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 (they need a risk assessment: see the MHRA bed rails guidance)
- 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 (England and Wales) and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (England) set the legal framework for how and when it may be allowed. Check the latest official guidance.
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. For a person who lacks capacity in England and Wales, section 6 of the Mental Capacity Act 2005 sets out the conditions for restraint. 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 or specially designed chairs to limit movement. Bedrails can also be restraint if they are used to restrict a person (see the MHRA bed rails guidance)
- 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:
- It is necessary to prevent harm and proportionate to the risk (for a person who lacks capacity in England and Wales, see section 6 of the Mental Capacity Act 2005)
- It has been decided in line with your organisation’s procedure, involving the right people and, where possible, the person or their family (in England, see the DHSC guidance on reducing restrictive interventions)
- It follows law and guidance such as the Mental Capacity Act 2005 (England and Wales), the Human Rights Act 1998, the Health and Social Care Act 2008, 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 restraint must be necessary to prevent harm and proportionate to the risk. For a person who lacks capacity in England and Wales, see section 6 of the Mental Capacity Act 2005 and your organisation’s policy. 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 and Wales, this is covered in hospitals and care homes by the Deprivation of Liberty Safeguards (DoLS) in the Mental Capacity Act 2005. Check the current government guidance for any changes.
Deprivation of liberty is a legal concept, judged on all the circumstances of the person’s situation. The Mental Capacity Act 2005 sets out when it can be authorised (see Schedule A1). See also the DHSC guidance on the 2026 Supreme Court judgment.
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
Whether someone is being deprived of their liberty is decided by looking at all the circumstances of their situation, not by a single test. Supervision, control and whether the person is free to leave are factors to consider, alongside others. If you think a deprivation of liberty may be happening, tell your manager straight away and follow your organisation’s process and the current DHSC guidance (the Mental Capacity Act 2005 applies in England and Wales).
If a deprivation of liberty may be happening in a hospital or care home, the organisation must follow the DoLS process (see Schedule A1 and the latest guidance). In practice this includes:
- Request authorisation under DoLS
- Cooperate with the assessments arranged by the supervisory body, including a best interests assessment, which looks at whether the deprivation is necessary and proportionate
- Support the person’s representative, who is appointed by the supervisory body once an authorisation is given
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 (a significant restriction to discuss with your manager)
- Using continuous 1:1 support where the person cannot go about freely (a factor to discuss with your manager)
- Restricting visits or contact with family
- Using medicines to control behaviour, controlling movement, and not offering choices (factors to consider: see the DHSC guidance)
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 (see Schedule A1 of the Mental Capacity Act 2005, England and Wales)
- 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, can breach a person’s rights under Article 5 of the Human Rights Act 1998. 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 it is necessary to prevent harm and proportionate to the risk (for a person who lacks capacity in England and Wales, see section 6 of the Mental Capacity Act 2005).
- 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 2005 (England and Wales), DoLS, and CQC requirements.
- Report incidents: Log every use of restraint or deprivation in the care record and, if required, tell safeguarding leads or parents, guardians, or advocates. Services in England must also notify CQC of certain events: see the Care Quality Commission (Registration) Regulations 2009.
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 they are necessary to prevent harm, proportionate, there is no less restrictive alternative, and the law allows it (for restraint, see section 6 of the Mental Capacity Act 2005, which applies in England and Wales). 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.