guidance on restricting an individual’s freedom of movement in settings other than hospital is scarce. Some observers believe that no one receiving care for any form of mental illness, learning disability or related conditions should ever be locked in a room on their own. However, it is clear from observation and inquiries that seclusion is used in a number of hospitals in Scotland, and in other settings. In some situations, especially when there is a risk of harm to others, it may be an option preferred by both the individual and those providing care. For instance, where the alternative may involve long periods of restraint with an increased risk of injury, seclusion may be a safer option. Similarly, where a person may have a respiratory problem or bone density issues, the risk of injury during physical restraint would be considerable. However, locking someone alone in a room is a serious intervention and must be carefully regulated and monitored, both internally and externally. We believe that this is best done by applying a set of principles to its use and ensuring that there is a clear local monitoring framework. As well as being the least restrictive measure, the use of seclusion must always have the benefit of the individual at its heart. Therefore, evaluation of the intervention should be carried out after each episode of seclusion. Seclusion, whether in hospital or other settings, is a form of restraint that requires careful management by an agreed decision-making process and monitoring by mental health and learning disability professionals and support staff who are fully trained in the prevention and management of behaviour which may cause harm to others. Seclusion itself can carry risks to the individual, both physical and psychological. It is often used in association with physical restraint and rapid tranquillisation, sometimes in confined spaces. Moreover, inappropriate seclusion in substandard environments will increase the level of stress experienced by a person in serious distress and increase the risk of, and opportunity to, self-harm. In all situations where seclusion is being considered, there needs to be careful consideration of the balance between the risk of self-harm and the risk of assault on others. Scope of this guidance This guidance relates to the care and treatment of people with mental illness, personality disorder, dementia or learning disability or related conditions (‘mental disorder’ under the legislation 14) in health and social care settings. It is not intended to cover seclusion in other areas including prisons, young offender’s institutions, other custodial care settings and schools, which will all have their own guidance, written for those specific settings. Restrictions in community settings The Keys to Life 15 is Scotland’s learning disability strategy and was launched in 2013. A priority within the strategy is that all adults with learning disabilities, including those with complex needs, experience meaningful and fulfilled lives. Section 328 of the Act provides that “mental disorder” means any mental illness; personality disorder; or learning disability, however caused or manifested 15 Scottish Government (2013) The keys to life - Improving Quality of Life for People with Learning Disabilities https://keystolife.info/wp-content/uploads/2019/03/Keys-To-Life-Implementation-Framework.pdf 14 8