The Mental Welfare Commission’s view The Commission does not advocate the use of seclusion as a first line response to aggressive and/or violent behaviour. Seclusion should not be regarded as a therapeutic intervention but, in certain situations, it may be an option for managing extremely difficult behaviour. Our view is that it must only be used in the context of a comprehensive policy for the management of behaviour where there is serious risk of harm to others. We would expect that, in most instances, proactive behavioural support plans would largely negate the need for such restrictive measures. It is essential that services try to minimise the use of all forms of restrictive practice and work to find other, less restrictive, care arrangements for people as alternatives to the use of seclusion. Failure to do this has the potential to lead to inhuman and degrading treatment of some of the most vulnerable people in our society. Without the necessary legal authorisation, seclusion may also amount to an infringement of a person’s human rights, and we discuss this further in the legal section at page 20. We recognise that where all other options have been considered, in some situations, seclusion may be the one that presents the lowest risk and is likely to be of short term benefit to the individual concerned. We believe it is necessary to acknowledge the use of seclusion and ensure that it is properly monitored, with the aim of reducing the known risks associated with its use. To help us in the writing of this guidance, we have incorporated views from a wide range of stakeholders. In addition to written contributions, we held a consultation event in November 2018 with over 70 attendees including representation from a wide range of clinical staff, people with lived experience of mental illness, carers, health and social care regulators and educators. At this event we explored how seclusion is used in a range of situations and heard about good practice already in place. Something which emerged from these discussions was that there are commonly two distinct levels of seclusion to which an individual may be subject, depending on whether the person is restricted by explicit means or by implication via instructions from staff. We will return to this later in the guidance. Our engagement and participation officer (lived experience) also consulted with expatients/service users at a series of meetings across the country to hear about individuals’ experiences and to listen to their views. Defining seclusion There is no definition of seclusion in the Mental Health (Care and Treatment) (Scotland) Act 2003. The Northern Ireland Human Rights Working Group on Restraint and Seclusion defines seclusion as “…the supervised confinement of a (person) alone in a room... the door of which cannot be opened from the inside and from which there is no other means of exit available.” It 6