5.1 Explain the following terms and the application of each to practices within own work setting: • ‘restrictive practices’ • ‘restraint’ • ‘deprivation of liberty’

This guide will help you answer 5.1 Explain the following terms and the application of each to practices within own work setting: • ‘restrictive practices’ • ‘restraint’ • ‘deprivation of liberty’.

Restrictive Practices

Restrictive practices refer to any action or intervention that limits a person’s freedom, movement, or choice. In adult care settings, these practices sometimes happen when staff try to keep a person safe or to prevent harm. These measures might be used with older people, people with learning disabilities, or those living with dementia.

Some examples include:

• Locking doors so residents cannot leave
• Using bedrails to stop falls
• Withholding access to personal items
• Restricting phone calls or visits

A restrictive practice should never be the first option. Staff must always consider the least restrictive approach. This means looking for solutions that respect the person’s rights as much as possible. The Mental Capacity Act 2005 and the Care Quality Commission regulations give guidance on how and when it may be allowed.

In everyday practice, use of restrictive measures needs thoughtful planning and isn’t just a quick fix. Here’s how it works in most settings:

• Only introduce a restriction after considering alternatives.
• Document every decision to use a restriction, including the reason, alternatives explored, and the agreed plan.
• Always inform the person if possible, and, if needed, their family or advocates.
• Keep restrictions under regular review.

Staff need to promote individual rights. This means supporting people to make choices and control their own lives. Using restrictive practices without clear reason or without following the law can take away these rights. It might even be seen as abuse.

In your work setting, apply these points:

• Carry out person-centred risk assessments before using restrictions.
• Record every use of restrictions, even short-term ones.
• Train staff so they understand when a restriction is or isn’t acceptable.
• Encourage staff to suggest less restrictive solutions.
• Be open about restrictions with people using services and their families.

The use of a restrictive practice only becomes acceptable if it aims to prevent harm, and if it is the least restrictive method available. Decision-making must focus on the well-being of the person. Staff, managers, and others must reflect on their practice and challenge any misuse.

Restraint

Restraint is a specific type of restrictive practice. Here, an action prevents a person from moving freely. There are many ways restraint can appear in a care setting.

Common forms of restraint:

• Physical restraint: Staff holding someone’s arms or body to stop them moving
• Mechanical restraint: Using equipment like belts, bedrails, or specially designed chairs
• Chemical restraint: Giving medicines to calm or sedate a person
• Environmental restraint: Removing walking aids, locking rooms, or placing furniture as barriers
• Psychological restraint: Repeatedly telling someone they cannot do something or making them feel afraid of consequences

All restraint carries risks. For example, holding someone can cause injury or distress. Using medication to sedate may affect their health and well-being. As a manager or leader, you need to pay close attention to every situation where restraint might be considered.

Before using restraint, always ask:

• Is this the least restrictive option?
• Have all other possibilities been tried?
• Does it follow the person’s care plan?
• Will restraint prevent harm?
• How might it affect the person emotionally or physically?

Restraint should only be used if:

• There is a real and immediate risk to the individual or others
• It has been discussed with other professionals and (where possible) the person or their family
• It follows law and guidance such as the Mental Capacity Act, the Human Rights Act, the Health and Social Care Act, and recommendations from the Care Quality Commission

Your service’s policies and procedures should set out when restraint may be used and how staff are trained. These may include:

• Reporting and recording any incident where restraint has been used, including the type, duration, and reason
• Having a clear care plan that sets out what triggers challenging behaviour and how best to support the person
• Reviewing any incident as a team to identify learning or gaps
• Using debriefing sessions for the person involved and for staff

The law says you must not restrain someone unless you have to keep them or others safe. You have a duty to care for the person. Your actions must be reasonable and proportionate to the situation. Unnecessary or excessive restraint is a breach of rights, and in some cases, can be a criminal act.

In your management practice, always:

• Foster a culture where staff feel able to raise concerns if restraint is being used inappropriately
• Lead by example by exploring alternatives to restraint
• Invest in staff training about positive behaviour support and least restrictive practice
• Review and audit the use of restraint regularly
• Listen to individuals and their families about their experiences

Restraint can sometimes be necessary, but it must always be a last resort. The use must be proportionate, justifiable, and used for the shortest time required. Good record keeping is key.

