Reducing Restrictive Practices: Practical Strategies for Health and Social Care Teams

Across the UK, there is growing recognition that reducing restrictive practices must be a central priority for safe, ethical and effective care. Whether within mental health units, wider mental health settings, or community-based social care services, providers are expected to balance the need to protect safety with a clear commitment to upholding people’s human rights, dignity and autonomy.

Restrictive practices – including physical restraint, seclusion, long-term segregation and environmental restrictions – have historically been used in response to perceived risk, behavioural escalation or concerns about serious harm. However, a growing body of evidence indicates that the use of restrictive interventions can cause significant psychological distress, exacerbate trauma, and undermine the development of trusting therapeutic relationships.

The Growing Focus on Reducing Restrictive Practices

National guidance now emphasises the need to actively work toward restraint reduction, ensuring that restrictive interventions are used for the shortest possible time, and within clear legal and ethical frameworks.

For organisations supporting autistic people, individuals with a learning disability, behaviour perceived to be challenging, or adults experiencing mental health problems, the challenge is not simply to respond to crisis. It is to create environments, training, and person-centred approaches that prevent escalation in the first place.

This article explores how health and social care providers can move beyond reactive responses and embed practical strategies that meaningfully reduce restrictive practices, including our clinically-informed approaches at Gray Healthcare.

Understanding Restrictive Practices

Restrictive practices are actions or interventions that limit a person’s freedom of movement, liberty, or ability to make choices about their own life. While they are often associated with more extreme form, such as physical restraint or long-term segregation, restrictive practices can also include more subtle restrictions that limit autonomy or control over everyday decisions.

Examples may include:

• Physical restraint or the use of force
• Seclusion or segregation within a mental health ward
• Blanket restrictions on movement within an environment
• Limiting access to activities, communication or relationships
• Institutional routines that restrict autonomy
• Environmental controls that limit a person’s liberty

These restrictions may occur in mental health settings, mental health units, residential social care services, or community services supporting adults, children or young people.

Regulatory Oversight and Growing Concern

The Care Quality Commission (CQC) has repeatedly highlighted concerns about the inappropriate use of restrictive practices, particularly in services supporting autistic people and individuals with learning disabilities.

While restrictions are often introduced in response to immediate safety concerns, they can sometimes become embedded in routine practice rather than being regularly reviewed.

To address this, national frameworks emphasise the importance of understanding both the extreme forms and the subtle forms of restrictions that can affect a person’s freedom.

The Policy and Legal Framework

Across the UK, a number of national frameworks and regulatory expectations shape how services approach reducing restrictive practices. These frameworks are designed to promote safe, ethical and proportionate care while ensuring that restrictive interventions are minimised wherever possible.

One of the most significant developments in recent years has been the work of the Restraint Reduction Network (RRN), supported by the British Institute of Learning Disabilities (BILD). The organisation has developed the national RRN Training Standards, which aim to ensure that staff working across health and social care settings receive appropriate training in safe and ethical approaches to restraint reduction.

These standards emphasise several key principles that should underpin all practice, including:

• Respect for human rights
• The use of trauma-informed care
• Co-produced approaches to support planning
• Preventing crisis through proactive planning and early intervention
• Transparency and accountability in the use of restrictive practices

Together, these principles encourage organisations to move away from reactive responses and towards support models that prioritise prevention, understanding and personalised care.

Legislative Responsibilities in Restrictive Practice

Alongside national guidance, several pieces of legislation place clear responsibilities on providers to ensure restrictive interventions are used lawfully and proportionately.

Under the Mental Health Act, restrictive interventions must only be used when necessary to prevent serious harm, and any response must be proportionate to the level of risk presented. The Act emphasises the importance of protecting individuals’ dignity and ensuring that interventions remain the least restrictive option available.

Additional safeguards were introduced through the Mental Health Units (Use of Force) Act, commonly known as Seni’s Law. This legislation places further responsibilities on providers within mental health units, including requirements for appropriate staff training, improved incident recording, and oversight by a designated responsible person. This role helps ensure accountability for the use of force and promotes greater transparency in how restrictive interventions are used.

