This section covers young people who may be eligible for adult packages of support at a moderate to high level and who may be at risk of ending up with a package which unintentionally restricts them.
Restrictive care and support packages can come in many different forms – They can range from using CCTV to continually monitor someone, to restricting access to areas in a person’s home, or locking cupboards and wardrobes – all the way to highly restrictive practices such as constant close high ratio staffing and restraint.
All forms of restrictive practice can be damaging and impede on a person's human rights and where these are in place for any reason there must be legal frameworks in place and consistent regular review.
CQC recognises that “most people know and accept that restraint, seclusion, and segregation are more extreme forms of restrictive practice. But there are more subtle forms of restrictive practice that easily become day-to-day normal responses to perceived risk or lack of time. There is the risk that without regular review, the use of restrictive practice can increase gradually over time without really being noticed and passed off as “just the way we do things here.
The use of restraint in caring for people with a learning disability and autistic people is governed by several pieces of statutory guidance and legislation designed to protect vulnerable people and promote their rights. For people with low support needs, the same principles apply to ensure their safety and dignity. The Restraint Reduction Network and the Challenging Behaviour Foundation are sources of guidance on a broad range of issues related to restraint. PCH guidance can be found here.
Guidance on Reducing Restrictive Practice can be found here Reducing restrictive practice | Local Government Association.
Guidance about human rights for young autistic people and young people with a learning disability aged 14-25 can be found LGA full resource.
Key pieces of statutory guidance and frameworks
- The Mental Capacity Act 2005: This legislation provides a framework to protect and empower people who may lack the mental capacity to make decisions for themselves. It emphasises that any decision made on behalf of someone who lacks capacity should be in their best interest and should be the least restrictive option.
- The Human Rights Act 1998: Under this act, people have the right to freedom from degrading treatment (Article 3), and their right to liberty and security (Article 5) should be considered, making it crucial that restraint is used only when absolutely necessary.
- Reducing the Need for Restraint and Restrictive Intervention: Jointly published by the Department of Health and Social Care and the Department for Education in 2019, this guidance focuses on restraint and restrictive intervention in special schools and health and social care settings.
- It emphasizes creating supportive environments and using positive behavioural support strategies as a first-line approach.
- Positive and Proactive Care: Reducing the Need for Restrictive Interventions (2014). Published by the Department of Health, this guidance advises service providers and commissioners to reduce reliance on restrictive practices and develop preventive strategies. It promotes training for staff in understanding the individual's needs, triggers, and positive behaviour support strategies.
- Building the Right Support (2015): This plan focuses on reducing the number of inpatient facilities by moving more people with learning disabilities and autism into community settings with appropriate support, emphasising person centred care.
- The Mental Health Act and proposed reforms: The Mental Health Bill was introduced in the House of Lords on 6 November 2024, and the reforms are now undergoing parliamentary scrutiny. One of the aims of the reform is to support the move from autistic people and people with a learning disability being inappropriately detained in hospitals. You can see the mental health bill published on 06.11.24 and updated progress through parliament HERE. https://bills.parliament.uk/bills/3884.
The overarching principle from these guidelines and legislation is that restriction of a person’s liberty (including all types of restraint) should only ever be used as a last resort, in situations where it is necessary to prevent harm, and when all other strategies have failed. It should be proportionate to the situation at hand and be part of a holistic care approach aimed at minimising its frequency and severity. Any sort of restriction to liberty should be reviewed regularly and can be stepped down when appropriate and safe, additionally, when any form of restraint is used, it should be recorded, monitored, and reviewed to ensure transparency and accountability.
For those supporting people with low support needs, the emphasis should be placed on personalising the approach to care, ensuring clear communication, understanding unique patient needs, proactively recognising potential stressors, and employing preventive and positive support measures tailored to each person.
Additional Resources
General background
- ADASS Preparing for Adulthood report, written in partnership with IMPOWER, looks at improving outcomes for young people as they move from children’s services into adult social care, focusing on practical solutions to long-standing issues.
- This NCEPOD report highlights the barriers and facilitators for young people with complex chronic health conditions as they move into adult services.
- From the Pond into the Sea. CQC report into the transition from children’s services into adult services
- Moving into adulthood – a provider perspective. This guide was produced by Dimensions and gives a provider perspective on moving into adulthood. It was written with the involvement of both families and a range of professionals, aiming to make a complex time as simple as possible.
- Area SEND thematic reviews. Reports on thematic visits of local area partnership arrangements for children and young people with special educational needs and/or disabilities (SEND).
- Making it Real is a set of coproduced statements that set out what good care looks like.