The provision of a safe environment for seclusion There can be no justification for placing someone in a room that increases the potential for harm to others or self-harm. The decision about whether an individual needs to be in a purpose designed seclusion facility or their own bedroom (with or without adaptations) will be dependent upon the risk assessment carried out. Curran, Adnett and Zigmond 21 noted that there is very little specific Government or NHS estates building guidance available to healthcare professionals and their architects in respect of the design and furnishings of seclusion facilities. They set out guidance on seclusion room design and associated facilities, including staff alarm systems and communication facilities. The guidance is aimed at the construction of new seclusion facilities, but provides a useful basis for the risk assessment of existing facilities. • • • • • • • • • • • • • • • • • The room should be set apart from other people but not isolated. It must be large enough to accommodate the individual and the maximum number of staff who may be involved in any restraint procedures. The construction of walls, windows, doors, hinges and locks must be robust enough to withstand high levels of violence aimed at damaging the physical environment. There must be no ligature points or access to electrical fixtures and fittings that pose a risk of shock. There must be no opportunity to barricade the door to prevent entry. Furnishings must be comfortable but safe and robust and not be of use as a weapon. Observation into the room should be clear and effective. It should not be possible for onlookers to view into the room from the outside. However, there should be a clear view to the outside for the person. If CCTV is in use, respect for the person’s privacy should be taken into account. Lighting should be externally adjustable to accommodate observation, but should also include a light that is controllable by the person in the room. It is essential that there is effective control of temperature and ventilation with temperature sensors to ensure effective monitoring. There is a high risk where restraint involving a number of staff has taken place that the individual becomes overheated. This is very dangerous, particularly in the context of someone having received high doses of medication. The room must be non-threatening and should be decorated in a calming manner. It must be kept clean and fresh. Bedding must be as safe as possible. Clothing should be risk assessed prior to seclusion to ensure that any potentially dangerous items are removed. While safety is vital, due regard must be paid to the individual’s dignity. The principle of least restriction should be applied to the removal of items. Nothing should be removed unless there is clear justification on the basis of risk of harm to the person or to others. Personal items of religious or cultural significance should remain unless these may compromise safety. Any room identified in the care and support plan for use in seclusion or environmental restraint must be regularly risk assessed by staff. Great care must be taken to ensure that no items that may pose danger are left in the room. Attention should be given to procedures for safe evacuation in the event of a fire. Curran, C., Adnett, C. and Zigmond, D. (2005), “Seclusion: factors to consider when designing and using a seclusion suite in a mental health hospital”, Hospital Development, Vol. 36 No. 1, pp. 19-26. 21 16