What is Physical Restraint in Health and Social Care?

Physical restraint is a term that many hear but fewer truly comprehend in depth. In health and social care in the United Kingdom, this practice touches on legal, ethical, and emotional issues. Physical restraint refers to any method that uses bodily force to limit a person’s movement for their own safety or the safety of others. It often raises strong feelings and is surrounded by strict rules to protect both service users and staff.

What is the Definition of Physical Restraint?

Physical restraint means restricting someone’s movement, freedom, or normal access to their body. This can include holding an individual so they cannot move, preventing them from leaving a room, or using equipment to stop movement. The main goal is to prevent harm—either to the person themselves or to others around them.

The Health and Social Care Act, NHS guidance, and sector policy say that restraint should only be used when absolutely necessary and as a last resort. It must not be used for disciplinary, staff convenience, or as a form of punishment.

Physical restraint is different from other types, such as:

• Chemical restraint: Giving medication to control behaviour, not for medical treatment.
• Mechanical restraint: Using equipment (like belts or bed rails) to restrict movement.
• Seclusion: Isolating someone in a locked room or space.

Types of Physical Restraint

Several methods of physical restraint are used in care settings, each with outlined procedures and training. Examples include:

• Holding: Staff physically hold the person to limit their movement, usually until they calm down or the immediate danger passes.
• Guided walking: Staff guide a person away from a situation by gentle physical prompting or leading them by the arm.
• Containment: Blocking doorways or exits so a person cannot leave.
• Escort holds: Used when helping someone out of a potentially harmful situation.

Each method comes with its own risks and should be chosen carefully. The goal is always to use the least amount of force and for the shortest time possible.

Reasons Staff Might Use Physical Restraint

Staff use physical restraint in health and social care settings when:

• Someone’s behaviour becomes dangerously aggressive or violent.
• A person is at threat of injuring themselves—such as trying to jump from a window or pull out medical equipment.
• There is an immediate risk of harm to other residents, staff, or visitors.

Staff must use professional judgement, working within the law, and always respect the dignity and rights of those being cared for.

Settings Where Physical Restraint May Happen

Physical restraint can take place in a range of settings, including:

• Hospitals: Especially in emergency departments, mental health wards, and intensive care units.
• Care homes: Residential homes for older people or those with dementia.
• Learning disability or mental health facilities.
• Community settings: For example, during home visits or when supporting people in public spaces.

Each environment has specific protocols and guidance to keep everyone safe.

Legal Guidelines and Framework

The use of physical restraint is closely regulated by laws and policies. Key pieces of legislation and guidance include:

• Mental Capacity Act 2005: Staff must show that restraint is in the best interests of a person who lacks capacity to consent, and it must be necessary and proportionate.
• Human Rights Act 1998: Protects individual rights, including the right to liberty and freedom from degrading treatment.
• Care Quality Commission (CQC) Standards: The CQC inspects and rates services. Providers must show their restraint practice is justified, trained, and monitored.
• NHS England Guidance (Positive and Safe Care): Focuses on reducing all forms of restraint using positive behaviour support.

Failure to follow these legal standards can lead to criminal prosecution, disciplinary action, or loss of registration for individuals and organisations.

The Ethics of Physical Restraint

Restraint is an emotive subject. It can feel traumatic and humiliating to the person being held. Staff must balance safety with respect for autonomy and dignity. Using restraint wrongly can:

• Cause physical injury, distress, or psychological harm.
• Damage relationships between service users, families, and professionals.
• Lead to complaints, legal claims, and harm to professional reputation.

Ethical practice means restraint is used sparingly, reviewed frequently, and always explained clearly to the person and their supporters.

Risks Associated with Physical Restraint

Physical restraint carries genuine risks. Sometimes restraint can cause more harm than benefits. Possible harms include:

• Bruising, cuts, or broken bones if holds are applied incorrectly.
• Breathing difficulties, especially if someone is held face-down (prone restraint).
• Increased agitation or mental trauma, including fear and loss of trust.
• In rare cases, restraint can lead to death.

Due to these risks, NHS guidance encourages staff to use alternative de-escalation methods first and save restraint for genuine emergencies.

Alternatives to Physical Restraint

Organisations encourage staff to explore all other options before using restraint. These methods often prove effective and carry fewer risks, such as:

• Verbal de-escalation: Calm conversation, listening actively, and using non-confrontational language.
• Environment adjustment: Removing triggers, reducing noise, or allowing personal space.
• Personalised support plans: Knowing an individual’s preferences, warning signs, and what soothes them.
• Involving families: Drawing on the experience of relatives or friends can help manage behaviour without physical force.

Staff are trained to spot warning signs and use early intervention. Good communication and trust often prevent situations from escalating.

Training and Competence

Workers in health and social care must receive proper training before using restraint. Training covers:

• Safe holding techniques for different age groups and physical needs.
• Recognition of signs that a situation is escalating.
• How to de-escalate without force.
• Recording and reviewing any use of restraint.
• Understanding the law and human rights.

Trained staff know that restraint should never be an automatic response. Instead, it is part of a wider plan for care that values safety, dignity, and respect.

Recording and Reporting Physical Restraint

Every incident of restraint needs careful documentation. This keeps practice transparent and open to scrutiny. Accurate records should include:

• Who was restrained and why.
• How long restraint lasted.
• Type of intervention used.
• Staff involved.
• What happened afterwards, including medical checks and support.

This process for recording and reviewing ensures lessons are learned and helps organisations adjust care plans to avoid future incidents.

Impact on Staff

Physical restraint can affect staff emotionally and physically. Staff may feel guilt, anxiety, or distress after an incident. Support through debriefing, supervision, and regular training is important. Reflective practice helps teams spot patterns, share learning, and make improvements.

Involving the Person and Their Family

Sometimes, people who have experienced restraint or their loved ones want answers or reassurance. Open communication is important. Service users and families should have opportunities to raise concerns, ask questions, and suggest changes to care plans. Involving families in the planning process can lead to better outcomes and safer, more positive care experiences.

Promoting Positive Behaviour Support

Modern best practice moves away from restraint wherever possible. Positive behaviour support (PBS) focuses on understanding the reasons for challenging behaviour and meeting needs in a proactive way. PBS offers:

• Individual behaviour assessments.
• Personalised strategies to manage specific problems.
• Teamwork between professionals and families.
• Review of incidents to improve future practice.

PBS has reduced restraint use and improved quality of life in hospitals, care homes, and other settings.

Prevention and Culture Change

Changing the organisational culture is one of the most effective ways to reduce restraint. This means:

• Listening to service users and staff experiences.
• Regularly reviewing incidents and sharing learning.
• Developing clear policies and supporting staff to question poor practice.
• Recognising and celebrating positive outcomes.

This shift prevents over-reliance on restraint and focuses resources on prevention, communication, and meaningful engagement.

Final Thoughts

Physical restraint is one of the most challenging aspects of care work. It requires skill, reflection, and above all, respect for each individual’s rights and dignity. Understanding the practice, context, and consequences leads to safer, kinder, and more effective care.