focus on detention issues Conditions Special seclusion rooms are designed to be ‘low stimulus’, which might mean they only contain a bed/mattress, toilet and wash basin, or sometimes a bed with separate access to a toilet. NPM members have identified many cases where there have been no attempts to make isolation spaces more ‘homely’, which is particularly important where isolation is long-term. Procedures and governance One NPM member found that continuing episodes of solitary confinement were designated variously as seclusion or LTS. There is a risk that detaining authorities may redefine extended periods of seclusion as LTS, to justify relaxing the regularity of formal reviews, although the increasing prescriptiveness of the MHA Code of Practice might discourage this. NPM members have identified situations in which patients are denied normal clothing, which should only be as a last resort. One member found instances where female patients were secluded without access to sanitary products for reasons of ‘safety’. Several visits identified patients who did not have sight of a clock. In many instances, there was regular review of isolation by multidisciplinary teams, but in one case where a detained patient with intellectual disabilities had been segregated from the main population of the ward in a ‘flat-like’ facility continuously for two weeks, records did not provide evidence of any consultation or agreement with the multidisciplinary team for this, and there was no evidence of a ‘restrictive practice care plan’ that could have provided a rationale for the isolation. Concerns about conditions Critical comments about infrastructure had been made by one NPM member in 52 out of 126 visits. These included: lack of privacy; lack of ventilation; rooms too hot or too cold; dirty rooms; unrepaired damage; dangerous sharp corners/raised screws in fittings; inadequate furnishing or bedding; lack of call point. In one case, a female patient had been secluded on a men’s ward because the female ward facility was already in use, and in another case, a female patient had been secluded unclothed, and then been observed by male staff. A previously criticised practice of passing food through a hatch in a door facing the seclusion room toilet area had recurred. In around one-fifth of its visits, one NPM member identified concerns about the review of seclusion, including many instances where medical and other reviews did not take place as often as required, and inadequacies in record keeping. In some instances, internal oversight of seclusion was found to be deficient. In one visit, an NPM member found no overarching system to monitor seclusion, and staff were unable to say when it had last been used. In another visit, a clinical governance group tasked with the oversight of seclusion and LTS had not discussed the matter for over a year. 37