Every learning disability service restricts somebody, every day. The front door is locked, the kitchen cupboard has a catch, someone's money is held in the office. Most of that is necessary and some of it is lawful. The difference between a good service and one that ends up in an enforcement notice is whether it knows which restrictions it uses, why, who agreed them, and what it is doing to need fewer of them.
The short answer
A restrictive practice is anything that limits a person's rights, movement, freedom or independence. In a learning disability service every restriction needs four things: a lawful basis, an individual record naming the less restrictive options that were tried, a count so you know how often it is happening, and a plan to reduce it. If you cannot produce a list of every restriction in your service with those four things attached, you do not know what you are doing to people, and that is what inspectors are looking for.
What is a restrictive practice?
A restrictive practice is any deliberate act that restricts a person's movement, liberty, freedom of action or independence, including physical, mechanical and chemical restraint, seclusion, segregation, environmental restrictions and restrictions on choice, possessions, relationships, communication and money.
The word restraint makes people think of holding somebody, but most restriction in learning disability services is quieter than that. It is the fridge with a lock on it, bedtime at nine because there is one waking night worker, a phone kept in the office, a support plan that says staff will redirect the person away from the front door. None of those involve touching anyone, and all of them are restrictions.
The test is simple. If the person would do something different were the restriction not there, it is a restriction, and it needs the same four things as a physical hold.
Why this matters more in learning disability services
Learning disability and autism services carry more restriction than almost any other part of social care, because the people supported are more likely to lack capacity for some decisions, more likely to be at risk in ways that invite protective responses, and much less likely to be able to challenge what is being done to them.
There is also a history. Transforming Care, Winterbourne View, Whorlton Hall and a series of inspections into long-term segregation all told the same story: restriction becomes routine, then invisible, then part of the culture. The regulator's expectations for learning disability and autism services, set out in Right support, right care, right culture, are written with that in mind. That is why counting matters, because restriction nobody counts always grows.
The types of restrictive practice
| Type | Examples in a learning disability service | What must be in place | What to record each time |
|---|---|---|---|
| Physical restraint | Guiding by the arm, holding to prevent self-injury, a two-person hold during personal care | Individual plan, trained staff, a capacity assessment and best interests decision, or Mental Health Act authority | Time, duration, hold used, staff involved, trigger, injuries, the person's response, debrief |
| Mechanical restraint | Lap belts, arm splints, gloves to prevent self-injury, harnesses in vehicles used to restrict rather than for safety | A named clinician's recommendation, capacity and best interests, a wearing schedule, skin checks | Hours worn, who applied and removed it, skin condition, any refusal |
| Chemical restraint | PRN lorazepam or a PRN antipsychotic given to control behaviour rather than treat a condition | A written PRN protocol, what to try first, maximum dose and interval, capacity, STOMP review | Reason, what was tried first, dose and route, time, effect after an hour, who authorised |
| Seclusion and segregation | Keeping someone alone in a room they cannot leave; long-term segregation from other people in the service | Rarely lawful outside a hospital setting; requires clinical oversight and external scrutiny | Start and end time, who observed, reviews during, the plan to end it |
| Environmental | Locked front door, locked kitchen, locked fridge, key-coded bedroom, window restrictors, removing the kettle | An individual reason per person, or a recorded and reviewed shared restriction with a rationale | Who it applies to, why, what alternatives were tried, review date |
| Surveillance | Door sensors, bed sensors, CCTV in communal areas, monitors in bedrooms, GPS trackers | Capacity assessment, best interests, data protection impact assessment, least intrusive option chosen | What is monitored, who can see it, how long data is kept, review date |
| Restrictions on choice and possessions | Money held in the office, cigarettes rationed, phone kept in the office, food portions controlled | Individual reason, capacity, agreement with the person or a best interests decision | What is restricted, who decided, how the person can access it, review date |
| Restrictions on relationships and contact | Limits on visits, supervised contact, restrictions on relationships or sexual expression, internet limits | A clear safeguarding or best interests rationale, legal advice where contact is being prevented | The restriction, the basis, who agreed, how it is reviewed and by whom |
What actually authorises a restriction?
