Autism adult services: safeguarding risks linked to restrictive practice
Restrictive practice is often introduced to manage safeguarding risk, yet poorly governed restriction can create new forms of harm. In adult autism services, power imbalance, isolation and dependency can increase vulnerability to abuse, neglect and exploitation. This article explores how providers manage safeguarding risks within restrictive practices, DoLS, LPS and legal safeguards, and how safeguarding must be integrated into everyday service models and care pathways, not treated as a reactive process.
How restrictive practice can increase safeguarding risk
Restriction becomes a safeguarding issue when it:
- Limits a person’s ability to report concerns.
- Creates excessive dependence on individual staff.
- Reduces external oversight or community contact.
- Normalises control rather than support.
Autistic adults may find it particularly difficult to challenge or articulate concerns if communication is restricted or routines are tightly controlled.
Safeguarding indicators linked to restriction
Providers should be alert to safeguarding indicators that often accompany restrictive practice, including:
- Unexplained withdrawal or increased compliance.
- Distress during care tasks linked to control.
- Staff resistance to reducing restriction.
- Inconsistent application of “rules”.
These indicators require scrutiny of both care practice and organisational culture.
Operational example 1: isolation created by excessive supervision
Context: An autistic adult is rarely left alone and has limited contact with family due to “risk concerns”. The person becomes withdrawn and less communicative.
Support approach: The provider treats isolation as a safeguarding risk rather than a safety measure.
Day-to-day delivery detail: Family contact is reinstated with support. Supervision is reduced during low-risk periods. Independent communication opportunities are introduced, including private phone access and advocacy involvement.
How effectiveness is evidenced: Engagement improves and safeguarding risk reduces. The provider documents reduced restriction alongside increased protective factors.
Operational example 2: power imbalance through informal rules
Context: Staff enforce unwritten rules that limit choice. The person complies but shows signs of distress and anxiety.
Support approach: The provider audits restrictions and treats informal rules as safeguarding concerns.
Day-to-day delivery detail: Rules are replaced with clear support plans. Staff receive supervision focused on rights and least-restrictive practice. The person is supported to understand and challenge decisions using accessible formats.
How effectiveness is evidenced: Complaints reduce, staff practice becomes consistent, and safeguarding monitoring shows improved wellbeing.
Operational example 3: safeguarding risk during emergency restriction
Context: Following an incident, restrictions are rapidly increased. Oversight reduces as staff focus on control.
Support approach: The provider introduces enhanced safeguarding oversight during emergency restriction periods.
Day-to-day delivery detail: Additional management checks are introduced, advocacy is offered, and restriction reviews are scheduled within strict timeframes. Staff are reminded that emergency restriction increases safeguarding risk and scrutiny, not reduces it.
How effectiveness is evidenced: Emergency measures reduce quickly, safeguarding oversight is documented, and no new safeguarding concerns emerge.
Commissioner expectation
Commissioners expect providers to recognise safeguarding risks created by restriction. They look for evidence that providers do not rely on control to manage risk and that safeguarding oversight increases, not decreases, when restriction is used.
Regulator and inspector expectation (CQC)
CQC expects restrictive practice to be managed in a way that protects people from abuse and harm. Inspectors will look for safeguarding awareness, accessible complaints routes, advocacy use, and governance that prevents power imbalance and closed cultures.
Governance and assurance
- Safeguarding checks linked to restriction reviews.
- Advocacy referral pathways for restricted individuals.
- Unannounced management observations.
- Whistleblowing awareness and culture checks.
What good looks like
Good practice shows safeguarding risk reducing as restriction reduces. Providers can evidence that restriction does not create isolation or dependency and that safeguarding remains central even in high-risk situations.