Balancing Safety and Restriction: Governance of Reactive Behaviour Support in High-Risk Settings
Reactive behaviour support is most visible in high-risk settings such as crisis services, forensic pathways and complex supported living. In these contexts, the presence of reactive strategies is not itself a failure; governance determines whether their use protects people or exposes them to harm.
This article builds on reactive strategies and incident response and the wider principles and values of Positive Behaviour Support, focusing on how organisations maintain lawful oversight in challenging environments.
Why governance matters in reactive support
Without strong governance, reactive strategies risk becoming routine, poorly understood, or misapplied. Governance provides the structure through which services ensure strategies remain exceptional, proportionate and continually reviewed.
This includes oversight of authorisation, training, incident trends, and alignment with human rights and safeguarding duties.
Operational example: Governance in forensic supported living
A forensic supported living provider implemented a central restrictive practice register reviewed monthly by senior leadership. Each reactive intervention was logged, reviewed and linked to individual PBS outcomes.
This governance approach identified services where reactive strategies were increasing and triggered targeted clinical input, preventing escalation and external scrutiny.
Operational example: Board-level oversight of incidents
In a national provider organisation, summary dashboards of reactive incidents were reviewed quarterly at board level. Data included frequency, duration, injury and review outcomes.
This enabled strategic investment in training and staffing models, directly reducing high-risk incidents across multiple services.
Operational example: Local authority partnership governance
A local authority-commissioned crisis service established joint review panels for serious incidents. Commissioners, clinicians and providers reviewed cases collaboratively, ensuring transparency and shared accountability.
This strengthened trust and reduced adversarial responses following unavoidable incidents.
Commissioner expectation: Assured oversight
Commissioners expect providers to demonstrate clear governance structures around reactive support, including senior oversight, escalation processes and continuous improvement mechanisms.
Failure to evidence governance often leads to concern regardless of frontline practice quality.
Regulator expectation: Human rights and proportionality
The CQC expects providers to show how governance frameworks protect people’s rights, particularly where restrictive practices are used. This includes evidence of reduction, review and involvement of the individual.
Inspectors will examine whether reactive strategies are supported by policy, training and leadership oversight.
Sustaining safe, lawful reactive practice
Effective governance ensures reactive strategies remain aligned with PBS values even in high-risk contexts. It shifts focus from incident avoidance at all costs to lawful, ethical and proportionate responses that prioritise dignity and safety.
When governance is strong, reactive behaviour support becomes a controlled safeguard rather than an unmanaged risk.