Ministry of Health/DHBs: 2017 recommendations H1 The Ministry of Health and individual DHBs should be applauded for their commitment to policies aimed at the reduction, and eventual elimination, of seclusion. This commitment must be supported by a reassertion of why seclusion needs to be minimised in the first place: i.e. because it is damaging, inappropriate, not conducive to the therapeutic relationship between the patient and their care givers, and because it has no therapeutic value. This can be done through further training which may also help to address staff concerns about policies to eliminate the use of seclusion. H2 The physical environment of seclusion units and rooms needs to be improved. ‘Low stimulus’ need not mean barren and drab. Basic furniture can and should be introduced to rooms, especially where patients may spend longer than a few hours in seclusion. This can be special ‘safe furniture’ designed from tamper-proof materials aimed specifically for high risk patients. Patients should be allowed to keep some personal belongings and provided with something to do inside seclusion rooms. H3 Call bells should always be located inside the room so that the patient always has means of communicating with staff. Light switches and blind controls should be located inside seclusion rooms unless there are compelling and temporary reasons not to do so. Mechanisms which enable staff to override patients’ control can be installed to allay any safety concerns. This will help to normalise the environment and will afford the patient/client a degree of control over their environment. H4 All regular seclusion rooms should have drinking water. Where water is not provided, better arrangements for providing it need to be made to ensure 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. H5 Outdoor yards should be made more accommodating and contain, as a minimum, somewhere for the patient to sit down, and ideally also stationary exercise equipment. H6 The 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. 51