Again, in certain high security, individuals may be locked in their room overnight, depending on the general level of restrictions in a particular ward. There is an argument that, if the person cannot leave their room, this could be seen as constituting seclusion. The Commission believes that in this situation the principles of least restriction and of benefit should apply. If staff are available to allow the person to leave their room on request or where clinically indicated, then this restriction would not constitute seclusion. The practice of night time confinement in high security settings is contentious and its use in the UK was criticised by the Committee for the Prevention of Torture in its report to the UK government 18. Night time confinement is in place at the State Hospital (as it is in all high security hospitals within the UK). We are aware of this practice and view it as different to seclusion. The use of seclusion should be considered in the light of a range of alternatives. Positive support Positive support is an approach which incorporates the safe use of reactive strategies (including restrictive practices) alongside other targeted, proactive preventative approaches. The sole purpose of any reactive strategy is to make a situation safe and return an individual to a state where they can resume their normal activities. Written support plans ensure a consistent and shared proactive approach to meeting the person’s needs so that they are supported to develop alternative approaches to situations which cause distress. The support plan also details those reactive strategies to be used when the person’s agitation further escalates to the point where behaviours are presented which place either themselves or others at significant risk of harm. These may include the use of restrictive practices. 19 Given the NPM definition of seclusion, the following practices should be recorded as seclusion: Seclusion – Level 1 • • • Where staff lock a person alone in a designated seclusion room or seclusion suite; Where staff lock a person alone in a room or suite of rooms; Where staff place a person alone in a room and prevent them from leaving either by holding the door shut, standing in the doorway or instructing them not to leave. Seclusion – Level 2 • • Where staff remain with a person in a room or suite of rooms and prevent them from leaving or instructing the person not to leave; Where staff place restrictions on the physical environment the person can move to with the intention of keeping them separated from others. European Committee for the Prevention of Torture and Inhuman and Degrading Treatment or Punishment, Report to the Government of the United Kingdom, Council of Europe, 2017. 19 Problems: A Good Practice Statement. Royal College of Nursing (2013) Draft guidance on the minimisation of and alternatives to restrictive practices in health and adult social care, and special schools. 18 11