This guide will help you answer The RQF Level 2 Diploma in Care Unit 1.5 Describe restrictive practices.
Restrictive practices are measures or interventions that limit an individual’s freedom and autonomy. In health and social care settings, they are used to manage challenging behaviours and ensure the safety of the individual and others. However, their use must be justified, proportionate, and in the best interest of the person receiving care.
Types of Restrictive Practices
Physical Restraint
Physical restraint involves using, or threatening to use, force to make someone do something they are resisting, or restricting their movement (Mental Capacity Act 2005, section 6, England and Wales). Equipment used to reduce the risk of falls, such as belts, is covered under mechanical restraint below. Physical restraint should be a last resort and used only when absolutely necessary to prevent harm.
Examples:
- Holding arms to prevent self-harm or harm to others.
- Holds that restrict a person’s movement must meet the conditions in section 6 of the Mental Capacity Act 2005. Equipment such as bed rails is considered separately from physical holds; follow your organisation’s policy.
Mechanical Restraint
Mechanical restraint means using equipment to restrict a person’s movement. This method includes things like specialised chairs with belts or cuffs. It’s typically used when there is a significant risk of injury, and other methods have failed.
Examples:
- Equipment that restricts movement should only be considered after less restrictive options, and only where the conditions in section 6 of the Mental Capacity Act 2005 are met (England and Wales). Follow your organisation’s policy.
- Chairs with safety belts to maintain the position of individuals who can’t sit unaided.
Chemical Restraint
Chemical restraint involves using medication to control or subdue behaviour. This should only be done under medical supervision and as part of a care plan. Continuous assessment is really important to ensure the dosage and its necessity remain appropriate.
Examples:
- Any medicine that affects how alert or calm a person is must be decided by a prescriber and reviewed regularly. Follow the person’s care plan and your organisation’s policy.
- Medicines should not be used simply to control a person’s behaviour. Medicine decisions belong with the prescriber; see the NHS England STOMP and STAMP programmes (England).
Environmental Restraint
Environmental restraint is about controlling a person’s access to certain areas or items. It involves changing the environment to reduce risks and harm. This method must balance the individual’s freedom and safety, always respecting their rights.
Examples:
- Locked doors to prevent access to hazardous areas.
- Removing sharp objects to prevent self-harm.
Seclusion
Seclusion is a restrictive practice used in specific mental health settings and is governed by the Mental Health Act 1983 and its Code of Practice (England). Check the current Mental Health Act code of practice and the Mental Health Units (Use of Force) Act 2018 statutory guidance, and follow your organisation’s policy.
Examples:
- Seclusion is a matter for specific mental health settings and is governed by the law and the Mental Health Act code of practice. It is not a general care home response.
- Using a secure room in a psychiatric hospital for acute management of dangerous behaviour.
Ethical Considerations
Person-Centred Approach
Every restrictive practice must follow a person-centred approach. This means understanding the individual’s needs, preferences, and rights before implementing any restriction. Care plans should be reviewed regularly to avoid unnecessary or prolonged use.
Least Restrictive Option
Always use the least restrictive option. This principle ensures that the person’s freedom is limited as little as possible to achieve the intended safety outcome. Any action taken must be proportional to the risk presented.
Consent and Capacity
Assessing consent and capacity is essential. If a person has the capacity, they should be involved in making decisions about their care. When they lack capacity, decisions should be made in their best interest, considering past preferences and involving their family or advocates.
Legal Framework
In England and Wales, the main laws include the Mental Capacity Act 2005 (sections 5 and 6), the Mental Health Act 1983 and, in mental health units, the Mental Health Units (Use of Force) Act 2018, alongside the Human Rights Act 1998. Scotland and Northern Ireland have their own laws. Check the latest Mental Health Act code of practice. Adhering to these regulations ensures practices are ethical, legal, and in the best interest of the individual. An accessible complaints procedure also helps people raise concerns about the care they receive. Overall, these laws and guidelines aim to promote the autonomy and well-being of individuals while balancing the need for safety and support.
Minimising the Use of Restrictive Practices
Positive Behaviour Support
Positive Behaviour Support (PBS) focuses on understanding the reasons behind challenging behaviours. By addressing the root causes, PBS reduces the need for restrictive practices. It involves creating supportive environments and teaching new skills to replace challenging behaviours.