In addition, Deprivation of Liberty Safeguards (DoLS) and wider liberty protection frameworks require providers to ensure that any restrictions affecting a person’s liberty are properly authorised and subject to regular review.

Taken together, these frameworks establish a clear expectation across health and social care services: restrictive practices should be minimised wherever possible, used only as a last resort, and continually reviewed as part of ongoing efforts to reduce restrictive interventions.

Why Restrictive Practices Continue to Occur

Despite increasing policy attention and regulatory oversight, restrictive practices remain present across many health and social care settings. While most services aim to minimise this, several systemic and environmental factors can contribute to their continued use.

Understanding these factors is essential if organisations are to move beyond reactive responses and make meaningful progress in reducing restrictive practices.

1. Perceived Risk and Crisis Response

In high-pressure environments such as mental health wards and acute care settings, staff are often required to make rapid decisions in situations where there is a perceived risk of harm.

When an individual reaches crisis point, restrictive interventions may appear to be the most immediate way to maintain safety for the person or those around them. However, research increasingly shows that reliance on restrictive interventions can unintentionally reinforce patterns of escalation. Without proactive strategies and early intervention, services may find themselves responding repeatedly to crisis rather than preventing it.

2. Environmental and Institutional Factors

The design and culture of a service can also influence the likelihood that restrictive practices are used.

Busy mental health units, limited privacy, high noise levels and inconsistent routines can contribute to heightened anxiety and distress. For autistic people and individuals with sensory sensitivities, these environmental factors may significantly increase the likelihood of behavioural escalation.

Where environments are not adapted to meet individual needs, staff may face increased pressure to manage behaviour rather than address its underlying causes.

3. The Impact of Trauma

A significant proportion of individuals receiving support within mental health settings or social care services have experienced trauma.

Without trauma-informed care plans, interventions intended to manage behaviour can inadvertently trigger past experiences, increasing distress and undermining trust. This can result in further escalation and a greater likelihood that restrictive interventions are used.

Embedding trauma-informed practice is widely recognised as a critical component of effective restraint reduction.

4. Workforce Confidence and Training

The confidence and preparedness of staff teams also plays an important role. Supporting individuals with complex needs requires a high level of skill, particularly when responding to situations involving distress, anxiety or behavioural escalation.

Without appropriate training, staff may feel underprepared to implement alternative strategies and may rely more heavily on restrictive interventions as a means of maintaining safety. This is why national frameworks, such as the Restraint Reduction Network (RRN) Training Standards, emphasise the importance of equipping staff with the knowledge, skills and confidence to identify early warning signs, implement de-escalation techniques and ensure that any intervention remains the least restrictive option available.

At Gray Healthcare, this principle is supported through a structured training approach based on Positive Behaviour Support (PBS), which is a widely recognised, person-centred approach to understanding behaviour, and identifying how best to meet an individual’s needs. By focusing on the underlying causes of distress and implementing proactive strategies, staff are better equipped to deliver responsive, compassionate support to individuals with complex needs.

Practical Strategies for Reducing Restrictive Practices

Reducing restrictive practices requires more than policy commitments or regulatory compliance. It requires a systemic approach that addresses culture, workforce capability, service design and governance across health, social care and education settings.

Achieving meaningful restraint reduction depends on embedding preventative, person-centred approaches across every aspect of service delivery.

1. Identify Restrictive Practices Across the Whole System

A fundamental step in reducing restrictive practices is ensuring that organisations can accurately identify where restrictions occur.

Restrictive interventions are often associated with visible actions such as physical restraint or seclusion. However, restrictions can also appear in more subtle forms within everyday practice.

Services should therefore examine:

• Physical interventions such as restraint or seclusion
• Environmental restrictions within wards, homes or care environments
• Blanket policies that limit choice or movement for multiple individuals
• Restrictions embedded within routines or institutional practices

Auditing practice allows organisations to identify where restrictions may be unnecessary, disproportionate or no longer justified.

The Care Quality Commission (CQC) expects providers to demonstrate that restrictive practices are continually monitored, regularly reviewed, and reduced wherever possible.

