3.2. Explain the use of restrictive interventions

This guide will help you answer 3.2. Explain the use of restrictive interventions.

Restrictive interventions are actions that limit an individual’s rights, freedom of movement, or access to an activity, environment or object. These interventions are used in health and social care to prevent harm. They are only applied when there is no safer or less restrictive option.

The aim is to keep people safe while respecting their dignity and rights. Restraint or restriction is never a first response. It is used only when the risks of not acting would cause harm to the person or others.

Some restrictive interventions involve physical measures. Others involve changes to the environment or to the way care is provided.

Legal and Ethical Context

In the UK, the use of restrictive interventions must follow the law. This includes the Human Rights Act 1998, the Care Act 2014, the Mental Health Act 1983 (amended 2007), and the Mental Capacity Act 2005 with its Deprivation of Liberty Safeguards (DoLS).

These laws aim to protect people’s rights, dignity and safety. They require any restriction to be justified, proportionate, and in the person’s best interests.

The Department of Health and Social Care guidance says that restrictive interventions should be:

• Used only as a last resort
• Used for the shortest time possible
• The least restrictive option available

Types of Restrictive Interventions

There are several types of restrictive interventions used in health and social care. Each has different impacts and must be handled carefully.

Physical restraint

This involves physically holding or blocking a person to stop movement or prevent harm.
Examples include holding someone’s arm to stop them hitting, or guiding someone away from danger. Physical restraint should use approved techniques to prevent injury to both the person and the staff member.

Mechanical restraint

This uses equipment to limit movement.
Examples include straps, belts, bed rails, or specialised chairs. Mechanical restraints are more common in hospital settings and are strictly controlled. They require documented justification and clear care plans.

Chemical restraint

This is the use of medication to control behaviour or restrict movement that is not related to treating a medical condition.
An example is giving sedatives to calm aggression. Use of chemical restraint must be carefully assessed, prescribed by a medical professional, and reviewed regularly. It must not replace proper care or behavioural support.

Seclusion

This is isolating a person in a room or area from which they cannot leave. Used in some mental health settings, it is a significant restriction. Staff must observe and support the person, and seclusion should end as soon as it is safe.

Environmental restraint

This involves changing the environment to limit movement or access.
Examples include locked doors, coded keypads, removing dangerous items, or using secure gardens. Environmental restraints can prevent harm but must be balanced with access to freedom and stimulation.

Blanket restrictions

These are rules that apply to everyone in a setting, regardless of individual risk.
For example, banning all residents from leaving without staff. Blanket restrictions should be regularly reviewed to check if they are fair and lawful.

Reasons for Using Restrictive Interventions

Restrictive interventions are used only to keep people safe. The main purposes include:

• Preventing harm to the person
• Preventing harm to others
• Preventing serious damage to property
• Allowing essential care or treatment to be given when the person resists

In each case, the risk must be serious and immediate. Staff must show that no other way could keep someone safe at that moment.

Risk Assessment and Decision-Making

Before using a restrictive intervention, staff must carry out a risk assessment. This involves:

• Identifying the behaviours that may cause harm
• Looking at the triggers and warning signs
• Assessing the level and likelihood of risk
• Considering less restrictive alternatives
• Deciding on the safest and most proportionate response

Any decision should be based on real evidence, not assumptions or stereotypes about the person.

Good practice means involving the person in discussions about their care when they are calm. This promotes understanding and helps create strategies to avoid restrictions.

Minimising the Use of Restrictive Interventions

Best practice in health and social care focuses on avoiding restrictions whenever possible. Methods to reduce use include:

• Using positive behaviour support plans
• Providing meaningful activities that reduce distress
• Training staff in de-escalation and communication
• Involving families in care planning
• Using diversion or distraction techniques

Staff are encouraged to use these methods first, then only use restriction if these fail and risk remains high.

Proportionality and Time Limits

Any restrictive intervention must be proportionate. This means the level of restriction must match the level of risk. For example, you would not restrain someone for a minor disruption if they are not at risk of harm.

The intervention should last only as long as needed to remove the risk. The moment the person is calm or the danger has passed, the restriction should stop.

Monitoring and Recording

Every use of restrictive intervention must be recorded in detail. The record should include:

• The reasons for the intervention
• The type of intervention used
• How long it lasted
• Who was involved
• The impact on the person
• Any injuries to the person or staff
• Steps taken afterwards to support the person

Records help with accountability. They also help identify patterns so that future restrictions may be avoided.

Impact on the Individual

Restrictive interventions can be distressing. They may cause emotional upset, physical injury, or feelings of fear and mistrust.

People may feel they have lost control or freedom. This can harm relationships with staff and reduce trust in the care setting. In some cases, restrictive interventions can trigger past trauma.

For these reasons, staff must support the person afterwards. This might mean talking through what happened, providing reassurance, or giving extra comfort or care.

Staff Training and Skills

Staff need the right skills to use restrictive interventions safely and lawfully. Training should cover:

• Legal requirements and human rights
• Recognising early signs of distress
• Using de-escalation techniques
• Safe physical restraint methods, if needed
• Recording and reporting procedures
• Supporting recovery after an incident

Training should be refreshed regularly to maintain competence and confidence.

Safeguarding Considerations

The inappropriate use of restraint can be abuse. Overuse or misuse of restrictive interventions may breach safeguarding standards and the person’s human rights.

Safeguarding teams must be alerted if there are concerns about repeated or unnecessary restrictions. Inspectors from the Care Quality Commission (CQC) check on how organisations apply these interventions.

Best Practice Guidance

National Institute for Health and Care Excellence (NICE) provides detailed advice on management of violence and aggression in health and social care. The Department of Health and Social Care also issues guidance on positive and safe approaches.

Both recommend:

• Preventing the need for restriction where possible
• Using it only for immediate safety
• Reviewing incidents to learn and improve practice

The Role of De-escalation

De-escalation is the process of calming a situation before it becomes unsafe. It reduces the need for restriction.

This can include:

• Using a calm tone of voice
• Giving the person space and time
• Offering choices to maintain control
• Listening actively to concerns
• Moving to a quieter space

Staff who are skilled at de-escalation tend to use restrictive interventions far less often.

Working in Partnership

Good care means working with the person, their family, and other professionals. This builds trust and helps identify what triggers distress. It also leads to better strategies for keeping everyone safe without heavy restrictions.

Care plans should reflect the person’s wishes and preferences where possible. Involving advocates can help if the person struggles to express their own views.

Reviewing Practice

Regular review meetings help check if restrictive interventions are still needed or if better approaches can be used. Reviews look at:

• The frequency of incidents
• The triggers involved
• The outcomes for the person
• Possible changes to care or environment

This keeps care person-centred and reduces reliance on restrictions over time.

Final Thoughts

Restrictive interventions are serious actions that limit a person’s freedom. They can prevent harm, but they also carry risks to dignity, well-being, and relationships. That is why they are always considered the last resort after all other options have been tried or judged unsuitable for urgent safety reasons.

Your role is to use these interventions only when you must, for the shortest time, and in the least restrictive way. By focusing on prevention, de-escalation, and positive support, you can help create an environment where restrictions are rare, respectful, and always in the person’s best interests.

If you approach every situation with the aim of keeping people safe while respecting their rights, you will be meeting both the letter of the law and the standards of good care practice in the UK.