A restriction is only lawful if it has a legal basis, and in social care there are really four: the person's own consent, the Mental Capacity Act where they lack capacity for the decision, a Deprivation of Liberty Safeguards authorisation or Court of Protection order where the restriction amounts to a deprivation of liberty, and the common law in a genuine emergency.
House rules, custom and practice, the staff team's judgement and the family's preference are not legal bases. Nor is a risk assessment. A risk assessment explains why you think a restriction is needed; it does not authorise it.
The Human Rights Act sits over all of it. Article 8 protects private and family life, which covers where someone goes, who they see and what they do with their day, Article 5 protects liberty, and Article 3 prohibits inhuman or degrading treatment. A service that thinks about restriction in rights terms rather than risk terms usually gets to the right answer faster.
The Mental Capacity Act conditions for restraint
Under the Mental Capacity Act, a care worker may only restrain someone who lacks capacity for the relevant decision if two conditions are met: they reasonably believe it is necessary to prevent harm to the person, and the restraint is a proportionate response to the likelihood and seriousness of that harm.
Both words do work. Necessary means there was no less restrictive way of preventing the harm, and the record should say what else was tried. Proportionate means the restriction matches the actual risk, so a hold to stop someone running into traffic is a different proposition from a hold to stop someone taking a second biscuit.
Note what the conditions do not say. They do not permit restraint to prevent harm to other people, to make a shift easier, or to enforce a house rule. Preventing harm to others may be justified by other routes, including the common law and, in some services, the Mental Health Act, but it is not covered by section 6 of the Mental Capacity Act, and services that assume it is get this wrong. The Mental Capacity Act and DoLS checklist sets out the assessment and best interests steps in full.
When does restriction become a deprivation of liberty?
Restriction becomes a deprivation of liberty when the person is under continuous supervision and control and is not free to leave, and lacks capacity to consent to those arrangements. That is the acid test, and it applies regardless of whether the person is happy, whether the door is locked, or whether they have ever tried to leave.
In a care home this means a DoLS authorisation through the local authority. In supported living, a person's own tenancy, or anywhere DoLS does not reach, it means an application to the Court of Protection. Services routinely miss the second category, on the basis that the person lives in their own flat, which is not the test.
Where an authorisation exists, the conditions attached to it are part of the care plan and must be evidenced, not filed. And if the restrictions in place go beyond what the authorisation covers, the authorisation does not protect you.
What is the Mental Health Units (Use of Force) Act 2018 and does it apply to my service?
The Mental Health Units (Use of Force) Act 2018, known as Seni's Law, sets out duties on mental health units about the use of force: a responsible person, a published policy, information for patients, training, and detailed recording and publication of every use of force. It applies to mental health units, not to care homes or supported living services.
That scope matters, because providers sometimes cite the Act as the authority for what they do, which is wrong, and others ignore it entirely, which is a missed opportunity. The Act came from the death of Olaseni Lewis after prolonged restraint, and what it requires is simply a good recording standard.
Copy it. For every use of force, the Act requires a record of the reason, the type of force, whether it was planned, the duration, who was involved, whether the person had a mental disorder, the outcome including any injury, and the person's relevant characteristics including age, sex, race and disability. That last item is the one social care almost never records, and it is the one that shows whether restraint falls disproportionately on particular people. If your service holds those fields and reports on them, you are ahead of the standard that applies to you.
Restraint Reduction Network training standards
If your staff are trained in any form of physical intervention, that training should meet the Restraint Reduction Network Training Standards, which are the recognised certification standard in England and are referenced in national guidance. Training that teaches holds without teaching prevention does not meet them.
The standards require that training is person-centred and rights-based, that it prioritises prevention and de-escalation, that it prohibits techniques that carry high risk such as those involving pain or pressure on the chest, airway or neck, and that organisations commission training to fit their population rather than buying a generic package.
Two practical implications. Check that your training provider is certified against the standards and hold the certificate. And do not train staff in holds they do not need, because teaching a repertoire of restraint techniques where restraint is rare makes it more likely, not less.
What is a blanket restriction?
A blanket restriction is a rule or practice that applies to everyone in a service regardless of individual assessment or need. Blanket restrictions are rarely lawful, because a restriction has to be necessary and proportionate for the individual, and one that applies to everybody by definition has not been assessed for anybody.
