Restrictive Interventions as a Last Resort: Lawful Use, Governance and Incident Review in Practice
Restrictive interventions sit at the most sensitive end of reactive strategies and incident response. Their use carries significant legal, ethical and regulatory implications, particularly within services supporting people with learning disabilities, autism and complex needs. Within Positive Behaviour Support (PBS), restrictive interventions must always be understood as a last resort, used only where necessary to prevent serious harm and only within a robust governance framework.
This article forms part of the Reactive Strategies & Incident Response knowledge series and should be read alongside core principles outlined in PBS principles and values. Together, these frameworks ensure that reactive responses remain lawful, proportionate and rooted in human rights.
What Counts as a Restrictive Intervention in Practice
Restrictive interventions include any action that restricts a person’s movement, liberty or freedom to make choices. In operational settings, this may include physical restraint, mechanical restraint, chemical restraint or environmental restrictions such as locked doors.
In practice, ambiguity often arises where staff view certain responses as “routine” rather than restrictive. For example, holding a person’s arm to prevent self-injury, blocking exits during heightened distress or physically guiding someone away from a situation may all constitute restrictive practices depending on context and impact.
Clear organisational definitions, aligned to national guidance, are essential to prevent normalisation of restriction.
Legal Frameworks Governing Restrictive Practice
Restrictive interventions must operate within a complex legal framework. Key considerations include:
- The Mental Capacity Act (MCA), including best interests decision-making
- Human rights law, particularly Articles 2, 3, 5 and 8
- Common law principles of necessity and proportionality
- CQC expectations regarding restraint and safeguarding
Where a person lacks capacity, any restrictive intervention must be demonstrably necessary, proportionate and the least restrictive option available. Failure to evidence this exposes providers to regulatory enforcement and safeguarding scrutiny.
Operational Example 1: Emergency Physical Intervention
Context: A supported living service supports a man with autism who becomes physically aggressive during periods of sensory overload.
Support approach: A reactive strategy permits brief physical intervention only where there is immediate risk of serious harm to the individual or others.
Day-to-day delivery: Staff are trained to intervene only after de-escalation attempts fail, using approved techniques and withdrawing as soon as risk reduces.
Evidence of effectiveness: Incident records demonstrate reduced duration of restraint, fewer injuries and increased use of preventative strategies over time.
Commissioner Expectation: Clear Restrictive Practice Governance
Commissioners expect providers to demonstrate active reduction of restrictive practices. This includes:
- Clear thresholds for use
- Evidence of ongoing reduction strategies
- Transparent reporting and review mechanisms
Failure to demonstrate this may impact contract monitoring and future commissioning decisions.
Operational Example 2: Environmental Restrictions
Context: A residential service introduces keypad-controlled exits due to repeated absconding risks.
Support approach: Restrictions are documented within care plans, supported by risk assessments and reviewed monthly.
Day-to-day delivery: Staff must evidence attempts to increase independence through supervised access and skills development.
Evidence of effectiveness: Review records show gradual reduction in restrictions as risk decreases.
Regulator Expectation: Proportionality and Review
The CQC expects restrictive interventions to be subject to frequent review, with clear evidence that they are temporary, necessary and proportionate. Inspectors will examine incident records, staff understanding and governance oversight.
Operational Example 3: Post-Incident Review and Learning
Context: A service identifies repeated restraint use for one individual.
Support approach: A multi-disciplinary review examines triggers, staff responses and environmental factors.
Day-to-day delivery: The PBS plan is updated, staff retrained and additional proactive strategies introduced.
Evidence of effectiveness: Subsequent data shows a sustained reduction in incidents requiring restriction.
Governance, Oversight and Continuous Improvement
Effective services embed restrictive practice oversight within quality assurance systems. This includes senior review, data trend analysis, safeguarding escalation where appropriate and engagement with families and advocates.
Restrictive interventions should never exist in isolation. They must form part of a broader commitment to positive risk-taking, dignity and rights-based support.