All health and social care organisations, including those in the public and private sectors, need to encourage measures that reduce the use of restrictive practices. When such practices are necessary as a last resort to prevent harm to a person or others, they must be guided by people’s human rights. This should be at the centre of any decision and before taking any action.
This approach takes into account the context of the service setting and prioritises the safety and well-being of the person, those they interact with, and those providing care.
What Is Restrictive Practice?
A restrictive practice refers to any action or intervention that limits the rights or restricts the freedom of movement of people with a learning disability, autistic people and people with mental ill health.
Restrictive practices can have a serious impact on the rights and freedom of people with neurodevelopmental differences and mental health needs. Any decision to implement restrictive practices needs to be made thoughtfully, keeping the person’s rights and choices at the center.
These practices should be part of a positive and supportive approach that focuses on understanding and meeting the person’s needs. In rare cases, restrictive practices may be necessary to protect the person or others from harm, but they should only ever be used as a last resort.
Concerning Recommendation 16, the March 2022 review further observed based on its findings and feedback:
“There is a continued over-reliance on restrictive interventions. People are too frequently subjected to practices that are about containment and are not therapeutic. Restrictive interventions include restraint, seclusion and long-term segregation.
“It is important to remember that each time a restrictive intervention is used, it has an impact on that person and staff; restrictive interventions can cause further trauma to people and add to feelings of dehumanisation.”
The Human Rights in Restrictive Practices
Seclusion and restraint are widely recognised as human rights issues, causing emotional and physical harm to people receiving care, their families and staff. They often reflect a system under strain and there is little evidence internationally to support their use in mental health services.
Restrictive practices involve a range of actions that limit people’s ability to engage in activities they choose or encourage them to participate in actions they would prefer to avoid. This often includes restricting access to basic daily life activities, such as socialising, moving freely, or making personal choices about their routines. Other examples can include the use of physical restraints, seclusion, or limiting communication and interaction with others.
Can Restrictive Interventions Be Harmful?
Restrictive practices should never be used as a form of punishment or to intentionally cause you pain or distress. They should be used sparingly, with clear guidelines in place. These practices should only be considered once all other options have been exhausted or in emergencies where there is an immediate risk of harm to you or others.
Yet, in 90% of cases, restrictive practices cause long-term emotional and physical trauma.
When restrictive interventions are used excessively and inappropriately, they can cause real harm to a person’s well-being. The Mental Health Act sets clear guidelines to ensure that these interventions are only used when absolutely necessary and in a way that minimises any negative impact.
NHS Foundation Trusts play a crucial role in protecting the people they support, making sure that any restrictive practices are justified, proportionate, and focused on the person’s needs. If not handled with care, these interventions can lead to serious harm, not just physically, but emotionally as well, making it even harder for someone to trust the care system and engage in their own recovery.
Positive Approaches to Reduce Restrictive Practices in Health and Social Care
When working in social care or mental health settings, we must be fully aware of the circumstances and challenges people face. In most cases, the people we support may feel distressed, frightened, angry, confused or in pain. Consequently, they will try to express their emotions in a way that’s best known to them at the time. This is often labelled as ‘challenging behaviour’, neglecting the fact the person at the moment needs understanding and compassion rather than restriction and isolation.
Experiencing the sense of being truly heard, understood, and in control of our lives has a profound impact on how we behave. When these fundamental needs are unmet, feelings of powerlessness and distress can arise, often leading to actions that may challenge others.
The same applies to the people we care for and support. Their circumstances may leave them feeling, at times, unable to make meaningful changes in their lives. This is why, in every interaction, it’s vital to treat people with the same compassion, dignity, kindness, and understanding that we would wish for our own families and ourselves.
Trauma-Informed Approach
Trauma often shows up in ways that don’t align with what society sees as acceptable behavior. This can lead to reactions that focus on the behavior itself rather than understanding what’s really behind it. At Catalyst Care Group, we’ve introduced trauma-informed care training for every member of our team. This involves creating personalised trauma-informed care plans that help us understand the person as a whole, with all their fears, challenges, strengths and expectations.
Through this journey, we’ve come to understand that each of us carries our own struggles. It’s taught us to choose acceptance and support over judgment and exclusion. With this approach, we are also deeply committed to reducing restrictive practices and creating an environment where everyone feels valued and understood.
The trauma-informed approach encourages us to ask, “What happened to you?” rather than, “What’s wrong with you?” It helps us see that what may seem like challenging behaviour is often a coping strategy shaped by experiences of adaptation and survival.
Strengths-Based Approach
In a strengths-based approach, strengths go beyond a person’s skills to include their character traits and values, such as empathy, kindness, curiosity, ambition, and honesty.