They are extremely common and they usually start reasonably. One person cannot be trusted with hot water, so the kettle goes in the office. One person takes other people's food, so the fridge is locked. One person leaves at night, so the front door is locked from the inside. Within a year those become the house rules and nobody remembers which person they were for.
The test an inspector uses is whether the restriction is recorded against a named person with a reason, or whether it is just how the house runs. The fix is the same as the test: make every restriction individual, or if a shared arrangement is genuinely unavoidable, write it down as a restriction with a reason, the alternatives considered, who agreed it and a review date.
The blanket restrictions inspectors actually find
These are the ones I see most often, in services that consider themselves good. Read this list with your own house in mind.
- The front door locked or key-coded with no individual assessment for each person
- The kitchen locked, or access only when staff are present, for everybody
- Fridge or cupboard locks, and food kept in the office
- Fixed bedtimes and getting-up times driven by the rota
- Fixed bath or shower days
- No access to the kettle, the cooker or hot drinks unsupervised
- Phones, tablets or chargers kept in the office overnight
- Wifi switched off at a set time
- Cigarettes or vapes rationed and held by staff
- All money held in the office, including the person's own cash
- Visitors only at certain times, or visits only in communal areas
- No entry to the office, the laundry or the garden without staff
- Bedroom doors that staff open without knocking as a matter of routine
- One activity for everyone because there is one car
Several may be defensible for a particular person. None is defensible for everybody by default.
Jordan: the locked kitchen
Jordan, 29, has cerebral palsy and a moderate learning disability, and lives in a four-person supported living house. The kitchen was locked between meals. When I asked why, the answer was that a previous tenant, who had moved out two years earlier, had a habit of eating raw food.
Jordan wanted to make toast. He had made toast at his mother's house for fifteen years. The lock was not on his support plan, there was no capacity assessment, and no review date existed because nobody had ever written it down as a restriction at all. It had simply become the way the kitchen worked.
Removing it took an occupational therapy assessment for one other tenant, an isolator switch on the cooker rather than a lock on the door, and a line in two support plans about supervision for specific tasks. Jordan makes his own toast. The service also gained a written record showing that a restriction had been identified, assessed and removed, which is exactly the evidence inspectors look for.
What does least restrictive really mean?
Least restrictive means choosing the option that achieves the necessary safety while interfering least with the person's rights, and being able to show the alternatives you considered and rejected. It is a recorded reasoning process, not an adjective you attach to what you were going to do anyway.
The practical version is a short list on the record for every restriction: what is the risk, what would happen without any restriction, what three less restrictive options were considered, why each was rejected, what is now in place, and when will it be looked at again. A service that writes those six things for each restriction will remove a third of them in the writing, because the process exposes the ones that exist out of habit.
Technology often provides the less restrictive option. A door sensor that alerts a waking night worker is less restrictive than a locked door, and an isolator switch is less restrictive than a locked kitchen. But surveillance is a restriction too, so the sensor needs its own assessment rather than being treated as the automatic good answer.
Chemical restraint and PRN psychotropics
Chemical restraint is the use of medicine to control behaviour rather than to treat a diagnosed condition, and in learning disability services it usually appears as PRN lorazepam, PRN promethazine or a PRN antipsychotic written into a support plan. It is a restrictive practice and it must be counted as one.
A defensible PRN psychotropic has a written protocol saying what it is for in observable terms, what must be tried first and for how long, the dose, the route, the maximum in 24 hours, the minimum interval, what to monitor afterwards, and when the prescriber reviews it. If the protocol does not say what to try first, the medicine will become the first thing tried.
Count every administration as a restriction, record what preceded it and what was attempted, and record the effect an hour later. Then report the totals monthly per person. A person receiving PRN lorazepam eleven times in a month does not have an as-required medicine, they have a regular one that nobody has reviewed, which is the exact situation STOMP exists to find. Our guides to PRN medication protocols and STOMP and the learning disability health duties cover the prescribing side.
Priya: PRN lorazepam as a restriction
Priya, 46, has Down's syndrome and early onset dementia. Her PRN lorazepam 0.5mg was written for severe agitation. Over one month it was given nine times, all between 4pm and 7pm, and the reason recorded each time was agitated.
