Restrictive interventions can include: 

• seclusion 
• environmental restraint 
• physical restraint 
• medication (sometimes referred to as chemical restraint) 
• mechanical restraint 
• psychological restraint. 

Restrictive interventions may be overused for people with learning disabilities. It is acknowledged that, in some situations where managing risk and maintaining safety, restrictive interventions may need to be used.

However, as restrictions will be acting against people’s wishes and could potentially be against their human rights, we need to avoid the use of restrictive interventions where possible. If used, it is vital to ensure that any restriction that is part of someone’s planned support underpinned by a personalised assessment and plan and within a clear legal framework. 

There are some guiding principles that should be considered when using any restriction proposed as part of someone’s planned support when deciding whether the restriction is ethical and justifiable.  

For any restriction to be part of someone’s support, it must:  

1. Be necessary to avoid significant harm to the person or others. 
2. Take account of the emotional effect of the restriction on the person. 
3. Be proportionate − the level of restriction is a fair response to the risk of harm. 
4. Be the least restrictive option − no more than necessary and there isn’t another lesser restrictive alternative. 
5. Be imposed for no longer than necessary. 
6. Balance the interests of the individual and others. 
7. Be within the context of a caring, person-centred, adult-to-adult approach. 

In line with the Mental Health Act Code of Practice 2015 (England and Wales), all services where restrictive interventions may be used must have in place restrictive intervention reduction programmes which can reduce the incidence of violence and aggression and ensure that alternatives to restrictive interventions are used. 

The Restraint Reduction Network has downloadable free resources providing guidance on reducing restrictive practices within services. 

• CQC (2020). Out of sight – who cares? A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition (PDF).
• Department of Health (2014). Positive and Proactive Care: reducing the need for restrictive interventions (PDF).
• Department of Health (2012). Transforming care: A national response to Winterbourne View Hospital (PDF).
• Department of Health and Social Care (DHSC) and Department for Education (2019). Reducing the need for restraint and restrictive intervention: government response.
• Equality and Human Rights Commission. Human rights framework for restraint. 
• Health Information and Quality Authority (HIQA). Guidance on restrictive practice. 
• HM Government. Reducing the need for restraint and restrictive intervention (PDF).
• NHS England. You said, we did it – Restrictive practices (PDF).
• NHS Education for Scotland. National trauma training programme. 
• NICE guideline. Violence and aggression: short-term management in mental health, health and community settings. 
• NICE quality standard. Violent and aggressive behaviours in people with mental health problems. 
• Restraint Reduction Network. Six core strategies and human rights infographic. 
• Royal College of Psychiatrists. Reducing Restrictive Practice programme.