5.5 Analyse the potential impacts of restrictive practices on individuals and others

This guide will help you answer 5.5 Analyse the potential impacts of restrictive practices on individuals and others

Restrictive practices in adult care are any actions or interventions that restrict an individual’s freedom, movement, choices or rights. This can include physical restraint, use of locked doors, withholding personal items, close supervision, or medication given to control behaviour instead of treating a medical condition.

These types of interventions are sometimes used to prevent harm. For example, a care home might use bedrails to stop someone falling out of bed if they are at risk. Staff might supervise someone more closely if they are likely to leave the building and come to harm. Staff may even withhold certain items if they could be used to hurt oneself or others. In some cases, sedative medication might be used to calm someone who is very distressed and at risk of hurting others.

Even though restrictive practices can sometimes seem helpful for risk management, they carry significant implications for the person and those around them.

The Immediate Impacts on Individuals

Restrictive practices can have clear and negative effects on the person subjected to them. These impacts can touch every aspect of a person’s wellbeing.

Impacts include:

• Loss of dignity and respect, as people may feel embarrassed or belittled by the actions.
• Loss of autonomy and independence.
• Physical harm or injury: Restraints can cause bruising, cuts, fractures, or more serious medical issues.
• Distress and trauma: Being restricted can be frightening and humiliating.
• Loss of trust between the individual and staff or the organisation.
• Difficulty communicating needs if a person is restrained or secluded.
• Reduced quality of life if choices are limited.
• Social isolation, especially with restrictions limiting social contact.

For example, a person who is physically restrained during a period of agitation may become frightened and confused. They might not understand why it is happening. This confusion or fear may remain long after the event, or trigger other behaviours.

People often feel powerless when their movements or choices are restricted. This can lead to frustration, anger, or withdrawal. People placed in seclusion often experience loneliness, confusion, and fear that worsens challenging behaviour.

Longer-term Impacts on Individuals

Over time, restrictive practices can cause further complications.

Some possible effects:

• Institutionalisation: Accepting restrictions as normal, which can limit recovery or personal development.
• Loss of self-esteem: People may begin to see themselves as a problem or as someone who cannot be trusted.
• Depression or anxiety: Mental health problems can develop or become worse.
• Reduced ability to make decisions: Prolonged restrictions may reduce opportunities for skill learning and decision making.
• Physical deconditioning: Lack of movement leads to muscle weakness, pressure sores, or poor circulation.
• Dependence on staff or the care environment: Reduced confidence in managing independently.

Case studies show that ongoing restrictive practices can have serious and lasting effects on an individual’s identity, self-worth, and wellbeing.

Impact on Physical Health

Physical restraints and other restrictions can directly harm health. Potential causes of injury come from poorly applied restraint, prolonged restriction, or restriction used inappropriately.

Possible harm includes:

• Bruising or broken bones from improper restraint.
• Breathing problems or asphyxiation if restraint affects chest movement.
• Blood clots or poor circulation with prolonged immobilisation.
• Pressure ulcers caused by immobility.
• Infection risk from limited hygiene opportunities.
• Muscle wastage from lack of physical activity.

Chemical restraint can introduce risks such as:

• Side effects from medication, including drowsiness, falls, or digestive problems.
• Reactions with other prescribed medicines.
• Reduced mobility due to sedation.

Healthcare records and incident reports highlight the need to review restrictive practices to protect physical health.

Psychological and Emotional Effects

Restrictive practices often harm mental wellbeing. The psychological consequences go well beyond the period when restrictions are in place.

Potential impacts include:

• Fear, anxiety or panic attacks prompted by restrictions.
• Mood swings or depression as a result of feeling helpless.
• Anger, frustration, or aggression leading to escalation of behaviour.
• Loss of hope and motivation.
• Post-traumatic stress reactions, especially if the restriction feels threatening or humiliating.

People may become fearful of care settings or staff, which affects cooperation with care plans or treatments. These psychological effects can be severe, particularly for people with a history of trauma.

Impacts on Social Participation

Restrictive practices can lead to social exclusion. Individuals may avoid activities, contact with peers, or community involvement due to loss of confidence or embarrassment.

