Policies for seclusion The following guidance refers to both levels of seclusion. Where particular safeguards are indicated for level 1 seclusion, these are clearly highlighted. In a hospital or care setting, including individual tenancies, we believe there must be a policy and associated procedures for the prevention and management of violent and aggressive behaviour. Physical restraint, rapid tranquillisation and the seclusion of a person who presents with harmful behaviour can potentially be very dangerous and has led to fatalities in a number of care settings in the United Kingdom. 20 This policy should set out clear courses of action for staff and managers. Staff must be trained and regularly updated in the principles of positive behavioural support, how to reduce aggression and its consequences and the use of physical restraint. Where seclusion may be used, the service should develop a policy and protocol for its use and should only consider it as an option in the light of a range of alternatives to manage potentially harmful behaviour. Managers of health and social care services should pay particular attention to the use of seclusion and ensure that it is carefully monitored in their area of responsibility. The policy must address: • Situations where seclusion can be considered and guidance on risk assessment; • Who can make the decision to use seclusion; • Communication with the individual; • Maintaining the safety of the secluded person; • Care planning during seclusion; • Record keeping; • The arrangements for continuous assessment and review during a period of seclusion; • The provision and maintenance of a safe environment for seclusion; • How senior management in any care setting monitors the use of seclusion; • The impact of seclusion; • Staff and service user debriefing; • Staff training. Who can make the decision to use seclusion? The decision to use seclusion in hospital should only be made by a member of medical staff or the nurse in charge of the ward. The decision should be made in the light of available information and consideration of alternative interventions. The decision to use seclusion must be in response to a clearly identified risk of significant harm. That risk must be clearly recorded. For level 1 seclusion, where the decision in hospital is taken by someone other than the Responsible Medical Officer (RMO) then the RMO (or duty doctor) should be notified at once and should attend as soon as practicable, unless the seclusion has been for a very brief period (less than five minutes). Where the duty doctor is a junior member of medical staff then he or she should discuss the seclusion with the senior on-call doctor and record the decision. A senior member of nursing staff must be notified, and should visit as soon as practicable, to 20 Paterson, B., Bradley P., et al (2003) – Learning the Lessons Mental Health Practice 6(9), 10-17 13