Social workers can support people in recognising their strengths by using a variety of assessment tools. These tools can help:
- Identify what people do well
- Explore how to develop their key strengths
- Apply those strengths to work towards their aspirations and lead a fulfilling life
- Highlight resources, skills, or personal attributes that have previously helped them overcome challenges
Social workers can also use the three conversations model, developed by the Social Care Institute for Excellence in the UK. This approach involves structured discussions aimed at understanding a person’s strengths and needs:
- Assess the person’s needs and identify sources of support in their life, such as family or community networks.
- Consider risks in their life and develop strategies to address any immediate concerns or crises.
- Discuss long-term support requirements, such as financial assistance or access to community resources, and define outcomes based on the person’s vision of a good life.
While there are various techniques and frameworks within the strengths-based approach, they all share the same principle: people are the agents of change in their own lives, with the ability to improve their circumstances.
Positive Behaviour Support (PBS)
Reducing restrictive practices requires the adoption of alternative, preventative approaches, with Positive Behaviour Support (PBS) being a key example. Over the past 25 years, PBS has evolved into an evidence-based, multi-component framework designed to support people who display behaviours of concern or are at risk of developing them.
The approach centres on enhancing quality of life by understanding the reasons behind a person’s behaviour-how it is used to communicate and meet their needs. This insight is then applied to develop improved support, achieve positive outcomes, and enhance the services provided to people.
Outcome-Based Approach
In health and social care, an outcome-based approach emphasises understanding what is important to people and supporting them in achieving what matters most to them. This approach lies at the heart of a personalised and human rights-based model of care, fostering collaboration with people rather than working on their behalf.
Our outcomes-focused approach is guided by the following principles:
- People are the experts in their own lives and are best placed to determine what brings them purpose, meaning, and well-being.
- People value engaging in activities that hold personal significance in ways that feel right for them.
- Each person has distinctive strengths, skills, and abilities that should be recognised and celebrated.
- The care and support process begins with identifying a person’s outcomes and developing tailored plans aimed at achieving and evaluating these outcomes.
- Whenever possible, family, friends, and the local community are included in the support planning process.
- Open, meaningful conversations and genuine relationships are essential to understanding and identifying outcomes.
At Catalyst Care Group, our care and support services prioritise identifying what truly matters to each person, empowering them to achieve their desired outcomes.
Principles of Reducing Restrictive Practices
These are the core values and principles that underpin all aspects of social care practice. These values are aligned with the human rights and freedoms outlined in the United Nations Conventions on the Rights of the Child, the Rights of Persons with Disabilities, and the United Nations Principles for Older People.
Key areas of focus include:
- Ensuring people have a voice and control in decisions affecting their lives.
- Focusing on prevention and early intervention to address challenges before they escalate.
- Promoting well-being as a central part of support.
- Emphasising co-production to create solutions together.
- Strengthening multi-agency working for better outcomes.
In order to reduce restrictive interventions, it’s essential that we build our care and support practices based on the following principles:
- Gain an understanding of what it means to take a positive and proactive approach.
- Recognise the various ways people communicate and how this shapes their behaviour.
- Reflect on working practices and consider the impact they may have on a person.
- Explore positive and proactive strategies to support people experiencing stress, distress, or anger, aiming to minimise the use of restrictive practices.
- Develop an understanding of restrictive practices and physical interventions, recognising their use as a last resort based on risk assessment and person-centred care planning.
- Understand the legal and ethical considerations surrounding restrictive practices, where applicable.
- Acknowledge that any form of restrictive practice or intervention should only be used in emergencies or as part of a planned, multidisciplinary response agreed upon by the team and, wherever possible, the person themselves.
Catalyst Care Group is Dedicated to Preventing Unnecessary Hospital Admissions and Restrictive Practices
At Catalyst Care Group, we are dedicated to delivering person-centred and integrated care that prioritises the human rights model of care. Through the use of Positive Behaviour Support (PBS) strategies, our team is able to effectively manage crises, support smooth transitions, and prevent unnecessary hospital admissions. We are a certified PRO-ACT SCIPr training centre, equipping our team with the skills to provide comprehensive and compassionate support to people with behaviours of concern
Our support plans are intentionally designed with proactive strategies to reduce the need for reactive and restrictive interventions. To further minimise the use of restrictive practices, we provide a wide range of specialised services, including occupational therapy, speech and language therapy, mental health, and multimedia support.
Working with a multidisciplinary team of PBS specialists, speech and language therapists, community psychiatric nurses, and in collaboration with the Restraint Reduction Network, we ensure the best possible outcomes for people. Our approach includes:
- Conducting functional and intentional assessments of behaviours of concern
- Developing evidence-based support strategies
- Offering regular, personalised training for support teams
- Crafting tailored PBS plans
- Engaging in multidisciplinary and cooperative work
- Providing emotional support and fostering open conversations with our support workers
Fully committed to Building the Right Support for people, grounded in the human-rights model of care, Catalyst Care Group collaborates with colleagues across systems to find solutions that allow people to receive high-quality, person-centred support in their own homes and communities.
For more information, contact us today!
