Key good practice points • • • • • • • • • • • • • • • • • • • There should be a clear positive support plan in place to minimise the need for restrictive measures. Any seclusion must be for the minimum necessary length of time. Seclusion should not be used as an intervention for suicidal or self-harming behaviour. Seclusion must never be used solely to protect property. Seclusion must only be used in the context of a clear policy on the prevention and management of aggression and violence. Seclusion should never be used to compensate for insufficient staffing or an inadequate environment. The use of, or threat of, seclusion must never be used as a punishment. The decision to seclude an individual must be made by a senior member of the care team in discussion with paid and informal carers. Where the decision has been made by a nurse in hospital, then a member of medical staff must attend as soon as practicable. Any person who is secluded must be subject to compulsory powers of detention in hospital (except in emergency situations) or to Welfare Guardianship in a community setting. The use of CCTV must be legally sanctioned as per guidance. The seclusion environment must not increase risk to the individual. There must be a clear plan to identify when the risk that led to the seclusion is no longer present and the seclusion should end. Staff who may be involved in managing violence and aggression must be fully and regularly trained in methods of risk reduction and safe restraint. 23 The general use of seclusion must be recorded and monitored in any area where it may be used. NHS Boards, or the management boards of private hospitals or care providers, must monitor the use of seclusion in their area of responsibility. Regular safety inspections of the environment of designated seclusion rooms must be carried out. Post seclusion debrief sessions should be arranged for staff. The person who was secluded should be offered the opportunity, at a time suitable to them, to discuss what happened and be offered appropriate support. Staff should involve family/carers as appropriate in relation to the use and review of the use of seclusion. The principles of least restriction and benefit must always be applied: we have provided some case examples. These can be found in the Appendix 1. 23 Recommendation Rec (2004)10 of the Committee of Ministers to member states concerning the protection of the human rights and dignity of persons with mental disorder (Adopted by the Committee of Ministers on 22 September 2004 at the 896th meeting of the Ministers’ Deputies) Article 11 20