In addition, the Royal College of Psychiatrists Quality Network for Psychiatric Intensive Care Units, Standards for PICU’s state that 22 in wards where seclusion is used, there is a designated room that meets the following requirements: • • • • • • • • It allows clear observation; It is well insulated and ventilated; It has adequate lighting, including a window(s) that provides natural light; It has direct access to toilet/washing facilities; It has limited furnishings (which include a bed, pillow, mattress and blanket or covering); It is safe and secure – it does not contain anything that could be potentially harmful; It includes a means of two-way communication with the team; It has a clock that patients can see. “Maybe they could set aside a room as a seclusion room. I would like some sort of safe room where it is almost impossible to harm yourself or anyone else. It should have something comfortable to lie on; maybe even a comfortable chair rather than a bed, something calming on the walls; a painting of scenery or something soothing; preferably insulated from sounds from the outside. I would possibly also appreciate it even though I was ill, some sort of music or sound, I can stop liking music when I am ill, but maybe the sound of the sea on a beach or something”. Comment from ex-patient/service user consultation meeting. How managers should monitor the use of seclusion The use of seclusion or other environmental restrictions must be closely scrutinised through clinical governance or other similar monitoring processes. These processes should ensure that there is oversight of the use of seclusion by clinical and management staff distinct from the direct care team. Where use of level 1 seclusion extends beyond 72 hours, in order to safeguard the individual’s rights, it should be subject to external review. This could take the form of peer review by a senior clinician/manager from a separate part of the service or from a different service. Local policies should also specify how often external reviews should be repeated, should seclusion be assessed as necessary to continue beyond this time. The Commission also believes that, because of the seriousness of seclusion as an intervention and the associated risk, reports on its use should be regularly made to senior managers and, for NHS facilities (in aggregated and anonymous form) to members of the local NHS Board. Similar arrangements should be made for reporting to senior managers of independent health and social care providers. The Commission, when visiting services where seclusion is used, may ask to inspect records of the use of seclusion in that area. Hospitals The vision of the Scottish Patient Safety Programme for Mental Health (SPSP-MH) is to ensure people in wards or units in Scotland are both safe and feel safe. One of the resources developed by the SPSP-MH to help achieve this vision are the safety principles in mental RC Psych standards https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/qualitynetworks/picu/picu-qn-standards-qnpicu/qnpicu-standards-for-psychiatric-intensive-care-units2017.pdf?sfvrsn=2c6614a2_2 standard 142- type2 22 17