“All low stimulus areas have access to secure outdoor spaces. Refreshments are offered to service users during regular room entries (minimum of two-hourly). All rooms are air-conditioned with temperature being controlled centrally and adjusted automatically to help ensure it stays within the optimal range… Staff provide blankets if needed during cold weather and fans during the warmer weather.” (DHB) With regard to access to a toilet, the DHB noted that some of seclusion units have en suite rooms and others “…have toilets in the near vicinity. Wherever possible, these are made accessible to service users in seclusion. If there are concerns re risk, a toilet pan/urinal is made available to people.” These responses again fail to account for the de-facto conditions in many mental health and disability units, namely overcrowding and staff shortages. These mean that no matter how well-intentioned seclusion staff are, providing service users with toilet access or water on request in a timely manner is likely to stretch them beyond capacity. Access to basics should be ongoing and not dependent on staff goodwill and availability. The use of restraints The Ministry of Health informed this review that data on restraint use was not currently collected, but plans were underway to introduce national reporting. I look forward to hearing more about national reporting as it evolves. Good record keeping, as noted earlier, is crucial for any meaningful change to take place. Although this review did not benefit from nationwide data on the use of restraints, however, it might be useful to examine the use of restraint by one DHB by way of illustration. The data examined below was provided to this review by the DHB. Between September 2019 and February 2020 restraints were used 358 times. More than half of these uses were with female service users, and 42% were Mäori service users. The majority of restraint uses involved personal holds, but close to a third (114) of the uses involved prone restraints, where the person is held chest down, including several very lengthy holds – 1463 minutes in one case, 290, 100 and 125 minutes in others. These, clearly, are incredibly long times, especially considering that because of the health risks associated with prone restraints, international good practice suggests that they should only be used in exceptional, emergency situations. 46