is “…an emergency procedure, only to be resorted to when there is an immediate risk of physical harm”. 8 The Code of Practice to the Mental Health Act 1983 in England defines seclusion as “…the supervised confinement of a (person) alone in a room, which may be locked, for the protection of others from significant harm. Its sole aim is to contain severely disturbed behaviour, which is likely to cause harm to others”. 9 The Court of Appeal in England further described seclusion as “…keeping a person under regular frequent observation, while he is prevented from having contact with the world outside the room where he is confined…” 10 The United Kingdom National Preventive Mechanism (NPM) has adopted the following specific definition: (Seclusion) “In health settings refers to the supervised confinement and isolation of a patient or resident, away from other patients or residents, in an area from which the patient or resident is prevented from leaving, where it is of immediate necessity for the purpose of the containment of severe behavioural disturbance which is likely to cause harm to others”. It is further highlighted that it does not matter “…whether the place of isolation is an enclosed room (rather than, for example, a part of a larger space), or whether the door to such a space is closed or open, locked or unlocked.” 11 This is a comprehensive definition which would encompass all scenarios where seclusion is used and is the definition applied to frame this guidance. Seclusion implies use of a locked door. However, where someone prevents a person from leaving a room, for example, by physically blocking the exit, this should still be considered seclusion. Where someone goes to their room by agreement to access a low stimulus environment, this does not amount to seclusion unless they are prevented from leaving. An individual may prepare an advance statement 12 advocating use of seclusion over other treatments and careful consideration should be given to how this would be managed, bearing in mind the potential infringement of their human rights. Why is guidance needed? The Commission has published guidance applying to use of restraint in all care settings (Rights, risks and limits to freedom 13) whereas our specific guidance on the use of seclusion has previously limited its application to hospital settings. Most research and guidance also tends to focus the area of concern on individuals detained in hospitals. Research and Human Rights Working Group on Restraint and Seclusion – Guidance on Restraint and Seclusion in Health and Personal Social Services, August 2005 9 Mental Health Act 1983, Code of Practice (March 1999), The Stationery Office, London 10 R (on the application of Colonel Munjaz) v Mersey Care NHS Trust and (i) Secretary of State for Health and (ii) MIND; S v Airdale NHS Trust and (i) Secretary of State for Health and (ii) MIND [2003] EWCA Civ 1036 11 National Preventive Mechanism Guidance: Isolation in detention ( 2017) p9 12 https://www.mwcscot.org.uk/sites/default/files/201906/advance_statement_guidancesep2018revision.pdf 13 http://www.mwcscot.org.uk/media/125247/rights_risks_2013_edition_web_version.pdf (This guidance will be updated in autumn/winter 2019) 8 7