Responding to Distress Without Restraint: Ethical Dementia Behaviour Support
Responding to distress in dementia without resorting to restrictive practices is both an ethical and regulatory expectation. Services must demonstrate that behaviour support prioritises dignity, choice and understanding over control. This article contributes to the Distress, Behaviour Support & Meaningful Activity series and aligns with recognised dementia service models used across UK adult social care.
Understanding restraint beyond physical intervention
Restrictive practice in dementia extends beyond physical restraint. Environmental controls, rigid routines and over-medication can all contribute to distress if not carefully managed.
Ethical behaviour support requires services to recognise these risks and actively seek alternatives that respect autonomy while maintaining safety.
Operational example 1: Reducing environmental restraint
Context: A person with dementia repeatedly attempted to leave communal areas, leading to increased supervision and restriction.
Support approach: The service reviewed environmental design and introduced clear signage and safe walking routes.
Day-to-day delivery: Staff encouraged movement rather than preventing it, offering companionship and reassurance.
Evidence of effectiveness: Distress incidents reduced and independence increased, recorded through care reviews.
The role of staff skill and confidence
Staff confidence is central to reducing restrictive responses. Training must focus on recognising early signs of distress, de-escalation techniques and the use of meaningful activity as prevention.
Operational example 2: De-escalation through engagement
Context: A residential service experienced repeated incidents of verbal aggression during busy periods.
Support approach: Staff were trained to redirect using personalised conversation and familiar objects.
Day-to-day delivery: Engagement strategies were embedded into daily routines.
Evidence of effectiveness: Incident severity reduced, with improved staff confidence noted in supervision records.
Commissioner expectation: Least restrictive approaches
Commissioners expect providers to evidence that restrictive practices are avoided wherever possible. Behaviour support must demonstrate proactive strategies and clear escalation pathways.
Regulator expectation: Safeguarding and proportionality
The CQC expects providers to evidence how distress is managed proportionately, with clear recording, review and learning when restrictive interventions are considered.
Operational example 3: Governance oversight of restraint reduction
Context: A service identified inconsistent recording of restrictive practices.
Support approach: Governance systems were strengthened to review all incidents monthly.
Day-to-day delivery: Learning was shared across teams and reflected in updated behaviour support plans.
Evidence of effectiveness: Reduced use of restrictive responses and improved inspection readiness.
Embedding ethical practice
Ethical behaviour support is sustained through governance, training and reflective practice. When distress is understood and responded to without restraint, services deliver safer, more respectful dementia care.