Frequently Asked Questions Concerning Restraint
1.
What is restraint?
The Framework for Good Practice on the Prevention and Management of the
Use of Restraint (last reviewed December 2011) defines restraint as:
“Anything that prevents someone doing something”.
This could be through a variety of means, including but not limited to:
 physical – e.g. hands on restraint, chemical restraint using drugs
 mechanical – e.g. use of aids such as lap straps, splints or rails
 restricting choice – when to go to bed, when to visit friends, when to
spend one’s own money, matters relating to eating and drinking or
 withholding information – not letting people know information about
their care or own personal circumstances in order to restrict their
choice.
2.
Why is the definition so broad?
Some restraints may appear to be “low level interventions”. However when
combined these may have a huge impact on a person’s freedom and feelings
of safety. The definition is broad so that workers can reflect on the impact of
their actions, particularly with respect to service users who lack the capacity to
consent to their care plan. In addition the broad definition helps to keep
practice in line with the key principles of the Mental Capacity Act [section 1(6)]
and the Deprivation of Liberty Safeguards (see FAQ 12 for more on this).
3.
Why do we need guidance and procedures?
The guidance produced will help workers make sure that their practice is in
line with the law, most notably the Mental Capacity Act.
It is clear that implementing such legislation may involve workers changing
longstanding working practices and it also involves rethinking our
relationships with, and ideas about, service users. These procedures will help
with that process.
4.
Who can use restraint?
There is no list of approved people; it is simply a matter of need and context.
Anyone using restraint as part of a care plan should have training in any
techniques or equipment used.
5.
Is restraint against the Law?
It could be if it is not proportionate to the risks involved and isn’t implemented
following the correct legal procedures.
Usually restraint would be lawful if it is conducted using agreed local
procedures. It may be unlawful NOT to use restraint where it is necessary to
act in someone’s best interests, either under the Mental Capacity Act or the
Common Law.
6.
Is there legal protection?
Legal protection exists within the Mental Capacity Act for people who care for,
or treat someone, who lacks capacity (this could include restraint), but they
must follow the Act’s principles and act only in the person’s best interests.
For example, somebody using restraint would only have legal protection if the
restraint is:
 necessary to protect the person who lacks capacity from harm, and
 it is proportionate to the likelihood and seriousness of that harm, and
 it doesn’t conflict with a valid advance decision.
There is no protection under the MCA for an action that deprives someone of
their liberty unless it is authorised under the Deprivation of Liberty Safeguards
or by an order from the Court of Protection.
There may also be protection under the Common Law for using restraint with
an individual (who may or may not lack capacity) in situations where another
person could be harmed. Again the level of restraint would have to be
proportionate to the circumstances. This could happen in circumstances
where one service user may be harming another or where a service user may
be harming a member of staff.
7.
Is the use of restraint always a Safeguarding matter?
No.
The use of restraint may well be in a person’s best interests and therefore
necessary. If the Framework for Good Practice is followed by considering
less restrictive alternatives, and making a risk assessment of any intervention,
then it is unlikely that that restraint will be an abusive act.
Restraint could result in abuse, however, if it is unnecessary and not in line
with the Good Practice Guidelines, for example:
 it is not the least restrictive alternative, not proportionate to the risk,
and is not in the person’s best interest;
 it is used as punishment;
 it is part of poor institutionalised practice that results in neglect;
 it overly restricts freedom of movement or access;
 it deprives someone of their liberty and is not appropriately authorised.
8.
What should I do if a person agrees to restraint?
If there is any reason to doubt the person’s capacity to consent to the restraint
then an assessment of their capacity to agree to the care plan should be
undertaken. If the service user has the capacity to consent, and they do so
freely, then their agreement should be recorded on their records. The
restraint may then indeed be used as stated in the care plan.
Care should be taken if:
 the person does not have the capacity to consent - in which case a
Best Interests decision must be taken, or
 the person does have the capacity to consent, but is not giving consent
freely, i.e. they are under some pressure to agree. The circumstances
surrounding this should be considered and it may be a Safeguarding
matter, or
 a person requests a restraint that is clearly unnecessary or presents
ethical or safety issues for staff to implement, e.g. the person requests
a high level of physical restraint when it is not warranted by the risks.