Training and Supervision
Staff training is important. Workers must understand the types, ethical considerations, and legalities of restrictive practices. Regular supervision ensures that practices are used appropriately and that staff are supported in managing challenging situations.
Monitoring and Review
Regular monitoring and review are essential to ensure restrictive practices are necessary and effective. This includes maintaining detailed records and conducting regular audits. Reviews should involve multidisciplinary teams and, where possible, the individual and their family.
Involvement of Families and Advocates
Families and advocates should be involved in decisions about restrictive practices. They provide valuable insights into the individual’s history, preferences, and behaviours. Their involvement ensures that decisions are person-centred and respect the individual’s rights.
Example answers for 1.5 Describe restrictive practices
Here are example answers a care worker might write when completing this unit:
Example Answer 1: Physical Restraint
Physical restraint is when I use force to hold a person and stop them from moving freely. I’ve seen this used in our care home to prevent someone from harming themselves or others. For example, we had a resident who kept trying to hit other residents when they were upset. We responded using the methods we are trained in, our policy and the person’s care plan, choosing the least restrictive approach. We only used this when absolutely necessary and always recorded it, ensuring the restraint was the minimum needed to keep everyone safe.
Example Answer 2: Mechanical Restraint
Mechanical restraint involves using equipment to restrict movement. One instance I remembered is when we used a specialised chair with a belt for a resident who couldn’t sit upright by themselves and kept slipping, risking injury. The belt helped to keep them in a safe position. It’s important that we check the belt regularly to ensure it’s not causing discomfort and only use it as part of a care plan based on a best-interests decision, made with the person, their family and healthcare professionals. Family members cannot decide for the person unless they hold a relevant lasting power of attorney or deputyship; see section 6 of the Mental Capacity Act 2005 (England and Wales).
Example Answer 3: Chemical Restraint
Chemical restraint refers to using medication to manage behaviour. I recall a situation where a resident with severe dementia often became extremely agitated and posed a risk to themselves and others. After consulting the GP, the person’s family and the care team, the prescriber reviewed whether any medicine was appropriate, and the healthcare team monitored and reviewed it regularly. Medicines should not be used just to control behaviour; see the NHS England STOMP and STAMP programmes (England).
Example Answer 4: Environmental Restraint
Environmental restraint is about controlling access to certain areas or objects to ensure safety. For example, our care home has a kitchen with sharp utensils. Access to the kitchen is managed as part of each person’s risk assessment and best-interests decision, using the least restrictive option that keeps people safe; see section 6 of the Mental Capacity Act 2005. This helps prevent accidents and injuries while also ensuring the residents’ safety. We also explain to residents why certain areas are restricted to maintain trust and understanding.
Example Answer 5: Seclusion
Seclusion is a restrictive practice used in specific mental health settings, under the Mental Health Act 1983 and its Code of Practice (England). If you have seen it used, describe it in your own words without identifying anyone, and check the current Mental Health Act code of practice. Its use must follow the law, the Code of Practice and your organisation’s policy, including how it is recorded and reviewed.
Example Answer 6: Positive Behaviour Support
To minimise the use of restrictive practices, we use Positive Behaviour Support (PBS) approaches in our care setting. For instance, we had a resident who would often get very distressed during meal times. By observing and understanding their behaviour, we realised that the noise in the dining area overwhelmed them. We implemented a quieter mealtime setting for them, which significantly reduced their distress and eliminated the need for any restrictive practice. Positive Behaviour Support helps by addressing the root causes of challenging behaviours through personalised and supportive interventions.
These responses show a comprehensive understanding of different restrictive practices and feature the importance of ethical, person-centred care.
Final Thoughts
Restrictive practices are sometimes necessary to ensure safety in health and social care settings. However, they should always be the last resort and follow ethical and legal guidelines. By adopting a person-centred approach, using the least restrictive options, involving the individual and their advocates, and regularly reviewing practices, we can ensure that the use of restrictive measures respects the dignity, rights, and well-being of individuals in care.
Understanding restrictive practices enables care workers to balance safety and autonomy effectively. With proper training, supervision, and adherence to laws and ethical guidelines, restrictive practices can be implemented responsibly, ensuring the best outcomes for individuals in care.