Because the service counted it as a restriction, the pattern surfaced at the monthly review rather than at the next psychiatric appointment eight months later. The ABC records showed the same antecedents: shift handover, the television on, and the evening meal being prepared in a noisy kitchen. Nobody had recorded what was tried before the medicine, because the form did not ask.
The changes were unglamorous. Handover moved out of the lounge, a quiet hour was built into the late afternoon with her preferred music, and the PRN protocol was rewritten to require twenty minutes of a named low-arousal approach first, recorded. PRN use fell to once in the following two months, and the psychiatrist reduced the prescription at the next review with real evidence in front of her.
Mechanical restraint and equipment
Equipment becomes mechanical restraint when its purpose or effect is to restrict movement rather than to support posture or enable an activity. A lap belt used so a person can sit safely in a wheelchair while travelling is postural support; the same belt used so they cannot stand up is restraint, and the difference is in the reason, not the belt.
The honest question about any piece of equipment is: could the person remove this if they wanted to, and if not, why not? Arm splints, gloves, protective helmets, bed rails, harnessed seating and locked wheelchair brakes all need the same treatment: a named clinician's recommendation, a capacity assessment and best interests decision, a written schedule for use, skin and comfort checks, and a review date.
Record wear time rather than just noting that the equipment is in use. A splint prescribed for two hours a day that is being worn for eight is a different intervention from the one that was authorised.
Seclusion, segregation and time out
Seclusion is confining someone alone in a room they cannot leave. Long-term segregation is keeping someone apart from others in the service for a sustained period. Both are extremely serious, both are essentially hospital practices, and neither has a proper place in a care home or supported living service.
What social care services do have is a grey area they call time out, quiet time or low-arousal space, and the question that decides whether it is seclusion is whether the person can leave. If a worker stands in a doorway, if the door is held shut, if the person is told they can come out when they have calmed down, that is seclusion whatever it is called in the plan.
Legitimate versions exist: a person choosing to go to their room, a plan that says staff withdraw to a distance while remaining in sight, a sensory space the person uses freely. Write those in terms of what the person can do, not what staff will prevent, and if someone is in effect being kept apart from others, escalate it rather than normalising it.
Environmental restrictions and surveillance
Locks, sensors, cameras and trackers are restrictions, and they need the same assessment as a physical hold plus a data protection impact assessment, because they involve processing personal data about someone who often cannot consent.
For each one, record the purpose, the least intrusive option that would work, who can view the data, how long it is kept, and the review date. CCTV in communal areas of a person's home is a significant intrusion and needs a much better reason than general reassurance. Cameras in bedrooms or bathrooms are almost never justifiable and should involve the local authority and the person's representative before anyone buys anything.
Door sensors and bed sensors are usually the proportionate answer where night-time safety is the concern, and they are commonly the route out of a locked door. But write the assessment, because a sensor introduced quietly is still an unrecorded restriction.
Marcus: a support plan built on restriction
Marcus, 34, has a severe learning disability and is autistic. His support plan, inherited from a previous provider, contained eleven separate restrictions: two-person support at all times outside the house, a locked bedroom door during the day, staff holding his money, no access to the kitchen, an agreed hold for personal care, a PRN antipsychotic, a door sensor, restricted access to his tablet, no visitors to his room, portion control at meals, and a rule that he could not go out after 6pm.
Not one of the eleven had a capacity assessment attached. Three related to incidents from more than four years earlier. The two-person requirement had been set when he lived somewhere much larger and had never been reviewed.
The work took nine months. Each restriction got a single page: risk, what would happen without it, alternatives considered, decision, review date. Four were removed outright, three were replaced with less restrictive versions, three were kept with a best interests decision and a review, and one, the hold for personal care, was rewritten with a desensitisation plan and a target to stop using it. Two years later he goes out in the evening and his money is in his own wallet with a weekly plan he agrees. The restriction count went from eleven to four, and the count is the thing that made it visible.
How do you record a restrictive practice?
Record every restriction as a discrete, countable entry with a type, a person, a date and time, a duration, a reason, what was tried first, who was involved, the outcome, any injury, and the debrief. A note in the daily log saying staff supported him to his room is not a record of a restriction.
