Enhanced community services have reduced the need for in-patient admissions and many people with a learning disability who previously were in hospital for extended periods of time are now living in their own tenancy or social care setting. For some people with learning disabilities experiencing stressed and distressed behaviour in a community setting, behavioural support plans should be in place to minimise restrictive interventions. Practices such as physical restraint and seclusion may still be required to support some people in the community. There is, however, a lack of clear guidance on the subject at present, particularly for community-based care services. When seclusion could be considered Seclusion should only be considered where there is a clear and identified risk that the person who is to be secluded presents a significant degree of danger to other people and the situation cannot be managed more safely or appropriately by any other means. The use of seclusion must always be a proportionate response to any identified risk and the decision to use seclusion should only be made where the balance between the potential risks of seclusion and any other intervention, such as prolonged physical restraint, indicates that it would be safer to use seclusion. The assessment of those risks must take into account all available information and should be made, as far as possible in the circumstances, by the clinical and social care team. Consideration of the full range of options available must be made and recorded. There must be clear benefit to the individual for whom seclusion is being considered. Whilst seclusion is usually seen as a protective measure for others, clearly, it would not be in the interests of the person concerned if he or she were allowed to harm someone else. In most instances, seclusion is justified by staff on the basis of containing behaviour that is a risk to others. In some cases, it could be resolved by staff removing themselves from a situation. However, staff can be faced with a situation where an individual is extremely distressed as a result of some form of mental illness, learning disability or related condition. This can be where they are threatening or actively violent to others, may require restraint and possibly receive medication. In this type of situation, seclusion may be seen by staff as a way of reducing the impact of prolonged physical restraint or use of medication. Seclusion is also used in situations where a person with learning disability/autistic spectrum disorder and associated stress and distressed behaviour requires isolation for longer periods of time. This would always require legal authorisation except where the doctrine of necessity would immediately apply. The impact of seclusion In our experience the person who has been secluded often interprets the event that preceded the seclusion in a very different way to staff. The person secluded may describe being forced into aggressive and violent behaviour because of the way he or she has been treated. The person may be extremely angry about being detained, or having had their behaviour challenged and contained by staff. Those beliefs may be directly as a result of delusional ideas, misinterpretation of the intent of others, or because the person’s threshold for controlling their behaviour has been reduced by their mental illness, learning disability or related condition. The individual’s reaction may be because there is a reason for him or her to think they have been treated unfairly. 9