What is Restrictive Practice in Health and Social Care?

Restrictive practice refers to any action that limits a person’s rights or freedom of movement. In UK health and social care settings, this often involves people who need support due to learning disabilities, mental health conditions, or dementia. The main aim is to protect people from harm, but it is a serious intervention and must only be used as a last resort. The use of restrictive practices comes with clear rules and guidance set by law, regulation, and policy.

What are the Types of Restrictive Practices?

Restrictive practices can take many different forms. They are used in care homes, hospitals, mental health units, and community settings. Here are the most common types:

• Physical Restraint: Holding someone or using equipment (like belts or straps) to stop movement.
• Mechanical Restraint: Using objects or devices to restrict freedom, such as specialised chairs or beds.
• Chemical Restraint: Giving medication to manage behaviour, not to treat medical conditions.
• Environmental Restraint: Changing the surroundings to stop people from moving freely, for example by locking doors.
• Seclusion or Isolation: Keeping someone alone in a room or area where they cannot leave.
• Verbal or Emotional Coercion: Using language or instructions to force a person to act against their wishes.

Each type brings its own risks and challenges. All restrictive practices must be legally justified, documented, and regularly reviewed by health and social care teams.

Legal and Ethical Frameworks

The use of restrictive practices in the UK is governed by several laws and professional codes. The main legal frameworks include:

• The Mental Capacity Act 2005 (MCA): Supports people who cannot make decisions for themselves. Deprivation of liberty must follow the law.
• The Mental Health Act 1983 (as amended): Sets out when someone can be detained or treated without their consent.
• Human Rights Act 1998: Protects rights to liberty, respect, dignity, and a private life.

The Care Quality Commission (CQC) and other regulators require organisations to meet strict standards. Staff must prove they have good reasons for any restriction, and show they tried all other options first.

Why are Restrictive Practices Used?

In rare situations, restrictive practice can help keep people safe. There may be immediate risks—such as violence or self-harm—that cannot be managed in another way. The main reasons given include:

• Preventing injury to the person or others
• Preventing damage to property
• Dealing with challenging behaviour that threatens safety

Many people in care settings are more vulnerable. They may struggle to express distress or frustration. When things go wrong, staff must work quickly to balance safety and respect for each person’s rights.

The Principles of Least Restriction

Staff must use the least restrictive option at all times. This means:

• Assessing risks first
• Trying de-escalation techniques such as calming communication or changing the environment
• Using restrictive practice only as a last resort, for the shortest time possible
• Stopping immediately when the risk has passed

Providers must keep records showing how they made decisions and what steps were taken. Inspectors and families can ask to see these records.

Risks Associated with Restrictive Practice

Restrictive practices are not without dangers. They can cause:

• Physical injuries, such as bruises or broken bones
• Psychological trauma, leading to fear, anxiety, or loss of trust
• Loss of dignity and independence
• Harm to relationships between people receiving care and those providing it

People who have experienced past trauma may be especially affected. The emotional consequences can last long after the event.

Alternatives to Restrictive Practice

Reducing the need for restriction is a top priority in health and social care. Good practice includes:

• Positive Behaviour Support (PBS): Helping people find other ways to express needs
• Training staff in de-escalation and communication skills
• Personalising care plans to understand what triggers distress
• Changing routines or environments to prevent conflict
• Involving families, advocates, and the person being supported in all decisions

This approach puts the person at the centre of care. It recognises that challenging behaviour often means unmet needs.

Examples of alternatives:

• Using activity schedules or sensory objects for distraction
• Creating quiet spaces for people to calm down
• Allowing more choice and control in daily life

Accountability and Safeguarding

Organisations must put safety, rights, and dignity first. Every use of restrictive practice should prompt a review and sometimes a safeguarding referral. Staff must be honest about mistakes and learn from them.

Key points for accountability:

• Recording every incident, including what happened before, during, and after
• Telling people, relatives, and advocates about any restriction
• Reporting patterns of use to regulators and commissioners

Safeguarding duties require everyone to act if they think someone is at risk of abuse or neglect. Unjustified or excessive use of restriction might be classed as abuse.

Involving People Who Use Services

People receiving care must have a voice in their own support. This means:

• Explaining what might happen if restraint is needed, in a way they understand
• Checking for consent whenever possible
• Listening to feedback about how restrictions feel

Advocates or family members might help with this, especially for those with communication difficulties.

Good care plans will:

• Record preferences, fears, and past experiences
• Describe steps to avoid restriction
• Set out how to respond safely and respectfully if it is ever needed

Training and Support for Staff

Staff need the right knowledge and confidence to support people well. All health and social care workers should receive training on:

• Recognising and understanding challenging behaviour
• Positive Behaviour Support and de-escalation
• Physical restraint techniques (if their job might require them)
• The legal principles and recording requirements

Providers are responsible for regular refresher courses and support for staff who find restraint distressing to use.

Key features of effective training:

• Practical scenarios or role play
• Opportunities to reflect on values and attitudes
• Clear messages about the dangers and pitfalls

Policies, Procedures, and Regular Review

Good organisations develop clear procedures for restrictive practice. These include:

• Assessment and review processes for each person
• Step-by-step guidance for different situations
• Systems for recording, reporting, and learning
• Regular team meetings to discuss care plans
• Reviews with families and advocates

Inspectors and commissioners will check policies to make sure they meet national standards and protect people’s rights.

National Guidance and Good Practice

National bodies set the standards for safe and respectful care. In England, this includes the Care Quality Commission (CQC), the National Institute for Health and Care Excellence (NICE), and NHS England. They issue guidance based on evidence and consultation with people who use services.

Their advice recommends:

• Reducing use of restriction by planning ahead
• Clear leadership from managers and care providers
• Listening to people and learning from incidents
• Sharing good ideas and results across teams

Examples of good practice:

• Staff working together to prevent crises
• Using gentle touch, not force, where possible
• Reviewing restriction as soon as the person is calm

The Impact on Families and Carers

Restrictive practice affects not just the person supported, but their loved ones, too. Families may feel:

• Alarmed or distressed by the idea of restraint
• Grateful for steps taken to keep people safe
• Worried about the impact on trust and wellbeing

Open communication is vital. Family members should be involved in planning where possible, and kept informed after any incident.

Human Rights, Advocacy, and Inclusion

Human rights law protects people from arbitrary or excessive deprivation of liberty. This means that:

• Restrictions must be lawful, necessary, and in proportion to the risk
• Alternatives must be considered and tried first
• People must be able to challenge or appeal restrictions

Advocates help people have their say, especially where capacity is limited or communication is difficult. Inclusion means recognising every person’s values, wishes, and dignity.

Moving Towards Better Practice

Health and social care in the UK is moving towards reducing restrictive practices even further. This is being driven by:

• Campaigns from people with lived experience
• Care reviews and reports after serious incidents
• Policy changes and commitments from provider organisations

A culture of respect, transparency and learning supports safer care. This means listening to feedback, reviewing every incident, and openly discussing improvements.

Final Thoughts

Restrictive practice is a sensitive and challenging aspect of health and social care. It involves balancing the right to safety with the right to freedom. Using restriction wisely – only when legally justified, respectful, and temporary – reflects the values of dignity, fairness, and compassion at the heart of UK care. Staff, managers, people using services, and families all have a part to play in making sure everyone is safe, heard, and respected.