Restraint and seclusion

Restrictive practice is one of the hardest patterns in the archive because it is often described in professional language that makes it sound controlled, technical and necessary. Sometimes restraint may be used to prevent immediate harm. The archive asks what happened before it became necessary and what happened afterwards.

For autistic people, children, people with learning disabilities and people in mental health crisis, restraint and seclusion can become deeply traumatic. Public guidance stresses reducing the need for these interventions.

CQC's Out of sight, who cares? review looked at restraint, seclusion and segregation in services for people with mental health conditions, learning disabilities or autistic people. CQC reported examples of undignified and inhumane care.

GOV.UK guidance on reducing restraint and restrictive intervention sets out how health, social care and special education settings should support children and young people at risk of restrictive intervention and promote welfare.

NICE quality standards state that people with a learning disability and behaviour that challenges should have a documented review every time a restrictive intervention is used.

What was understood?

The key question is whether distress, environment, communication and unmet need were understood early enough.

What force was used and why?

The record must distinguish immediate safety from routine control.

Was it reviewed with the person?

A documented review should ask how to prevent recurrence and how the person experienced it.