The fields that matter, and which most systems do not have out of the box:
- Restriction type from a fixed list, so it can be counted and compared
- Whether it was planned in the support plan or unplanned
- Exact start and end time, giving a duration in minutes
- The trigger and the antecedent, linked to the ABC record
- Less restrictive options attempted first, named, with how long each was tried
- Staff involved by name, and whether they are trained and in date
- Injuries to anyone, with a body map
- The person's response and what they said or signed afterwards
- Debrief with the person, and debrief with staff, each with a date
- The legal basis: consent, best interests decision, DoLS or court order
- Whether it triggered a safeguarding referral or a CQC notification
- Manager review, separately dated from the entry itself
Holding those as structured fields rather than free text is the whole game, because free text cannot be counted. This is one of the clearest differences between a general system and a learning disability care management platform: whether restrictive practice is a form with a type list and a report behind it, or a paragraph in a daily note. Our guides to incident reporting and body mapping cover the related records.
Counting restrictions: the numbers a provider should hold
A provider should be able to state, for each person and each month, how many restrictions of each type were used, the total duration, how many were planned, how many resulted in injury, and the direction of travel over the last twelve months. If you cannot state those numbers, you cannot claim to be reducing restriction.
Per person is the important unit, because a service-level total hides the fact that thirty of last month's forty restrictions happened to one individual. Break the numbers down by time of day, by day of the week and by which staff were on shift, because those breakdowns tell you about the service rather than the person, and the service is the part you can change.
Report the numbers upwards every month and put them in the provider's governance pack alongside falls, medicines errors and safeguarding. Restriction that only appears in individual care plans never gets reduced, because nobody sees the total. A provider using care compliance software should be able to produce that breakdown in a couple of clicks rather than by hand-counting incident forms.
Post-incident debrief
Every use of restraint needs two debriefs: one with the person, in the way they communicate, and one with the staff involved. Both should be recorded and dated, and the one with the person is the one that gets skipped.
The debrief with the person is not an interrogation and does not have to happen immediately. It asks, in whatever form works, what happened, how they felt, what would have helped and what should be different next time. For someone without speech that might be a Talking Mat or a set of photographs. Our guide to communication passports and total communication covers how to make that meaningful.
The staff debrief covers what happened, whether the plan was followed, whether it worked, what the early warning signs were, and what needs to change in the plan. It should also check on the workers involved, because restraint is distressing to do as well as to experience, and teams that are not supported after an incident restrain more, not less.
Restraint reduction plans that work
A restraint reduction plan sets a measurable target for a named restriction, states what will replace it, names who is responsible, and sets a date to check. Without a number and a date it is an intention, and intentions do not reduce restriction.
The ingredients that make the difference are these. Start with the person's own view. Work on the antecedents rather than the response, using ABC data. Strengthen the positive behaviour support plan before reducing the restriction, never after. Change one thing at a time. Get the prescriber to write any medicine reduction down. Tell the whole team including bank staff exactly what is changing, because one worker reverting undoes months. And review monthly against the number, not against how it feels.
Expect a wobble. Reducing a restriction often produces a short-term rise in incidents before things settle, and a team that has not been warned will conclude it failed in week two.
What does an inspector ask about restrictive practice?
Inspectors ask to see the list. The first question is usually some version of: tell me every restriction in use in this service and who each one applies to. Then they check whether the list matches what they can see in the building and what staff describe.
The follow-up questions are predictable. Where is the capacity assessment? What less restrictive options were tried? Who authorised it and when was it last reviewed? How many times has this person been restrained in the last three months, and is that going up or down? Is your physical intervention training certified, and are these staff in date? Why is the fridge locked, and which person is that for? Can this person get a drink at eleven at night?
They will also ask the person and the family. A service whose account matches what the person says about their own life is in a strong position, and one where the care plan describes freedoms the person does not have is in trouble. Our guide to safeguarding adults covers when restriction crosses into a safeguarding referral.
Common mistakes
- Treating restriction as only meaning physical holds.
- House rules that are restrictions nobody has written down.
- Believing a risk assessment authorises a restriction.
- Using section 6 of the Mental Capacity Act to justify restraint aimed at protecting other people.
- Restrictions in supported living with no Court of Protection application because DoLS does not apply there.
- Recording restraint in free text so it cannot be counted.
- No count per person, so one individual's forty restrictions hide in a service total.
- PRN psychotropics not counted as restrictive practice.
