People who have experienced seclusion and restraint practices have also shared their thoughts and views. Gaining a better understanding of the impacts of being restrained or isolated has been identified as something that the NPMs need to look into further. That will provide important information about the impact of these practices on people who are directly affected. We are grateful to those who took the time and made the effort to participate in this work and look forward to exploring these issues further. There was also a high level of engagement from clinical professional bodies and associations, many of whom were troubled by a perceived tension between ensuring the safety and well-being of service users while simultaneously making sure that facility staff, or others, were protected from harm. The decisions and actions required from staff, sometimes on a daily basis, were clearly a source of concern and anguish for those involved. Dr Shalev has noted from her visits that there appeared to be high levels of risk aversion and that staff safety could sometimes take precedence over the comfort or rights of patients and prisoners. Again, this area needs attention. It is important to get this difficult balancing act right and to consider the perspectives of staff as well as service users. Observations The relevant domestic legislation and regulations were examined. The more significant of these are reproduced in the appendices to Dr Shalev’s findings. Some statutory provisions are more consistent with the principles upheld in international human rights laws and standards than others. There also appears to be scope for greater alignment of legislation to provide more coherency across different sectors in relation to seclusion and restraint related frameworks and safeguards. Further work needs to be undertaken to assess these requirements in more detail and to advocate for positive change. Dr Shalev noted the work being undertaken by Te Pou o te Whakaaro Nui (“Te Pou”) to reduce the use of seclusion and restraint.vi Te Pou is a national centre of evidence based workforce development for the mental health, addiction and disability sectors. It is funded by the Ministry of Health and the organisation has taken a lead in developing a range of tools to support inpatient mental health services to reduce seclusion and restraint. These activities include workforce training programmes such as SPEC (Safe Practice Effective Communication), use of sensory modulation tools and the development of a local version of the Six Core Strategies. The latter framework incorporates evidence based approaches that have been proven effective in reducing seclusion and restraint events. Dr vi 6 http://www.tepou.co.nz/initiatives/reducing-seclusion-and-restraint/102