Deprivation of Liberty

Deprivation of liberty is a more extreme limitation of a person’s freedom. It refers to situations where a person is under continuous supervision and cannot leave the place they live. In England, this is covered by the Deprivation of Liberty Safeguards (DoLS) and soon to be the Liberty Protection Safeguards (LPS).

Deprivation of liberty means that a person loses their freedom to make choices about their life and go where they want. The Mental Capacity Act sets out that this can only happen in specific circumstances and with proper authorisation.

You might see deprivation of liberty where:

• Someone is not free to leave the care home or hospital
• They are under continuous supervision throughout the day and night
• Staff make decisions for all aspects of their life – who they see, what they do, when or if they go out

To work out if someone is being deprived of their liberty, answer these questions (called the ‘acid test’):

• Is the person under complete and continuous supervision and control?
• Is the person free to leave?

If the answer is yes to the first and no to the second, a deprivation of liberty is likely taking place.

If this happens, the organisation must:

• Apply for authorisation under DoLS (or, soon, LPS)
• Complete a best interests assessment, showing that deprivation is necessary and proportionate
• Appoint a representative for the person

DoLS authorisation is only used for people 18 and over in hospital or care homes who lack mental capacity to consent. It protects their rights, makes sure decisions are reviewed, and gives them and their family a way to appeal.

Everyday practices that could result in deprivation of liberty:

• Locking exit doors with coded locks without allowing request for access
• Using continuous 1:1 support where the person cannot go about freely
• Restricting visits or contact with family
• Giving sedating medication, controlling movement, and not offering choices

As a manager or leader, you need to:

• Recognise when everyday restrictions might actually be deprivation of liberty
• Support staff to understand the difference
• Make sure correct authorisations are in place and kept up to date
• Work with families, advocates, and professionals
• Regularly review restrictions to see if they are still needed

People must only be deprived of liberty if:

• They lack capacity to consent
• It is necessary to prevent harm to them
• The action is a proportionate response to the risk
• There is no less restrictive way to keep them safe

Failing to get authorisation, or wrongly depriving someone of liberty, is a breach of the law. Staff and organisations risk fines, legal action, or closure. Most importantly, it can cause distress and harm to the people we care for.

Practical Application in Your Work Setting

Here is how you might recognise and act on each term within your own service:

• Review all care plans: Make sure they include risk assessments and a record of any restrictions or restraint.
• Train staff: Help teams accurately spot when actions could be restrictive practice, restraint, or even deprivation of liberty.
• Foster open discussion: Hold regular meetings to talk about alternatives to restrictions.
• Safety first: Only restrict or restrain when there is risk of significant harm to the person or others.
• Monitor and challenge: Check records and practice. Get feedback from people using the service.
• Work with legal guidance: Make sure policies match legal duties from the Mental Capacity Act, DoLS, and CQC standards.
• Report incidents: Log every use of restraint or deprivation in the care record and, if required, to safeguarding leads or parents, guardians, or advocates.

Practical tips:

• Use signage and pictorial reminders to give information if someone becomes anxious rather than using keys or barriers.
• Arrange furniture to promote free movement where possible rather than block access.
• Use positive behaviour support plans to reduce the risk of crisis situations.
• Work closely with families and other professionals to develop the least restrictive support plans.

Meeting Legal and Ethical Requirements

All three terms carry major legal and ethical importance:

• The Human Rights Act 1998 protects the right to liberty and security.
• The Mental Capacity Act 2005 explains when and how to make decisions for someone who cannot do so themselves.
• The Care Quality Commission expects services to work in the least restrictive way.

Poor practice puts people’s dignity, rights, and well-being at risk. Good leadership means building a culture where restriction is always questioned, not accepted as the norm.

As a leader or manager:

• Promote a clear message that restrictions, restraint, and deprivation are exceptional, not everyday practice.
• Support staff to innovate and try positive risk-taking.
• Keep discussions person-centred. Ask “What would you want if you were in this position?”
• Advocate strongly for the person’s rights.
• Always look for choices, not barriers.

Final Thoughts

Restrictive practice, restraint, and deprivation of liberty each mean limiting someone’s freedom, but to different degrees. They should only occur when there is a real risk of harm, no alternatives are available, and with full legal authority. As a manager or leader, your practice must put the individual’s rights and well-being first at all times. Good communication, record keeping, and partnership with other professionals, families, and the person themselves is the best way to achieve this.

Knowing the meaning and correct use of restrictive practices, restraint, and deprivation of liberty helps everyone to build care services that are safe, lawful, and respectful.