- Protocols that do not say what to try before the medicine.
- No debrief with the person, only with staff.
- Training in holds the service does not need, and restrictions inherited from a previous provider and never reviewed.
- A reduction plan with no number and no date.
What good looks like on inspection day
An inspector asks for the restriction list. The manager opens a single report: every person, every restriction in use, the type, the legal basis, the date it was agreed, the review date and the count for the last three months. Four of them show a downward trend and one is flagged because it went up.
They ask about Marcus. The manager shows the eleven restrictions he arrived with, the single page written for each, the four that were removed, the three that were replaced and the hold that now has a desensitisation plan and a target date. They show the monthly count falling from eleven to four over two years.
They ask a support worker what they would do before using Priya's PRN. The worker names the twenty-minute low-arousal approach, says where it is written, and says they would record what they tried. The inspector asks Jordan about his kitchen, and Jordan shows them the toaster. That is the evidence inspectors look for, and it comes from counting, not from policy.
Final conclusion
Restriction in learning disability services is not eliminated by good intentions. It is reduced by making it visible. Define every restriction, including the quiet environmental ones, and hold them as a list rather than as sentences buried in support plans. Give each one a legal basis, a record of the less restrictive options considered, a named person who agreed it and a review date. Count them per person every month and report the totals upwards. Debrief with the person as well as with staff. Then set a target for the ones you want to lose, strengthen the support first and change one thing at a time. A service that can show its restriction count falling is doing the job. A service that cannot count at all does not know what it is doing to people.
Frequently asked
What is a restrictive practice?
A restrictive practice is any deliberate act that limits a person's movement, liberty, freedom of action or independence. It covers physical, mechanical and chemical restraint, seclusion and segregation, environmental restrictions such as locked doors and fridges, surveillance, and restrictions on money, possessions, communication and relationships.
Are blanket restrictions lawful?
Rarely. A restriction must be necessary and proportionate for the individual, so a rule applied to everyone in a service by default has not been assessed for anybody. If a shared arrangement is genuinely unavoidable, record it as a restriction with the reason, the alternatives considered, who agreed it and a review date.
Does the Mental Health Units (Use of Force) Act 2018 apply to care homes?
No. Seni's Law applies to mental health units, not to care homes or supported living services. It is still worth copying its recording standard, which requires the reason, type, duration, whether the use of force was planned, who was involved, any injury and the person's characteristics including age, sex, race and disability.
Is PRN medication a restrictive practice?
Yes, where a psychotropic medicine is given to control behaviour rather than to treat a diagnosed condition, it is chemical restraint and should be counted as a restriction. Each administration should record what was tried first, the dose and route, the effect after an hour, and it should be reported monthly per person.
When does a restriction become a deprivation of liberty?
When the person is under continuous supervision and control, is not free to leave, and lacks capacity to consent to those arrangements. In a care home that requires a DoLS authorisation; in supported living or a person's own tenancy it requires an application to the Court of Protection.
What should be recorded every time restraint is used?
The type of restriction, whether it was planned, the exact start and end time, the trigger, the less restrictive options tried first, the staff involved and whether their training is in date, any injuries with a body map, the person's response, both debriefs, the legal basis, and a separately dated manager review.
What does least restrictive mean in practice?
It means choosing the option that achieves the necessary safety while interfering least with the person's rights, and being able to show which alternatives you considered and why you rejected them. It is a recorded reasoning process, not a description you attach to what you were already doing.
How should a provider measure restraint reduction?
Count restrictions per person per month by type, with total duration, how many were planned and how many caused injury, and track the direction of travel over twelve months. Break the numbers down by time of day and by shift, because those breakdowns tell you about the service rather than the person.
Sources
- Mental Capacity Act 2005, sections 5 and 6, and the Deprivation of Liberty Safeguards
- Mental Health Units (Use of Force) Act 2018 and its statutory guidance
- Restraint Reduction Network: Training Standards
- Department of Health: Positive and Proactive Care, reducing the need for restrictive interventions
- Care Quality Commission: Right support, right care, right culture, and guidance on restrictive practice
- NICE guideline NG10: Violence and aggression, short-term management in mental health, health and community settings
- Human Rights Act 1998, Articles 3, 5 and 8
- Care Act 2014 and the statutory safeguarding duties
