We also observed a noticeable variation in the quality and quantity of food served in the facilities we visited despite standardised menus now being offered throughout the prison estate. In most At Risk units food was served in paper plates and with cardboard cutlery as a matter of policy, and in some prisoners were only offered finger food, regardless of their individual risks and needs. Health and disability units The physical place where patients and residents in health and disability units could be held in separation from others is called Seclusion. Section 71 of the Mental Health (Compulsory Assessment and Treatment) Act 1993 sets out the conditions that apply when a mental health patient is placed in Seclusion. Additional safeguards are listed in Appendix 3. These include a requirement that Seclusion only be used where, and for as long as, it is necessary for the care and treatment of the patient, or the protection of other patients. Section 60 of the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 stipulates that a care recipient may be placed in seclusion to prevent them from endangering their own health or safety or that of others and /or where the care and wellbeing of other persons would be seriously compromised. Some of the issues around the use of seclusion and segregation practices in health and disability units included: The official objective of reducing seclusion was not always accepted by front line-staff While the Ministry of Health and the DHBs’ high-level commitment to the reduction and eventual elimination of seclusion was clear, the necessary change of mindset was not always evident on the ground, with some patients (or ‘clients’) spending much of their time in seclusion and/or restraint and some staff fearing that reduction in the use of seclusion and restraints would endanger their safety. There also appeared to be some tension over the more ambitious aim of eliminating the use of seclusion altogether. As staff in one of the units visited put it: ‘I’d like to see us not use seclusion at all, but to do that we’ll need more staff/ if you don’t [provide more staff] staff will feel unsupported, no matter what the evidence says’. (clinical Lead) ‘I agree. I don’t like seclusion. It has no therapeutic value. It’s an intervention to stop violence. From my perspective, the culture is still swayed towards staff safety. Fear is a big factor’ (Nursing lead). 36