more than 8 hours consecutively; or 12 hours intermittently over a period of 48
hours.'Regarding where the seclusion takes place, the Code of Practice provides:
`19.22 The room used for seclusion should:. provide privacy from other patients;
. enable staff to observe the patient at all times;
. be safe and secure;
. not contain anything which could cause harm to the patient or others;
. be adequately furnished, heated, lit and ventilated;
. be quiet but not soundproofed and with some means of calling for attention;
the means of operation should be explained to the patient.
Staff may decide what a patient may take into the seclusion room, but the patient
should always be clothed.'
The Mental Health Act Commission collates information on the usage made of
seclusion and this has been an area that merited particular attention'. Their Eighth Biennial Report indicated that nearly 5000 episodes of seclusion were used in 1997/8 in relation to just under 2000 patients. In addition, and perhaps of more concern, is the statement thatthere is a considerable number of units where
policies are either inadequate or out of date and the guidance in the Code is not
followed' [54].
9.7 Patients or individuals with personality disorders
As highlighted above, there has recently been an increase in concern, on the part of
the Government, in relation to individuals deemed to have a dangerous severe
personality disorder where their condition is not amenable to treatment. As such
this minority of personality disorder sufferers cannot be legally detained under the
MHA #other than, possibly, for a very short time under section 2 or section 4). This
is because, in the detention section provisions, personality disorder is classed
within the category of psychopathic disorder', and can only justify detention if the treatment islikely to alleviate or prevent deterioration' of the disorder [55]. The
result is that these individuals who are classed as having a dangerous and serious
personality disorder will be left in the community where they `pose a risk of serious
offending' [56]. Whilst the proposals are couched in terms of ensuring that these
individuals receive the help they need, it is not surprising that this is set in the
context of protecting the rest of society. As such, the nature of the proposals may
be questioned as being potentially Draconian in their application, and at odds with
the concept of innocent until proven guilty.
The basic thrust of the proposal is for the following [57]:
`. legislative powers for the detention of dangerous severely personality dis-
ordered people for as long as they present a risk to the public, and powers of
supervision and recall following release from detention;Mental Health Nursing 177