Seclusion rooms were not always used for their intended purpose Seclusion rooms were not always used for their intended purpose. Asked about the purpose of seclusion a mental health nurse in another unit said: 'we don’t view seclusion as a particularly therapeutic tool. It's a management issue'. Another nurse conceded that: ‘it’s about the circumstances of the person, but also about what’s happening on the unit at the time’. In one of the units visited, all three available cells (two 'designated' seclusion cells and one used for overflow) were occupied by people who were 'transitioning and here to sleep'. In another unit, only one of five rooms was officially designated as a seclusion room, but all were identical in appearance and of the four which were occupied at the time of our visit, all appeared to be used for the purpose of keeping individuals separated from others: one man was 'transitioning' back to the main unit, another was a very long term patient who had a bedroom in this unit as well as in the main unit, a third patient, a woman, had been at the unit for over two months because of 'inappropriate behaviour', and the fourth patient 'sleeps here because there is no room for him in the main unit'. This was not good practice. In yet another unit we were told that placements in the low stimulus area were "usually driven by perceived dangerousness; actual assault on staff; overstimulation; risk of escape and overcrowding". Overcrowding is not a justifiable reason for locking up a patient in a small, barren room with no personal belongings for days on end, nor is it provided for under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (section 71(2)). Stark physical environment and lack of patient control over their environment In all units visited, seclusion rooms resembled prison segregation cells, and were mostly barren other than a mattress and bedding. In many of the units visited patients had little control over their environment – for example light switches and blind controls were located outside the room and could not be operated by them. Where some control was given to service users, for example, allowing residents of one health and disability unit Seclusion room in a health and disability unit 37