2. Embed Trauma-Informed Care

Many individuals receiving support within mental health settings or social care services have experienced significant trauma.

Embedding trauma-informed care enables services to better understand:

• The factors that may trigger distress or escalation
• How previous experiences influence behaviour and communication
• What support strategies promote safety, stability and trust

Developing trauma-informed care plans allows services to move away from reactive responses and instead focus on prevention and understanding.

3. Develop Person-Centred Care Planning

Effective restraint reduction relies on person-centred care planning that reflects the individual’s needs, preferences and lived experience.

Care plans should be co-produced with individuals wherever possible, ensuring their communication styles, preferences and coping strategies are understood.

Key elements include:

• Early indicators of distress
• Preferred de-escalation strategies
• Environmental adjustments
• Support approaches that reduce anxiety

When care plans are personalised and regularly reviewed, staff are better equipped to intervene early and prevent escalation.

4. Create Therapeutic Environments

The physical and organisational environment within a service can significantly influence behaviour and wellbeing.

Services should consider:

• Sensory-aware environments
• Access to outdoor or calming spaces
• Opportunities for privacy and quiet reflection
• Meaningful activities that promote engagement and purpose

A supportive environment can reduce anxiety and help individuals feel safe.

5. Invest in Workforce Training and Development

Staff supporting individuals with complex needs require the skills to recognise early signs of distress and respond appropriately.

Training should include:

• De-escalation techniques
• Trauma-informed practice
• Human rights frameworks
• Legal responsibilities under the Mental Health Act and Seni’s Law

Training should also promote reflective practice so teams continuously improve their approach to restraint reduction.

6. Strengthen Governance and Accountability

Strong governance ensures restrictive practices are used appropriately and reduced over time.

Services should ensure:

• All restrictive interventions are documented
• Incidents are reviewed and analysed
• Data is used to identify trends
• A designated responsible person oversees compliance with legislation

This oversight helps organisations demonstrate accountability and progress in reducing restrictive practices.

A Clinically Informed Approach to Reducing Restrictive Practices

While national guidance sets the direction for reducing restrictive practices, implementation in day-to-day support requires clear frameworks, skilled staff teams and a consistent organisational culture.

At Gray Healthcare, reducing restrictive interventions is embedded within a clinically-informed support model that prioritises proactive strategies and person-centred care.

Central to this approach is the PROACT-SCIPr-UK® framework, which focuses on understanding the whole person rather than responding solely to behaviour.

Within this model:

• Proactive strategies focus on meeting the person’s needs and preventing distress.
• Active strategies help staff recognise early signs of anxiety or escalation.
• Reactive strategies are used only when there is a genuine risk of harm.

By combining trauma-informed care, positive behavioural support and proactive de-escalation strategies, the need for restrictive practices can be significantly reduced while maintaining safety.

Reducing Restrictive Practices in Community-Based Supported Living

While much national discussion focuses on inpatient settings, community-based support also plays a crucial role in reducing restrictive practices.

At Gray Healthcare, our supported living environments are designed to minimise restrictive interventions from the outset through:

• Stable housing environments where individuals hold their own tenancy
• Consistent staff teams recruited specifically for the individual
• Clinically-informed care planning
• Person-centred support strategies focused on prevention

When support is carefully designed around the individual, restrictive interventions can be dramatically reduced.

Creating Safer, More Therapeutic Services

Reducing restrictive practices is fundamentally about balancing safety with respect for people’s human rights, dignity and autonomy.

By embedding clinically-informed care, person-centred planning, skilled workforce training and strong governance, health and social care services can move beyond reactive responses and create environments that prioritise prevention, understanding and wellbeing.

For individuals with a learning disability, mental health needs or complex support requirements, this shift is essential.

It ensures services do more than manage risk – they create therapeutic environments where people feel respected, supported and able to live fulfilling lives.

Contact Us Today

If you are a commissioner, local authority partner, case manager or family member seeking specialist supported living for someone with complex needs, we welcome the opportunity to discuss how we can help.

Contact our team to explore how our clinically-informed community care model can support your referral.