Autism adult services: reducing restrictive practices within the law
Restrictive practices in adult autism services are rarely introduced with harmful intent. More often, they emerge gradually through unmanaged risk, service pressure or poorly matched support. The challenge for providers is not only to recognise restriction, but to reduce it safely within the legal framework. This article focuses on how providers identify, reduce and govern restriction within restrictive practices, DoLS, LPS and legal safeguards, and how reduction strategies must align with wider service models and care pathways to remain safe, defensible and sustainable.
What counts as restrictive practice in adult autism services
Restrictive practice is broader than physical intervention. In adult autism services it commonly includes:
- Locked doors, restricted access or constant supervision.
- Limits on movement, activities or community access.
- Control over routines, food, finances or communication.
- Use of medication primarily to manage behaviour.
- Environmental restrictions imposed “for safety”.
Restriction becomes unlawful when it is disproportionate, not clearly justified, or not reviewed. Even lawful restrictions must always be the least restrictive option available.
Why restriction increases rather than reduces risk
Excessive restriction often increases the very risks it aims to manage. For autistic adults, loss of autonomy and predictability commonly leads to increased distress, disengagement, and escalation. Providers frequently see:
- Increased incidents following tighter controls.
- Reduced skill development and independence.
- Entrenched reliance on staff presence.
- Safeguarding concerns linked to power imbalance.
Reducing restriction is therefore both a rights issue and a safety issue.
Operational example 1: reducing constant observation
Context: An autistic adult in supported living is under continuous observation due to past self-harm risk. The measure has been in place for over a year with no clear review.
Support approach: The provider reviews the restriction as a safeguarding and legal issue, not just a care decision. Risk assessment identifies early warning signs and protective factors that had been overlooked.
Day-to-day delivery detail: Observation is reduced in stages. Staff agree check-in intervals, environmental safety adjustments, and a clear escalation plan. The person is involved in designing their own distress plan using accessible formats. Staff are trained to respond early rather than monitor constantly.
How effectiveness is evidenced: Incident frequency, distress ratings and staff interventions are tracked weekly. Evidence shows reduced incidents and improved autonomy. The restriction is formally lifted and recorded, with governance sign-off.
Operational example 2: unlocking community access safely
Context: A provider restricts community access following previous incidents of absconding. The restriction has become routine rather than risk-led.
Support approach: Risk is reframed from “absconding” to understanding triggers, environmental stressors and communication breakdowns.
Day-to-day delivery detail: The provider introduces graded community access: planned short trips, predictable routes, visual schedules and agreed de-escalation strategies. Staff rehearse responses and carry clear guidance on when to intervene and when not to.
How effectiveness is evidenced: The provider records successful outings, reduced distress behaviours and increased independent choice. Restriction is reduced with documented rationale and review dates.
Operational example 3: replacing control with skill-building
Context: An autistic adult’s finances are fully controlled by staff due to previous impulsive spending.
Support approach: The provider treats financial restriction as a time-limited safeguarding measure rather than a permanent control.
Day-to-day delivery detail: Staff introduce budgeting sessions, visual spending tools and safe spending limits with consent. Small financial choices are returned gradually, supported by coaching rather than control.
How effectiveness is evidenced: Reduced financial incidents and improved money management are recorded. Restriction is reduced incrementally and reviewed formally.
Commissioner expectation
Commissioners expect restrictive practices to be exceptional, time-limited and actively reduced. They look for evidence of positive risk-taking, clear legal rationale, and governance that prevents restriction becoming default practice.
Regulator and inspector expectation (CQC)
CQC expects providers to minimise restriction and protect human rights. Inspectors will look for least-restrictive practice, evidence of review, involvement of the person, and lawful use of DoLS or LPS where deprivation exists.
Governance and assurance
- Restriction registers with review dates.
- Senior sign-off for ongoing restrictions.
- Routine audits of restriction reduction.
- Learning from incidents and complaints.
What good looks like
Good practice shows restriction reducing over time, not entrenching. It demonstrates lawful decision-making, positive risk-taking and governance that actively protects rights while maintaining safety.