ongoing access to drinking water without requiring the detained individual to have to ask for it or already stretched staff to provide it on request. ■ O  utdoor yards should be made more accommodating and contain, as a minimum, somewhere for the patient to sit down, and ideally also stationary exercise equipment. ■ T  he Ministry should consider the introduction of ‘Minimum Entitlements’ for patients in a seclusion unit, including exercise time, access to a shower, a telephone, and family visits, similar to those issued by the Department of Corrections.51 This would enhance consistency throughout the system and, importantly, it would help to ensure that secluded individuals are able to access basic provisions which may also help to mitigate the harms of seclusion. ■ C  onsideration should also be given to the amendment of sections 7.1 and 7.2 of the Ministry’s Seclusion Guidelines52 which may result in the unintended consequence of prolonging stays in seclusion and reducing time out of room. The requirement in Section 7.1 for three clinicians to authorise the termination of seclusion may lead to a delay in such termination due to lack of appropriate staff, whereas the stipulation in section 7.2 that where the patient has been out of seclusion for longer than an hour their seclusion would be deemed to have ended, may inadvertently lead to staff reluctance to allow secluded patients spend longer than an hour outside their rooms, because doing so would trigger a new seclusion event with its associated paperwork. Fresh air, exercise and engagement with staff are key elements in mitigating the adverse effects of solitary confinement and as such should be encouraged, for as long as possible. The guidelines should reiterate that this is the case. ■ M  ore work should be carried out to better understand the variation in practice between the different DHBs. 51 Department of Corrections, Prison Operations Manual, section F.O1 Minimum Entitlements. http://www.corrections.govt.nz/resources/policy_and_legislation/Prison-Operations-Manual/Prisonerfinance-activities/F.html 52 Ministry of Health. 2010. Seclusion under the Mental Health (Compulsory Assessment and Treatment) Act 1992. Wellington: Ministry of Health. February 2010. The Guidelines stipulate that: 7.1 If the goals for seclusion have been achieved, a decision to end seclusion should be taken by two suitably qualified clinicians, in agreement with the responsible clinician. If the decision is made to end seclusion after hours, the delegated authority must be notified at an appropriate time. 7.2 Each episode of seclusion is deemed to have ended if the patient leaves the conditions of seclusion without expectation of return, and in any case, is deemed to have ended if the patient has been out of seclusion for more than one hour. The purpose of this is to allow a short period of evaluation out of seclusion. 60