Restriction, Deprivation of Liberty and Proportionate PBS Practice

February 5, 2026

Restrictions are sometimes unavoidable in PBS, but they are never neutral. Within Human Rights, Legal Context & Ethical Decision-Making and the PBS principles and values, the core question is whether restrictions are proportionate, time-limited, the least restrictive option, and properly authorised and reviewed.

This article focuses on how providers recognise restrictive practice, avoid “restriction creep”, and evidence defensible decision-making where support arrangements may amount to a deprivation of liberty. It is written for Registered Managers, operational leads, commissioners and bid teams who need PBS to stand up to scrutiny.

What counts as restrictive practice in PBS

Restrictive practice is wider than physical restraint. In PBS delivery it often appears as:

Limiting access to the community, family contact, technology, food or money.
Environmental controls (locked kitchens, coded doors, restricted areas).
Continuous supervision (including 1:1 or 2:1) that effectively removes freedom to leave.
Rules that constrain choice (fixed routines, conditional access to activities).

The governance risk is that restrictions become “the way we do it” rather than a reviewed, justified response to a defined risk and a clear functional need.

Operational example 1: coded doors and “informal” restrictions

Context: In supported living, staff introduced a keypad code on the front door following repeated episodes of a person leaving at night and becoming disoriented. The intent was safety, but the control applied to everyone and became routine.

Support approach: The PBS lead reframed the plan around function and least restriction. The service moved from a blanket control to individualised strategies: sleep routine adjustments, proactive daytime activity planning, and a night-time wellbeing check schedule agreed with the person and family.

Day-to-day delivery detail: Staff used a nightly “predictor checklist” (late caffeine, anxiety triggers, missed medication, overstimulation) and implemented de-escalation routines at set times. The door control was replaced with an agreed support presence at high-risk times and a discreet alert system for staff (not physical locking).

How effectiveness is evidenced: Incident logs showed reduced night-time exits, ABC data indicated fewer anxiety-triggered attempts, and weekly PBS reviews recorded the rationale for removing the blanket restriction. The service could evidence that safety improved as restrictions reduced.

Recognising when restrictions may amount to a deprivation of liberty

In practice, many PBS arrangements include some form of supervision and control. The legal and ethical test is whether the person is under continuous (or near continuous) supervision/control and not free to leave. Providers should not treat this as a technicality; it is a key safeguard for the person and the organisation.

Operationally, the question for managers is: are we delivering support in a way that would cause a reasonable outsider to say “this person is not free”? If yes, you need clear authorisation routes, documented rationale, and a review mechanism that is not purely internal.

Commissioner expectation: demonstrable least restrictive practice

Commissioner expectation: Commissioners expect to see that restrictions are explicitly identified in care/PBS plans, justified against assessed risks, and reviewed with evidence that less restrictive options were considered. “We do this for safety” is not sufficient; the commissioning lens is proportionality, outcomes, and defensibility.

Regulator expectation: governance over restrictive practice

Regulator / Inspector expectation (CQC): Inspectors typically look for whether restrictions are recognised and managed as restrictive practice (not normalised), whether staff understand lawful authority and consent, and whether review mechanisms reduce restriction over time. They also examine how services learn from incidents and whether restrictions are used as a substitute for skilled support.

Operational example 2: long-term 2:1 becoming the default

Context: A person with a history of aggression had been on 2:1 for years. Staffing levels were defended as “essential”, but the arrangement limited choice (community access only with two staff) and reduced privacy at home.

Support approach: The provider commissioned a PBS re-assessment focused on triggers, setting events, skill deficits and trauma-informed support. The plan introduced a graded reduction approach with clear safety thresholds.

Day-to-day delivery detail: The team created a weekly exposure plan: short solo time in a preferred room with check-ins, then single-staff community trips for low-risk activities, building to public transport travel with a staff “shadow” at distance. Staff were trained to use a consistent de-escalation script and to record early warning signs rather than only incidents.

How effectiveness is evidenced: Outcome measures included reduction in staff interventions, increased activity participation, and improved quality-of-life indicators (time alone by choice, independent decision-making moments). Governance evidence included a monthly restrictive practice dashboard tracking whether 2:1 hours were reducing safely.

Practical governance mechanisms that stop “restriction creep”

Providers usually avoid problems when they build routine governance into restrictive decisions. Useful mechanisms include:

Restrictive practice register that records every restriction, rationale, review date, and step-down plan.
Monthly multi-disciplinary review for high-restriction PBS plans, including capacity/consent considerations.
Incident-to-restriction audit checking whether restrictions were introduced after incidents without functional assessment.
Positive risk-taking framework that requires documented alternatives and supports autonomy planning.

Operational example 3: post-incident “lockdown” avoided through structured review

Context: After a serious incident, a service proposed restricting the person’s community access “until things settle”. Historically this would have lasted months and caused deterioration.

Support approach: The Registered Manager applied a structured 72-hour review process: immediate safety steps, followed by functional review and rights impact assessment before any longer restriction.

Day-to-day delivery detail: For the first 72 hours, staff used a proactive low-arousal schedule, removed known triggers from the environment, and implemented a predictable routine with planned meaningful activity. A PBS lead gathered ABC data from every shift and held daily reflective huddles to check consistency and staff confidence.

How effectiveness is evidenced: The service evidenced stabilisation through reduced early-warning markers and no further incidents. The decision record showed that a blanket restriction was rejected, replaced with a time-limited, specific support plan with review dates and measurable indicators.

What “defensible” looks like in documentation

Defensibility is created by clarity and audit trails, not by long narratives. A strong PBS restriction record typically shows:

The specific risk and the function the restriction is intended to address.
Options considered and why less restrictive options were insufficient at that time.
The least restrictive version of the restriction (scope, duration, conditions).
A defined step-down plan and review schedule.
Evidence of involvement (person, family/advocate, MDT) and how views were considered.

Where services do this consistently, PBS remains credible: rights-led, safe, and operationally deliverable.