Care Quality Commission: Restrictive Interventions

"We expect care to be person centred and are committed to helping services promote positive cultures. While we have seen improvements in some areas, there is still significant work to be done to reduce restrictive practices"

The CQC recognises that the use of restrictive practices may be appropriate in limited, legally justified and ethically sound circumstances in line with people’s human rights. But their expectations are clear: everyone working in health and care has a role to play in reducing the use of restrictive practices.

Restraint must:

• Never be used to cause pain, suffering, humiliation or as a punishment
• Only be used to prevent serious harm
• Be the least restrictive option, applied for the shortest possible time
• Only be carried out with the correct authorisations beforehand

Over the last year, there have been some positive examples of people being involved in their care and supported as an individual. This has helped to keep them safe and reduce unnecessary restraint.

However, there is a lot more work to do. For example, the CQC remain concerned about the disproportionate use of force against some groups of people, including people from ethnic minority groups, autistic people and people with a learning disability.

Services must work to understand the events that led up to any incidents where restrictive practice was used, report on them, learn from them, and actively work to reduce them in future.

Restrictive practices in healthcare settings encompass more than just measures like restraint, seclusion, and segregation. They also include subtler forms that can become routine responses to perceived risks or logistical constraints. These practices can impact the autonomy and well-being of individuals under care, often without being recognised as restrictive.

Examples of Subtle Restrictive Practices

1. Access Limitations: Preventing individuals from making hot drinks after a certain time.
2. Visitor Restrictions: Denying access to visitors or friends due to staffing or time constraints.
3. Food Restrictions: Limiting access to food because of lack of staff or time.

In summary, while restrictive practices can sometimes be necessary for safety, they should be used sparingly and always as a last resort. Care providers must focus on person-centred approaches that respect individual autonomy and reduce the reliance on any form of restriction.

Source: www.cqc.org.uk/publications/monitoring-mental-health-act/2022-2023/restrictive-practices