Introduction and general observations In March 2020 I was invited by the New Zealand Human Rights Commission to conduct a short follow-up of my 2017 review of seclusion and restraint practices in New Zealand (Thinking Outside the Box?: A review of seclusion and restraint practices in New Zealand). I was delighted to accept the invitation. Thematic reviews of this type do not always benefit from the opportunity of a full follow-up, and the Commission and I agreed that three years were about the right length of time for recommendations to be implemented, and for changes to be bedded in – or not. Regrettably, the COVID pandemic broke out shortly before we were due to undertake field visits for the follow-up review, ruling out the option of visiting all the sites visited for the original report. This meant that the follow-up needed to be mostly paper based, although we were fortunate to manage visits in a number of prisons and in a secure care facility for children, which allowed us to see first-hand how things looked on the ground. This review also benefited from excellent submissions from a small number of civil society organisations whom we directly invited to comment on key developments since 2017. There have been some very positive developments in the three sectors this report covers – the Department of Corrections, the Ministry of Health and District Health Boards, and Oranga Tamariki – since the original review. It was good to learn that Corrections no longer used the ‘tie down’ beds, described in Thinking Outside the Box? (hereafter: TOTB) as ‘inherently degrading’. A greater focus on a mental health component has been introduced in prison Management and Intervention and Support units (ISUs, the successors of the ‘At Risk units’, also criticised in TOTB). This too was a welcome development, though, as discussed later, there was some evidence that the key focus in the ISUs remained the control and incapacitation of those deemed to be at risk, and they did not provide a therapeutic environment for people who were unwell. Some of the newly built facilities in the prison estate had improved physical conditions in segregation cells, though the choice of similar designs to those used in the past was, in my view, a missed opportunity. 10