regulate its use, and in some cases eliminate it altogether.11 The use of restraint is similarly controversial, and the application of restraints is known to have significant adverse physiological effects on the individual. These effects and the risks associated with them are elevated by medical conditions such as asthma, obesity, intoxication and psychotropic medications, with the risk of death or injury appearing to be higher for children and adolescents.12 In addition, people who have a history of abuse can experience restraint as a re-enactment of their original trauma (ibid.) Individuals who were restrained reported feeling a loss of their dignity and sense of autonomy.13 Staff also reported feeling demoralised following the application of restraint.14 The physiological risks associated with restraint include death (most commonly from asphyxiation), and physical injuries such as lesions, blood clots, sprains, and fractured bones (Mohr et all, ibid). The emerging consensus regarding restraints is that their use can and should be reduced if not eliminated altogether, and a growing body of research over the past decade documents the development of a range of effective alternatives to the use of restraint and further undermines its use.15 The current international consensus on minimum standards for the treatment of prisoners and detainees and on what constitutes prohibited treatment, as well as the position on solitary confinement and restraints, are expressed in the revised (2015) UN Standard Minimum Rules on the Treatment of Prisoners (now renamed the 'Mandela Rules', hereafter 'the Rues').16 The Rules make it clear that solitary confinement can amount to cruel, inhuman or degrading treatment or punishment, especially for children and people with disabilities, including mental health issues. The Rules stipulate that: 11 For a fuller discussion of the professional and human rights instruments relating to solitary confinement see Sourcebook on Solitary Confinement (cited above). 12 Mohr, W.K., Petti, T.A., and Mohr, B.D. (2003), Adverse Effects Associated with Physical Restraint, 48 Canadian Journal of Psychiatry 5 (2003) at 330-337. 13 Barnett, R., Stirling, C., Pandyan, A.D. (2012) A review of the scientific literature related to the adverse impact of physical restraint: gaining a clearer understanding of the physiological factors involved in cases of restraint-related death. Med Sci Law. 2012:52(3):137-42.; See also National Association of State Mental Health Program Directors Position Statement on Seclusion and Restraint. (https://www.nasmhpd.org/content/ position-statement-seclusion-and-restraint), accessed 10 February 2017. 14 Wynn, R. (2003). Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nordic Journal of Psychiatry, 57(6), 453-459. 15 Haimowitz, S., Urff, J.D., Huckshorn, K. A. (2006) Restraint and Seclusion Ð A Risk Management Guide. National Association of State Mental Health Program Directors Report. Virginia. (Online: https://www. power2u.org/downloads/R-S%20Risk%20Manag%20Guide%20Oct%2006.pdf, accessed 10 February 2017); American Psychiatric Nurses Association (APNA) Position Statement on Seclusion and Restraint (http:// www.apna.org/i4a/pages/index.cfm?pageid=3728) ), both accessed 10 February 2017. 16 For a guide on interpretation of the revised Mandela Rules see: Penal Reform International and Human Rights Centre, University of Essex (2017) Essex paper 3: Initial guidance on the interpretation and implementation of the UN Mandela Rules. (https://www.penalreform.org/resource/guidance-on-implementation-the nelsonmandela-rules/), accessed March 15, 2017. 19