Seclusion (or solitary confinement) continued to be disproportionately used with Mäori and Pacific Peoples in Health and Disability facilities, in children and young people’s care and protection and justice residences (where the practice is known as ‘secure care’), and in prisons (where the practice is known as ‘segregation’). Some positive developments notwithstanding, then, the first and clearest finding of this review is that seclusion and restraint practices were still very much in use in closed institutions across New Zealand, and that the documentation, reporting and analysis of data remain woefully lacking. As a Submission by the Tumu Whakarae, the National Reference Group of Mäori Health Strategy Managers within District Health Boards (DHBs), to the Government Inquiry into Mental Health and Addictions (2018)2 noted, sedation, seclusion, criminalisation and incarceration are strategies of a flawed system. A significant shift was needed: ‘There is a pressing need for effective dual diagnosis services for tangata whenua in the area of Mental Health and Addiction, including significant shifts in the justice system from a model of criminalisation and discrimination, to a Pae Ora paradigm that focuses on intervention, healing and recovery.’ (p 30.) I think that this is true across the board. This report demonstrates that, without a significant shift in the very way that detaining agencies think about the extreme tools of seclusion and restraint, a meaningful change will be impossible to achieve. National Preventive Mechanisms (NPM) have a key role to play in helping agencies realise this paradigm shift through monitoring closed institutions, reporting practices which fall short of acceptable standards, and holding detaining agencies to account. In general, this is something that New Zealand’s NPM bodies do well, producing excellent work individually, though there may be more scope for collaborative work and information sharing between them. Levels of resourcing appeared to vary between the NPM bodies, inevitably leading to a variation in the scope of monitoring work which could be carried by each body. It is crucially important that all NPMs are empowered to carry out their important roles and are properly resourced to carry these out. 2. 12 Tricia Keelan and Jodi Porter, Submission by the Tumu Whakarae, the National Reference Group of Mäori Health Strategy Managers within District Health Boards (DHBs) to the Government Inquiry into Mental Health and Addictions (August 2018).