Use of Restraint in Behaviour Support: Questions We Need To Ask Ourselves
The headline in the news around the use of restraint at Wetherby Young Offenders Institute makes for grim reading. An unannounced inspection of the secure facility between November and December 2023 by HM Chief Inspector of Prisons found that a young, vulnerable female inmate twice had her clothes removed under restraint by an all-male team of prison staff.
There were multiple, contextual factors given by the institute, which sought to explain the reasons behind this particular course of action. However, this doesn’t make the details any less harrowing, and, despite some good provision evident in some units, the published report was highly critical of the facility, and its approach to safety and care.
Use of restraint in other settings
Sadly, incidents such as these are not one-offs, nor are they limited to higher-risk, secure settings, such as prisons or young offenders’ institutes (YOIs). We only have to look at other examples, such as the treatment of patients at Whorlton Hall secure hospital and Winterbourne View private hospital, or the tragic case of George Floyd in the USA, to know that the use of restraint and other restrictive practices can have significant, and sometimes lethal, consequences.
While every setting has their own guidelines around the use of restraint, and staff may well be trained in and operating within the parameters of their organisation’s policies and practices, the report about Wetherby Young Offenders Institute is a timely reminder for all of us to reflect on our approach to restraint, and ask ourselves some important questions.
Team Teach’s perspective on the use of restraint
At Team Teach, our stance is clear and unequivocal: restraint and other restrictive practices should only ever be used as a last resort. If professionals judge this to be the only option in order to reduce risk of serious harm and to keep people safe, we should be using the least restrictive intervention, for the shortest amount of time. Any action should be reasonable, proportionate, and necessary, and should be carried out in a manner that preserves individuals’ dignity, respect, and safety.
Building relationships over using restraint
We recognise that, in some settings, restraint may sometimes be necessary. We respect a service’s right to adopt an approach that is effective and fitting for them and those they support, and where, if restraint is necessary, it is always used in a dignified, respectful, and safe manner.
However, we also believe that building strong relationships with those in our care, relationships rooted in mutual trust and respect, can enable us to mitigate the likelihood of escalation, and reduce the need for restraint and other restrictive practices in the first place.
So, as professionals across a range of sectors, including education, health, and social care, what sorts of questions should we be asking ourselves about the use of restraint and other restrictive practices?
Self-reflective questions around restraint
These questions can be used to frame professional conversations between leaders, practitioners, external agencies, and, where appropriate, family members and the individuals being supported. They are designed to prompt thought, encourage discussion, and facilitate reflection around best policy and practice:
1: What do we understand by restraint and restrictive practices?
Does everyone across the organisation have a shared understanding of what these terms mean? If not, it could lead to an inconsistent approach to incidents, and leave staff and individuals vulnerable to risk.
Clarifying terminology and creating consistency through extensive and thorough ongoing professional development is central to a joined-up approach within an organisation. By ensuring that teams are supported, if and when restraint is deemed necessary, all staff can carry out their duties safely, reducing risk to themselves, the individual they are supporting, and others.
2: Do we all understand the legal parameters around restraint?
As a sensitive, contentious, and potentially dangerous issue, it’s vital that all staff and other stakeholders understand the legal frameworks and guidance around the use of restraint and other restrictive practices.
The UK government has published guidelines around key principles for education and health and social care settings, as well as for the youth custody service. In addition, the CQC’s report, Out of Sight: Who Cares?, updated in March 2022, provides insights around the use of restraint in care services. And the Equality and Human Rights Commission Framework for Restraint is also a helpful document.
All of these resources can provide a useful starting point for discussion, to help staff understand their legal position when using restraint.
3: How are we building relationships with individuals in our settings?
There is, perhaps, a reluctance in some sectors, to invest in relationships with individuals, due to a fear of weakening positions of authority.
However, it is possible to forge strong and positive relationships while also maintaining a healthy, professional approach, based on clear boundaries, whatever the setting. Relationships are pivotal to reducing the need for restraint and other restrictive practices, and can be an effective way to create lasting, sustainable change.
Building positive relationships can have a huge impact, helping individuals to feel seen, heard, and valued. If we can change their experiences, we can also potentially change their thoughts, feelings, and behaviours.
4: How are we planning for known risk, and how do we respond to unexpected situations?
Often, when a person is restrained or subject to another type of restrictive practice, it’s not the first time they have engaged in a behaviour. We might hear staff saying things like, “Oh, they always do this”, or “It’s not the first time I’ve had to restrain them”.
The question for us as professionals, then, is: are we planning for known risk? If we know someone’s triggers, and can accurately anticipate how they may respond, we need to be adjusting our risk assessments and support plans accordingly.
Of course, we cannot foresee every eventuality, and sometimes, we may need to make a dynamic risk assessment in the moment. However, the same principles apply: we can use what we know about a person to think about how they may react, and then update documentation afterwards to reflect known risk, so that we can adapt our approach going forward.
5: How do we repair relationships when they are compromised?
If we all agree that good, strong relationships are key to protecting the best interests of those in our care, we also need to consider what we do when these relationships become strained, or even fractured.
Facilitating timely restorative conversations can be a highly effective way to repair any damage and allow both parties to have their say about what happened. This can only take place in a culture of openness, honesty, trust, and respect, where staff members and individuals feel safe and comfortable to share their views and opinions.
A commitment to reduce the use of restraint and other restrictive practices
The use of restraint and restrictive practices is a contentious and highly sensitive issue. While we are all committed to reducing the use of unnecessary restraint, perspectives on its use vary widely depending on the nature of a setting, the expectations on staff, and the needs of the individuals within that setting. In short, there are no easy answers.
However, upholding professional standards, reducing risk for all, building strong relationships, and treating people with dignity and respect are core principles that we need to keep front and centre at all times. It is only when we keep these principles at the heart of everything we do that we can give the most effective and supportive care.
