Reducing restrictive practice through least coercive care

Reducing restrictive practice resources

The NHS England ‘Identifying Restrictive Practice’ Resource for ICBs and NHS funded organisations can be found on the NHS England website.

This resource supports the reduction of the use of restrictive practices within mental health inpatient services. As restrictive practices occur in a range of settings, this resource also aims to raise awareness and support reduction of restrictive practices more broadly.

In addition, we have produced 2 resources for adults and children with a learning disability, autistic adults and children, the staff who support them and their families to inform and empower people to speak up about restrictive practice.

Both resources have been co-produced and piloted with people with lived experience of restrictive practice in hospital settings and professionals.

The resources take a human rights approach and aim to help people understand their restrictions and be more involved in developing least restrictive options. They also include information about who to speak to if there are any concerns about the way restrictions are used.

  • What are restrictive practices easy read booklet is designed for autistic adults and adults with a learning disability. It includes information about different kinds of restrictive practice and why they may be used.
  • The My Rights magazine is designed for young people. It is written in plain English and in a style that allows young people to easily turn to the topic they need and to personalise it through writing and doodles. It includes information about rights, types of restrictive practice, real stories and top tips from young people about ways to speak up.

Young people were very clear that the magazine will be most useful as a hard copy. They wanted to be able to write or draw on it, rip out and keep key pages or tips, and take it with them to meetings to remind them and others about their rights and needs. Please consider how you can work in partnership to promote this great resource and achieve hard copies for the young people in your area.

Staff working in hospital settings should share these resources with the people they support and actively work with them to help them understand and be involved in decision making around the use of restrictive practice.

Reducing the use of restrictive practice through a culture of care

A key factor for reducing the use of restrictive practices in inpatient mental health settings is the right culture in the ward environment. In its work around closed cultures, the CQC identified that the use of restrictive practices in a service should be considered an inherent risk factor. Its policy position statement (2023) states that restrictive practice represents a failure of person-centred planning.

The 12 core commitments of the NHS England » Culture of care standards for mental health inpatient services , which were co-produced with patients, identify what is needed to create a positive culture of care and in turn reduce or stop the use of restrictive practices.

Mental Health Units (Use of Force) Act 2018

The Mental Health Units (Use of Force) Act 2018 – GOV.UK, also known as Seni’s Law. Olaseni (Seni) Lewis was a young Black man who died following the disproportionate and inappropriate use of force in a mental health ward. After his tragic death, his family tirelessly campaigned for change. This led to the introduction of the Mental Health Units (Use of Force) Act 2018, which seeks to prevent the inappropriate use of force, ensure accountability, and promote transparency in these settings. The Act defines “use of force” to include physical, mechanical, and chemical restraints, as well as isolation (seclusion and segregation).

The Mental Health Units (Use of Force) Act 2018 requires every mental health unit to publish a policy on how it is minimising the use of force, including seclusion and segregation. Guidance for developing a policy to comply with Section 3 of the Statutory Guidance of the Mental Health Units (Use of Force) Act 2018, Implementing Seni’s Law, was commissioned by NHS England and developed by the Restraint Reduction Network in partnership Aji Lewis, Seni’s mother. You can find the guidance on the Restrain Reduction Network website: Implementing Seni’s Law.

The document shares examples of good restraint reduction policies to help providers shape their own.

Independent Care (Education) and Treatment Reviews (IC(E)TR)

The Care Quality Commission (CQC) are the lead organisation for IC(E)TRs as of 1 April 2025.

CQC have specially trained Mental Health Act Reviewers (MHARs) who are undertaking the Chair role on IC(E)TR panels with the rest of the panel remaining as independent experts alongside the responsible commissioner.  More information is available on their website: CQC’s programme of Independent Care (Education) and Treatment Reviews (ICETRs).

HOPE(S)

The HOPE(S) model is a human rights-based approach  which was developed  by  Mersey Care NHS Foundation Trust  to reduce the use of long term segregation that is sometimes experienced by autistic adults, adults with a learning disability and children and young people when in mental health hospital. ICBs and providers are able to commission HOPE(S) locally and this offer has been taken up across multiple regions and ICBs to date.

Commissioners can discuss the HOPE(S) model in more detail and explore costings for local areas by contacting: hopes@merseycare.nhs.uk

Senior intervenors

All-age senior intervenor support can be commissioned by local systems wherever a person is ‘stuck’ in a mental health hospital due to system rather than clinical issues. It is expected that many of these people with longest lengths of stay will now be identified through local Dynamic Support Registers, C(E)TR panels, and/or local oversight processes.

The intervenors who supported the national pilots can be requested via the NHS IMAS specialist talent pool or by contacting nhs.imas@nhs.net.

Restrictive intervention data

Mental health providers submit restrictive intervention data via the Mental Health Services Data Set (MHSDS). Providers and systems must ensure they have appropriate internal governance in place to routinely review restrictive intervention data, including analysis by protected characteristics, and to take timely action to support safe, proportionate and person‑centred care. 

Publications and additional resources

Additional information and resources can be located on the FutureNHS collaboration platform found at NHS Futures: Futures – Futures