Guidance: Use of seclusion in care for people with mental illness or learning disability

The Mental Welfare Commission has updated its good practice guide on the use of seclusion in hospitals and in the community for people with mental illness or learning disability.

The purpose of the document is to give clear guidelines on the use of seclusion and to ensure that, where this does take place, the safety, rights and welfare of the individual are safeguarded.

There are two reasons for updating the guide. The first relates to what seclusion actually means.

The Commission has found that some health boards and community services believe seclusion only relates to the use of a locked room. While previous guidance advised that there must be a policy in place for any service using seclusion as part of care and treatment, the Commission found that for some services, if they do not use locked rooms, they judge that they do not use seclusion.

The Commission’s new guide clearly identifies two main levels of seclusion – a locked room, but also a situation where staff are preventing a person from leaving where the door is not necessarily locked. This can apply in any setting, not just a specifically designed area.

The second reason for updating the guide follows the first.

The Commission recommends that every health board in Scotland now provides a policy on the use of seclusion, regardless of whether they say they use it or not. Currently some health boards have such a policy and others do not.

Alison Thomson, executive director (nursing), Mental Welfare Commission, said:“It is clear from observation and inquiries that seclusion is used in a number of hospitals in Scotland, and in other settings. In some situations, especially when there is a risk of harm to others, it may be an option preferred by both the individual and those providing care.

“But it is critical that care providers clearly understand whether or not they are using seclusion, and record each time it is used as part of the individual’s record of care. We ask all health boards and care providers in the community to read and adopt our definitions of seclusion.

“We also ask all health boards in Scotland to create a policy on the use of seclusion, regardless of whether they say it is used or not. This would allow staff to decide whether any particular situation meets the criteria or not.”

The guide is written for health and social care professionals working with people who are being treated for mental illness, dementia, learning disability or related conditions in health and social care settings.

Download the guide here.

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