What is Restrictive Practice in Health and Social Care

What is Restrictive Practice in Health and Social Care?

Dignity and Respect, Safeguarding

Care Learning

4 mins READ

In health and social care, restrictive practice refers to interventions or strategies used to limit the rights or freedom of movement of individuals.

Practitioners employ such methods to protect the individual or others from harm. While the primary goal is safety, restrictive practices must be used sparingly, ethically, and lawfully.

This guide explains restrictive practice, why it’s used, various forms it takes, and the legal and ethical considerations involved.

Definition and Purpose

Restrictive practice, in simple terms, involves any action that limits an individual’s freedom. This can mean physical restraint, seclusion, or even the overuse of medication to manage behaviour. The ultimate goal is to prevent harm. For example, someone with severe learning difficulties might harm themselves or others if not restrained.

Types of Restrictive Practices

Physical Restraint

Physical restraint involves direct physical contact to limit a person’s movement. This can include holding someone to stop them from hitting themselves or others. It’s crucial that physical restraint is:

  • Last resort: Only after other de-escalation strategies have failed.
  • Proportionate: Only as much force as necessary.
  • Time-limited: Used no longer than necessary.

Mechanical Restraint

Mechanical restraints use devices or materials to restrict movement. Examples include straps or belts to prevent someone from getting out of bed and causing injury. These must be used under strict guidelines to ensure safety.

Chemical Restraint

Chemical restraint involves using medication to control behaviour. Doctors may prescribe sedatives to calm an agitated person. These should be:

  • Clinically justified: Only when essential for safety.
  • Monitored: With regular reviews to avoid overuse.


Seclusion refers to isolating a person in a room away from others. It’s used to manage extreme behaviour that poses immediate danger. The isolation room must be safe, and staff should observe the individual continually.

Environmental Restraint

Environmental restraint involves altering the surroundings to restrict freedom. This can include locked doors or barriers preventing access to certain areas. It’s often seen in care homes to protect residents with dementia from wandering into unsafe areas.

Restrictive Practice Legal and Ethical Considerations

Legal Framework

Several laws govern the use of restrictive practices. These include:

  • Mental Capacity Act (2005): Ensures actions are in the best interest of those who cannot make decisions themselves.
  • Mental Health Act (1983): Provides a framework for treatment without consent for those with severe mental health disorders.
  • Human Rights Act (1998): Ensures that any intervention respects a person’s human rights.

Ethical Principles

Healthcare professionals must adhere to ethical principles:

  • Necessity: Only use restrictive practices when absolutely necessary.
  • Least Restrictive Option: Always seek the option that restricts the least.
  • Proportionality: Balance the risk of harm against the need for restriction.
  • Respect for dignity: Maintain the person’s dignity and autonomy as much as possible.

Best Practices for Restrictive Practice

Individual Care Plans

Develop personalised care plans that focus on positive behaviour support. Each plan should be tailored to the individual’s needs and preferences, aiming to reduce the need for restrictive practices.

Training and Staff Support

Effective training ensures staff know how to handle challenging situations without resorting to restrictions. Regular refresher courses can keep skills up to date.

Monitoring and Review

Regularly review the use of any restrictions. Care plans should be updated based on these reviews. Monitoring helps identify patterns and reduce the unnecessary use of restrictive practices.

Restrictive Practice Impact on Individuals

Psychological Effects

Restrictive practices can have severe psychological impacts. Individuals may feel:

  • Distressed: Confusion and fear can increase with frequent restraints.
  • Stigmatised: Feeling labelled as ‘difficult’ can lower self-esteem.
  • Alienated: Isolation can lead to a sense of abandonment.

Physical Effects

Physical restraints and seclusion can result in injuries or worsen medical conditions. Prolonged restraint can lead to muscle atrophy or pressure sores.

Alternatives to Restrictive Practices

De-escalation Techniques

Teach staff de-escalation techniques that use verbal and non-verbal communication to calm individuals. Techniques can include:

  • Active listening: Understanding the person’s concerns.
  • Empathy: Showing genuine care and understanding.
  • Redirecting focus: Shifting the person’s attention to something positive.

Behaviour Support Plans

Develop proactive behaviour support plans. These should:

  • Identify triggers: Point out what causes distress.
  • Outline strategies: Provide methods to avoid reaching crisis points.
  • Promote positive behaviour: Reinforce good behaviour with rewards and encouragement.


Restrictive practice in health and social care is a complex issue that requires careful consideration. Its primary aim is to protect individuals and others from harm, but it must be used sparingly and ethically.

Understanding the types, legal frameworks, and best practices helps ensure that when restrictive practices are used, they are justifiable and respectful of the individual’s dignity.

Always seek alternative methods and provide continuous training and support for staff to minimise the need for such interventions.

Regular reviews and personalised care plans can help reduce reliance on restrictive practices, improving the quality of life for those in care.

Restrictive Practice PDF Resources

What are restrictive practices – NHS England (PDF)

    • This booklet is for people who are patients in learning disability, autism, and mental health hospitals, as well as staff working in these hospitals.

    Restrictive Practice Guidelines (Full Resource Pack) (PDF)

      • These guidelines provide support to health and social care settings when restrictive interventions are being used, along with good practice guidance.

      Reducing Restrictive Practice | NHS England (PDF)

        • This document discusses restrictive interventions including actions to restrict a patient’s movement, liberty, and/or freedom to act.

        Positive and Proactive Care: reducing the need for restrictive practices (PDF)

          • This guidance provides information and good practice guidance to all health and social care services for adults delivered or commissioned by the NHS.

          Restraint in mental health services – Mind (PDF)

            • This report provides information about restraint and other restrictive practices, and includes guidance on how to influence practice.

            The mental health safety improvement programme: a national quality improvement collaborative to reduce restrictive practice in England (PDF)

              • This document details the mental health safety improvement programme aimed at reducing restrictive practice in England.

              Reducing restrictive practice: Developing and implementing behaviour support plans (PDF)

                • This article details the development and implementation of bespoke behavioural support plans at a large London mental health trust.


                  • This policy outlines the unlawful use of restraint and inappropriate techniques, highlighting the legal implications.

                  Mental Health Act – A focus on restrictive intervention reduction (PDF)

                    • This document focuses on the Mental Health Act’s expectation for services to commit to reducing restrictive interventions.

                    Reducing Restrictive Practice: A Story of Change (PDF)

                      • This document discusses the necessity of understanding situations in mental health services that require positive and proactive intervention.

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