For example:

• If a person is often kept in their room, they may miss out on social activities.
• A person who is chemically restrained may feel too drowsy or unwell to join communal events.
• Restriction of mobile devices, visits or telephone access can increase loneliness.

Isolation is a factor in the deterioration of mental and physical health.

Impact on Relationships

Trust is the foundation of good care relationships. When staff use restrictive practices, it can damage the trust between individuals, their families, and the care team.

Common issues:

• Family members may feel staff do not respect their loved one.
• The person may become distant or suspicious of care staff.
• Relationships with other residents can suffer if people witness restrictions being used.

Open, honest communication is essential to rebuild trust after restrictive interventions.

Impact on Staff

Those who use or witness restrictive practices are affected too.

Possible staff impacts:

• Emotional distress: Guilt, anxiety, or regret about having to act restrictively.
• Reduced morale: High staff turnover, absenteeism, or disengagement if use of restriction is routine.
• Burnout: Repeated use of restrictive measures can lead to exhaustion.
• Legal and disciplinary risks: Improper use of restriction can lead to complaints, regulatory action, or prosecution.
• Loss of job satisfaction: Many staff enter social care to enable autonomy and choice, not to control people.

Staff may require supervision and training to reflect on the use and effects of restriction, and support with the emotional consequences.

Impact on Other Individuals

Family members, friends, roommates, and other service users all feel the effects of restrictive practices.

Common outcomes:

• Distress or upset: Witnessing restriction can be frightening or distressing.
• Reduced sense of safety: Other residents may feel that restriction could be used on them.
• Breakdown in trust: Relatives might lose confidence in the care provider.
• Community concerns: Negative publicity or incidents can affect reputation, support, and funding.

Some people may try to intervene or challenge staff, risking further conflict.

Organisational and Legal Impacts

There are consequences for the organisation providing care. Restrictive practices must meet legal standards set by national policies, such as the Mental Capacity Act 2005 and the Human Rights Act 1998.

Risks include:

• Regulatory action: Care Quality Commission may issue warnings, place services in special measures, or suspend registration.
• Litigation: Legal action for unlawful restriction or harm to individuals.
• Reputational damage: Negative inspections or complaints can affect public trust.
• Financial loss: Through legal costs or reduced occupancy.

Organisations must apply the least restrictive options at all times, and keep clear records of any restrictive practice used, considering the law and individual consent.

Ethical Considerations

Ethical decision-making balances the duty of care (preventing harm) against the person’s right to freedom and autonomy.

Key points:

• Every person has a right to be free from unnecessary restriction.
• Restrictions should be used only if there is a clear, temporary risk to the person or others.
• The restriction should always be the minimum needed, for the shortest time.
• Consent should be sought if the person has capacity. If not, ‘best interests’ decision-making must be followed.

Staff and management need regular reflection, training, and supervision to make ethical choices.

Positive Behaviour Support as an Alternative

Modern adult care emphasises positive behaviour support (PBS) and other non-restrictive ways to manage risk or challenging behaviour.

PBS includes:

• Understanding the reasons behind someone’s behaviour.
• Adapting the environment.
• Providing meaningful activities.
• Positive reinforcement instead of punishment or restriction.

By using PBS, organisations can significantly reduce—sometimes eliminate—the need for restrictive practices.

Supporting Individuals and Others After Restriction

After any restrictive event, support and follow-up are vital.

Actions:

• Debrief with the individual to check for injury or trauma.
• Explain why the restriction was used and listen to concerns.
• Reflect with staff and the wider team.
• Review care plans and risk assessments.
• Offer emotional support to family and others.

Ongoing review of restrictive practices leads to safer, more person-centred care.

Final Thoughts

Restrictive practices should only be a short-term, last resort to prevent harm when all other options have failed. The impact reaches far beyond the immediate situation—affecting individuals, staff, families, other service users and the organisation itself.

Promoting choice, dignity, and autonomy protects wellbeing in adult care, and should always be the guiding principle for managers and leaders. Reviewing the effect of every intervention, listening to those affected, and seeking safer approaches will lead to better support and outcomes for all.