H7 Consideration should also be given to the amendment of sections 7.1 and 7.2 of the Ministry’s Seclusion Guidelines (52) 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. H8 More work should be carried out to better understand the variation in practice between the different DHBs. Department of Corrections: 2017 recommendations C1 Individual prisons and the Department more widely need to ensure that At Risk units are not merely another form of segregation. Prisoners in these units should be offered some form of a daily regime, and health staff should be more involved with prisoners in the units, and work with them to address the issues which resulted in their placement at the unit. C2 Efforts to prevent self harm should include assurance that cells are safe and free of ligature points. We observed unsafe cells with broken fittings which could be used for self harm and potential ligature points in At Risk units. This was unacceptable. As well as ensuring that the physical environment is safe, efforts should also include offering those considered to be at risk an individualised programme of treatment and support. C3 The Corrections Act allows for basic regime provisions, for example education, visits, and telephone calls, to be denied to people serving a disciplinary punishment. This runs contrary to international human rights law and should be amended. Basic provisions must always be provided. C4 In my view, restraint beds are inherently degrading, and there is no justification for their continued use in prison settings. This extreme form of restraint should be removed from the menu of options available in prisons, just as it has been in health and disability settings. C5 Mental health staff should engage more closely with segregated prisoners, and ensure that these prisoners are closely monitored for signs of deterioration (cf. Mandela Rule 46, requiring health staff to pay particular attention to the health needs of segregated prisoners). 52