If someone were to say “we can’t go out there at the moment, shall we have a cuppa we wait” or “sorry, it’s dark outside so garden’s not open until to 8am”, be provided with a medication to sedate or calm as a medical restraint such as promethazine or lorazepam, be secluded to a certain area to keep their dignity if undressed or be restrained in their best interest once all other alternatives have been trialled repeatedly, these are all forms of restrictive practices and restraint. No matter how cooperative or accepting of the support provided. They are different forms, different levels, but all restrictive, affecting a person’s freedom of movement and choice through limiting access, provision of sedative medication, seclusion or restraint.
Under the Mental Capacity Act (2005), it provides protection to any individual who is deprived of their liberties to safeguard their health and wellbeing through establishing all support to be the Least Restrictive option. That any restriction in place must be proportionate to the need of keeping the individual safe, necessary in terms of all other lesser options have been attempted multiple times and lawful. By this, it must be justifiable if needed to be defended in front of the Court of Protection.
Therefore, if an individual who falls under the Mental Capacity Act is becoming distressed and is at risk to themselves or others, before escalating to any form of medication, seclusion or restraint practices, all methods of positive behavioural support should be trialled in a graded person-centred manner. This should include identifying trigger(s), seeking to remove or reduce any stressors, supporting positive engagements and emotional resilience, giving time and space in a safe manner, listening, changing the staff working with them, building a joint wellbeing plan to address distress, sensory boxes, exercise, access outside to reconnect with nature and get fresh air etc. A person’s wellbeing and health should always be at the centre of all we do, so seeking to understand why a behavioural escalation is occurring and how to safely deescalate in the least restrictive way possible is essential. To do otherwise is against the Mental Capacity Act and their Human Rights. There are a wide range of resources and support available to help develop these safe best practices, including, but not limited to:
- Promoting-less-restrictiv-b0f.pdf (local.gov.uk)
- Restraint Reduction Network
- About Positive Behaviour Support – Positive Behaviour Support
- Sensory Ladders Open Access | anyone | anywhere | anytime – Sensory Ladders
- SCIE: Managing risk, minimising restraint
The core take away is to work alongside those within your care, to identify how to reduce distress in a person centred way, using the least restrictive support that is safe to do so. Any support must be proportionate, necessary and lawfully justifiable.
We aim to complete a further series of blogs addressing this vital area, including its relation to the Mental Health Act, Human Rights and Mental Capacity Act, please do keep an eye out for further discussions.