Seclusion can be seen as a negative experience by individuals and be very hard to come to terms with. A small study by Hoekstra et al 16 describes factors that can help in coming to terms with the experience of seclusion, including understanding the reason why it took place and the opportunity to discuss the event with others. Factors that adversely affect the process of coming to terms with seclusion include the danger of re-occurrence (seclusion seen as a daily threat) and “iniquitous” treatment by care providers during seclusion. There appears to be no doubt that clear processes for “debriefing” and support of the person who has been secluded are essential. As far as possible, the individual should participate and be supported in the decision-making process about seclusion and in the subsequent review and care planning process. “I was put into the IPCU and put straight into seclusion without knowing why – it was gym mats and barred windows and concrete walls – no one told me why I was in it. I didn’t understand and, when I asked, I was told it was calming. I wondered who it was calming for: me or them. The door was open with two people facing me. I don’t know how long I was in there. There was no clock and no routine that I could make sense of.” Comment from ex-patient/service user consultation meeting. Identifying seclusion Observation practice may involve restricting individuals to their bedroom or to a part of a ward or residential unit. Some people subject to enhanced levels of observation can spend considerable periods of time heavily restricted in their movements. We do not consider these interventions alone constitute seclusion. Where staff are in the unobstructed physical presence of the individual being supervised, then the nature of the relationship and restriction is different from seclusion because of the presence of direct human contact. However, this level of supervision can be highly intrusive and limit the freedom of the person concerned. Where the individual has their freedom of movement seriously curtailed, this could be considered as a form of restraint. We recommend in this situation the principles set out in this guidance are followed. NHS Scotland guidance on observation of people with acute mental health problems was recently published. The main focus of this document is to help move away from more restrictive practices in line with the other published work of the Scottish Patient Safety Programme. 17 In high security settings, the general arrangements for security may mean that, where an individual voluntarily wishes to be in their room, the door is locked. We do not believe that this constitutes seclusion as it is not for the management of individual risk and the person can ask to leave the room at any time. Hoekstra T., Lendemeijer H.H.G.M. & Jansen M.G.M.J. (2004) Journal of Psychiatric and Mental Health Nursing, 11, 276-283 16 17 https://ihub.scot/media/5508/spsp-iop-from-observation-to-intervention.pdf 10