health system to find temporary beds elsewhere – sometimes there is no option other than an open seclusion room.”12 One must not underestimate the strains and challenges of an overcrowded and understaffed system. However, locking up service users who are unwell in the barren, austere seclusion rooms for hours, days or weeks is not an acceptable solution for staffing and budgeting problems. It can also mask the extent of the use of de facto seclusion. Material conditions in seclusion units In TOTB I recommended that: the physical environment of seclusion units and rooms be improved; service users be allowed to keep some personal belongings and provided with something to do in seclusion, and; that yards be equipped with exercise equipment. Whilst the COVID pandemic had meant that we were unable to visit Health and Disability units ourselves, reports by monitoring bodies and submissions to this review indicate that, some new build and refurbishment work notwithstanding, many of the problems identified in Thinking Outside the Box? persisted in these units, including: • Stark environment with limited or no natural light and no fresh air; • Furnishings comprising of no more than a bed base and a mattress, often just a mattress; • No means to tell the passing of time of day or date (clock/ calendar); • Windows without curtains or, conversely, with blinds that are kept shut and are not working; • Seclusion rooms have no toilets. Instead, service users need to use cardboard bedpans for urinating and defecating; • No access to running water. Another issue highlighted in several reports was lack of privacy in seclusion rooms, with service users potentially having to attend to their bodily needs in full sight of unit staff.13 12. Response To The Chief Ombudsman’s OPCAT Report Press Release: New Zealand Nurses Organisation, 28 August 2020. https://www.scoop.co.nz/stories/GE2008/S00170/response-to-the-chief-ombudsmans-opcatreport.htm 13. See for example a series of OPACT inspection reports on visits to Health and Disability facilities by the Office of the Ombudsman between September 2019 and March 2020, available on the Ombudsman’s website: https://www.ombudsman.parliament.nz/resources?f%5B0%5D=category%3A1993 44