Restrictive practice

Restrictive interventions can be an essential part of providing safe support to people with learning disabilities, but as restrictions will be acting against peoples wishes and could potentially be against their human rights their use must be carefully considered.

Restrictive practice is sometimes referred to as restrictive interventions. This is when someone is made to do something they don’t want to do or when someone is stopped from doing something they want to do.

This can either be by the use of:

• seclusion
• environmental restraint
• restraint
• medication (sometimes referred to as chemical restraint)
• mechanical restraint
• psychological restraint.

It is acknowledged in extreme cases where managing risk and maintaining safety, restrictive interventions may need to be used. However, we need to ensure that any restriction which is part of someone’s planned support is sound, reasonable and legal. 

In addition, if restrictive practices are required and the person does not have capacity to consent to the restriction, the best interest decision making process must be followed. This process ensures the intervention is in fact the least restrictive option, in terms of the person’s rights and freedoms in order to meet the person’s need. (Mental Capacity Act 2005 Code of practice). 

There are some guiding principles that should be considered when using any restriction proposed as part of someone’s planned support, when deciding whether the restriction is ethical and justifiable. 

For any restriction to be part of someone’s support it must: 

1. be necessary to avoid significant harm to the person 
2. take account of the emotional effect of the restriction on the person
3. be proportionate − the issue is important enough to justify the restriction
4. be the least restrictive option − no more than necessary and there isn’t an alternative
5. be imposed for no longer than necessary
6. balance the interests of the individual and those of others
7. be within the context of a warm, person centred, adult to adult approach.

In line with the Mental Health Act Code of Practice 2015, all services where restrictive interventions may be used must have in place restrictive intervention reduction programmes which can reduce the incidence of violence and aggression and ensure that alternatives to restrictive interventions are used. Such programmes should form part of a governance structure demonstrating an understanding of the legal context for applying restrictions. Organisations must also provide effective training and development for staff. A more proactive and less reactive approach is promoted by organisations such as Restraint Reduction Network with a focus on organisational values. 

The Restraint Reduction Network has published an infographic: Six core strategies and human rights. The infographic shows how human rights and the Six Core Strategies enable the culture change necessary in organisations to reduce the use of restrictive practices.