Restrictive practice in adult social care: types, law and how to reduce it

What is restrictive practice?

CQC uses this definition, which the Local Government Association and others now quote: restrictive practice is "making someone do something they do not want to do or stopping them from doing something they do want to do, by restricting or restraining them, or depriving them of their liberty."

The definition is deliberately wide. In its State of Care 2025/26 report, CQC gives examples ranging from restraint and seclusion to less obvious practices, such as making someone use a wheelchair when they are willing and able to walk, or making them wear a bib when eating. It notes that restrictive practices can cause trauma and breach people's human rights.

In supported living the point matters even more, because the person is living in their own home with a tenancy. Rules that might seem normal in a shared service, such as set mealtimes or a curfew, can be restrictions on an adult in their own front room.

Types of restrictive practice

The definitions of physical, mechanical and chemical restraint and seclusion below follow the Department of Health's Positive and Proactive Care guidance. CQC's restraint policy guidance asks providers to define physical, mechanical, chemical and environmental restraint, and the difference between restraint and restriction.

Chemical restraint, PRN and STOMP

Positive and Proactive Care defines chemical restraint as "the use of medication which is prescribed, and administered for the purpose of controlling or subduing disturbed/violent behaviour, where it is not prescribed for the treatment of a formally identified physical or mental illness."

In adult social care, the most common risk is 'as required' (PRN) medication. A PRN sedative or antipsychotic given whenever someone is upset, or at the same time each day, is likely to be chemical restraint, even though it has been prescribed.

NHS England's STOMP programme (stopping over-medication of people with a learning disability, autism or both) asks that psychotropic medication is used for the right reasons, at the lowest dose and for the shortest time. NHS England says that in 2025 people with a learning disability are thought to be 15 times more likely, and autistic people 7 times more likely, than the general population to be prescribed an antipsychotic.

• Every PRN medicine should have a written protocol saying when it can be given and what to try first.
• Record each dose, the reason and what happened afterwards, and look at the pattern each month.
• Ask for a medication review if PRN is used often, or if the person's PBS plan has changed.
• People with a learning disability are entitled to an annual health check from age 14, which includes a medication review.

The law in plain English

Mental Capacity Act 2005

Section 6 says that restraining someone who lacks capacity is only protected in law if the person doing it reasonably believes it is necessary to prevent harm to the person, and it is a proportionate response to the likelihood and seriousness of that harm. Restraint here includes using or threatening force to make someone do something they resist, and restricting their liberty of movement whether or not they resist. Any decision must be in the person's best interests and take the least restrictive option.

Human Rights Act 1998

Restrictive practice touches several human rights: the right not to be treated in an inhuman or degrading way (Article 3), the right to liberty (Article 5) and the right to respect for private and family life and home (Article 8). Providers of publicly funded care must respect these rights.

Deprivation of liberty, and what changed in June 2026

If care arrangements deprive a person who lacks capacity of their liberty, the deprivation must be authorised. In care homes and hospitals this is done through the Deprivation of Liberty Safeguards (DoLS). In supported living and other community settings, it is done through the Court of Protection.

On 2 June 2026 the Supreme Court overruled the 2014 Cheshire West 'acid test', under which continuous supervision and control, and not being free to leave, were enough. The government's summary says the change applies with immediate effect across the UK and that the assessment is now multifactorial. It looks at the type, duration, effect and manner of the restrictions, whether the person objects, how normal the arrangements are and their purpose. It also says greater restrictions would be needed at home for a deprivation of liberty to arise, and that a person may be able to give valid consent even if they lack capacity under the Mental Capacity Act.

This does not mean restrictions matter less. Every restriction still needs to be necessary, proportionate, in the person's best interests and recorded. Many existing training materials, including SCIE's, were written under the old test and are being updated, so take up-to-date legal advice on individual cases. The Liberty Protection Safeguards, which are meant to replace DoLS, have not been brought in, and the government said in October 2025 that it would consult on them in 2026.

CQC Regulation 13

Under Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, people must be protected from abuse and improper treatment. CQC expects zero tolerance of unnecessary or disproportionate restraint, and says restraint includes physical, chemical and mechanical means.

Positive and Proactive Care (2014)

This Department of Health guidance applies to adult health and social care in England. It sets out how to reduce restrictive interventions, with positive behaviour support as the basis, and expects any planned restrictive intervention to be part of the person's behaviour support plan and reviewed.

Rules for using any restriction

• Use any restriction only as a last resort, when less restrictive options have been tried or would not work.
• Make it proportionate to the risk of harm, and use it for the shortest possible time.
• Never use restriction as punishment, to make someone comply, or because the staff team is short of people.
• Plan it in advance in the person's PBS plan wherever you can, and agree it with the person and the people who know them.
• If the person lacks capacity to agree, follow the Mental Capacity Act: a capacity assessment, a best interests decision and the least restrictive option.
• Record every use, including chemical and environmental restrictions, not just physical restraint.
• Support the person and the staff afterwards, and review what happened and why.
• Set a reduction plan, and check it at every review.

How to reduce restrictive practice

The services that reduce restriction treat it as a whole-service job, not a training event. These six steps are a practical starting point.

1. 1

   Find every restriction

   Walk through the service and each person's day. Count locked doors, house rules, PRN use and removed items, not just restraint.

2. 2

   Ask why each one exists

   For each restriction, record the risk it addresses, the evidence and who agreed it. Some will have no clear reason and can stop straight away.

3. 3

   Understand the behaviour

   Use PBS to work out what each behaviour is for, so you can change the conditions that lead to the risk.

4. 4

   Train the whole team

   Staff who understand behaviour and can de-escalate early have less reason to restrict. Training should be certified against the RRN Training Standards.

5. 5

   Debrief and look at the data

   Review every incident, look for patterns by time, place and staff, and share the learning in team meetings.

6. 6

   Set targets and report them

   Agree reduction targets for each person and the whole service, report them to leaders and check them at review.

Positive behaviour support sits at the centre of this. Our guides to PBS training for adult social care and writing a PBS plan explain how. For a structured service-wide approach, see our restraint reduction training and de-escalation training.

Guides for adult social care teams

Frequently asked questions