3. Health and Disability facilities Background and key developments since 2016/17 Since the publication of Thinking Outside the Box? efforts to reduce, and eventually eliminate, the use of seclusion in mental health, have intensified. There was a clear sense of a strong commitment to the goal of eliminating the use of seclusion by both the Ministry of Health (MoH) and the District Health Boards (DHBs). In December 2017 the Health Quality and Safety Commission (HQSC) and Te Pou announced that they would be collaborating on the Pathways to Eliminate Seclusion by 2020 project. The 2017 annual report of the Office of the Director of Mental Health and Addiction Services for the Ministry of Health, published in 2019, stated support for these efforts and noted that “Seclusion should be an uncommon event, and services should use it only when there is an imminent risk of danger to the individual or others and no other safe and effective alternative is possible”.9 Locally, DHBs reported being actively engaged in the Zero Seclusion project, including the setting up of dedicated Zero Seclusion teams and a greater focus on the gathering and analysis of data on seclusion practices. This is a very welcome development. In its submission to this review, one DHB emphasised their involvement in the Zero Seclusion Project, and the work of the Seclusion and Restraint Minimisation Committee as important drivers of positive change against TOTB’s recommendations. They noted, for example, a requirement for staff to undertake de-escalation training; the routine use of service user de-briefing after each seclusion event in most units; and better sharing of learning and good practice across DHBs. The DHB recognised that, nonetheless, more remained to be done to understand variation in practice across DHBs and noted that it was still the case that no guidance had been issued by the Ministry of Health on minimum entitlements for patients service users held in seclusion, as recommended in TOTB. 9. Ministry of Health. 2019. Office of the Director of Mental Health and Addiction Services: Annual Report 2017. Wellington: Ministry of Health, at p 44 37