Consideration must be given to the reasons behind this request and
how the person’s needs can be met in other ways.
9. Isn’t it better to use restraint rather than let someone hurt
themselves or someone else?
It may well be better but the guidelines should still be followed to ensure that it
is the least restrictive of the possible alternatives. For example, if a service
user is injuring himself by constantly rubbing his eyes, it might be because he
has a treatable infection. Appropriate medical intervention might solve the
self harming behaviour without the need for restraint.
It also has to be remembered that restraint may be necessary in an
emergency situation, to prevent harm to self or others. The Framework for
Good Practice accepts that this might happen but suggests any intervention
be reviewed afterwards to consider whether, if needed, it should be built into
the care plan.
10.
When is it appropriate to use restraint under the Mental
Capacity Act?
Where there is a reasonable belief that the person lacks the capacity to
understand the risks and they are at risk of harm.
 Section 6(4) states that restraint is only authorised if the carer “believes
that the restraint is necessary to prevent harm”.
 The restraint must be a “proportionate response” to the likelihood of the
person suffering harm.
 The minimum level of restraint must be used; if the risk of harm
reduces, then the level of the restraint must also reduce.
 All actions taken under the MCA must be the least restrictive option in
the person’s best interests.
11.
When is it appropriate to use restraint with a person who
does not fall within the MCA?
Restraint is permitted under the Common Law if a person’s behaviour
presents a risk to others or property, but the response must be proportionate
to the level of risk and the least restrictive necessary. You should also have
considered other options first. Obviously there may be times when you have
to act in an emergency before you have time to consider what else could have
been done. The case of an emergency the Framework for Good Practice
says that you should hold a review of the incident as soon as possible and
consider whether the care plan needs to be changed to include restraint.
Just because a person has the capacity to understand their care plan doesn’t
mean that they can refuse interventions if that refusal would put others at risk.
An example of this might be:
Mrs M has a mental disorder. Most of the time she has the capacity to make
decisions about her care plan. Sometimes, when she is acutely unwell, she
becomes quite paranoid and thinks that staff are trying to put poison in her
food. At these times she can become very distressed and has become
violent. In the past, after staff have tried other solutions first, she has been
restrained and given sedative medication to protect herself and others (a
decision under MCA due to her lack of capacity when acutely ill). She is
unhappy at these interventions and has stated, when well again, that she
doesn’t want to be restrained because it infringes her personal dignity. The
staff can still restrain her when she is violent even though her decision not to
be restrained was made with capacity. However, they should also plan for
future occasions when this may happen and think about other ways in which
the situation could be safely managed.
12.
Is restraint a Deprivation of Liberty under the MCA?
Not necessarily. In most cases restraint will be a restriction under sections 5
and 6 provided it is in someone’s best interests. Deprivation of Liberty is
dependent on:
 Frequency (how often it’s used), and
 Degree and intensity (the level, how restricting it is).
Where there is regular use of restraint (particularly physical or sedation to
control behaviour, or locked doors) the need for Deprivation of Safeguards or
a Court Order must be considered. This is because deprivation of liberty is a
breach of the European Convention of Human Rights and therefore illegal if it
has not been through a legal process.
13.
How should I record issues to do with restraint?
Your employer may have a set process for recording such work. Consult with
your manager to find out what this is. If it is unclear or you need to record
what has happened in a hurry, for example, because of an emergency, then
make sure you record:
 what happened,
 why restraint was or wasn’t required,
 who you consulted with about the intervention,
 whether the person was able to consent to the restraint or whether they
lacked capacity to do so,
 how the person was restrained,
 how long the person was restrained for,
 what the outcome was, and
 the date and time this happened.
Make sure this record ends up with the person’s notes and bring it to the
attention of your manager as soon as possible.
If your query has not been answered here then you may wish to contact us
directly. Please do this either by telephoning the MCA/DoLS helpline on 0114
205 3783 or email your question to mca@sheffield.gov.uk.
We will try to reply to you as soon as possible and in most cases you should
not be waiting any longer than 24 hours for an answer.