consider whether additional resources are required to enable an alternative and less restrictive intervention. In community settings, decisions to apply seclusion should only be authorised by the senior manager of the service or someone delegated to act in their absence. The restrictions should only be applied in exceptional circumstances, where other methods to reduce risk have been considered and rejected. There is a danger that individuals may be particularly vulnerable to overly restrictive treatment in settings where supervision of support staff is not appropriately monitored. Care planning Once a period of seclusion has commenced, it should not continue for any longer than is necessary. Therefore, care planning should involve a clear treatment goal and an exit strategy with a target end point; indicating the criteria required for this to be reached and the nature and frequency of reviews and the personnel to be involved. Should seclusion continue beyond 30 minutes, plans for meeting the individual’s need for eating, drinking and toileting should be clearly recorded. Consideration should also be given to how the person will be helped to reintegrate into the unrestricted environment. Best practice would also be to inform the named person or relative/carer where practical, with the person’s consent. Where the management of aggression or violence is a feature of a person’s care then this should be managed in line with local policies on the management of aggression and violence. Seclusion may be an option in that policy and care should be managed accordingly with all other options considered prior to its use. The point of this approach is to minimise the likelihood of seclusion being routinely used as a first option for managing violence. Each episode of violence and aggression should be dealt with using minimum restriction. Restriction of movement The use of seclusion can place severe restrictions on an individual’s freedom of movement. This can lead, in the absence of careful planning and review, to untoward physical and psychological consequences for the person. In particular, it can have a significant effect on a person’s ability to take exercise, to communicate needs and to have needs met. During a period of seclusion, consideration should be given to how these issues will be addressed so that vulnerable individuals are able to exercise their basic human rights. Maintaining the safety of the secluded individual Staff allocated to the individual must remain within sight and sound of the person at all times during the period of seclusion either directly through observation or via CCTV. Hospitals and care homes that use CCTV must have clear policies in place regarding its use. Staff must be able to communicate with other staff without having to leave the area and must ensure that the person is safe and pay particular attention to their consciousness level, particularly if he or she has been given sedative medication and/or has been physically restrained immediately prior to the seclusion. 14