Restraint in healthcare is one of the most challenging responsibilities faced by professionals working with vulnerable individuals. While protecting patients, service users and staff is essential, the use of physical intervention must always be approached with care, consideration and respect for individual rights.
But what if the most important part of restraint training isn’t learning how to restrain someone, but learning how to prevent the need for restraint altogether?
Across the healthcare sector, the emphasis is increasingly moving towards prevention, de-escalation and reducing restrictive practices.
Understanding restraint in healthcare
Restraint may become necessary when an individual presents an immediate risk of harm to themselves or others.
However, its use carries significant responsibilities and potential risks.
Restrictive interventions can have physical and psychological consequences, particularly for individuals who have experienced trauma or who may have difficulty understanding what is happening.
It is therefore essential that healthcare organisations prioritise approaches that prevent situations from escalating unnecessarily.
Physical intervention should never become a routine response to distress, communication difficulties or behaviour that professionals find challenging.
What does NICE guidance say?
The National Institute for Health and Care Excellence (NICE) provides guidance on managing violence and aggression in mental health, health and community settings.
NICE guideline NG10 recommends training staff to recognise early warning signs of agitation and aggression, understand potential causes and use effective de-escalation techniques.
These include:
Recognising changes in behaviour and emotional distress.
Understanding individual triggers and circumstances.
Using calm, respectful communication.
Maintaining appropriate personal space.
Responding without unnecessary confrontation.
Using appropriate techniques to reduce tension.
NICE recommends that restrictive interventions are only used when de-escalation and other preventative approaches have failed and there remains a potential risk of harm.
It also emphasises that any intervention must be proportionate, use the least restrictive appropriate option and last no longer than necessary.
These recommendations demonstrate why prevention should form a central part of healthcare training.
Understanding the causes of distressed behaviour
Behaviour that appears aggressive or challenging may have underlying causes that are not immediately obvious.
An individual may be experiencing fear, pain, anxiety, confusion, sensory overload or communication difficulties.
For example, a person living with dementia may become distressed in an unfamiliar environment.
Someone experiencing a mental health crisis may struggle to understand instructions or feel threatened by an unexpected approach.
Recognising these factors can significantly influence how professionals respond.
Instead of immediately focusing on controlling behaviour, staff can consider what may be causing distress and whether adjustments could improve the situation.
This is an important part of person-centred care.
De-escalation: An essential professional skill
Effective de-escalation is about more than asking someone to calm down.
It requires patience, communication skills, situational awareness and an understanding of individual needs.
Approaches may include providing reassurance, reducing environmental pressures, allowing time for someone to process information and recognising when additional support is required.
Staff should also understand how their own communication, body language and emotional responses can influence a situation.
While no single approach will be effective in every circumstance, appropriate de-escalation can reduce the likelihood of physical intervention becoming necessary.
The ability to prevent an incident is just as important as the ability to respond safely when one occurs.
De-escalation: An essential professional skill
Effective de-escalation is about more than asking someone to calm down.
It requires patience, communication skills, situational awareness and an understanding of individual needs.
Approaches may include providing reassurance, reducing environmental pressures, allowing time for someone to process information and recognising when additional support is required.
Staff should also understand how their own communication, body language and emotional responses can influence a situation.
While no single approach will be effective in every circumstance, appropriate de-escalation can reduce the likelihood of physical intervention becoming necessary.
The ability to prevent an incident is just as important as the ability to respond safely when one occurs.
The legal and professional responsibilities
Healthcare restraint is subject to legal and regulatory safeguards.
In England, Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires providers to protect service users from abuse and improper treatment.
Restraint must have a lawful basis and be necessary and proportionate to the risk of harm.
The Mental Health Units (Use of Force) Act 2018, commonly known as Seni’s Law, also places specific responsibilities on relevant mental health units in England.
These include requirements concerning the use of force, staff training, recording incidents and accountability.
The accompanying statutory guidance emphasises the importance of human rights, trauma-informed care and reducing the use of force wherever possible.
The legal framework varies depending on the care environment, the individual’s circumstances and the authority under which an intervention is undertaken.
Organisations must therefore ensure that their policies, training and operational practices reflect the legal requirements applicable to their services.
The risks associated with physical intervention
Even where restraint is necessary and lawful, it can present significant risks.
These may include physical injury, interference with breathing, psychological trauma and deterioration in an individual’s wellbeing.
NICE guidance highlights the importance of avoiding restraint methods that compromise an individual’s airway, breathing or circulation.
Healthcare professionals must understand the risks associated with restrictive practices, recognise signs of medical distress and follow appropriate emergency procedures.
Training must also address the importance of safeguarding, monitoring and documenting interventions appropriately.
The objective should always be to minimise harm while protecting everyone involved.
The NFPS Approach to Safer Physical Intervention
NFPS Ltd has been providing specialist training in physical intervention, conflict management and risk assessment since 1998, supporting professionals across healthcare, education, security and other sectors.
Its training approach combines practical skills with an understanding of legal responsibilities, human rights, risk management and the importance of preventing unnecessary restraint.
A key principle is that physical intervention should only be considered where necessary and legally justified, with appropriate attention given to de-escalation, proportionality and the safety of everyone involved.
NFPS also places emphasis on medically reviewed techniques, helping trainers and organisations understand and manage the risks associated with physical restraint.
For healthcare professionals, this reinforces an important principle: effective training must develop sound judgement and decision-making skills, not simply physical techniques.
The objective is to prevent unnecessary restraint while ensuring staff have the knowledge and skills to respond appropriately when intervention becomes necessary.
Learning from incidents and improving practice
Reducing restraint requires more than completing a training course.
Organisations should examine the circumstances surrounding incidents and identify opportunities for improvement.
Questions worth considering include:
Could early warning signs have been recognised sooner?
Were individual communication needs understood?
Were appropriate de-escalation strategies attempted?
Did environmental factors contribute to the incident?
Was any intervention necessary, proportionate and appropriately managed?
What could be done differently to reduce the likelihood of recurrence?
Incident reviews should encourage professional learning rather than simply allocate blame.
They should also consider the experiences of the individual involved, alongside those of staff.
By recognising patterns and addressing underlying causes, organisations can develop safer, more supportive environments.
Why professional training matters
Effective healthcare training should equip individuals with the knowledge and confidence to respond appropriately to challenging situations.
It should support an understanding of behaviour, communication, legal responsibilities, risk assessment and safer working practices.
Where physical intervention skills are required, they should form part of a wider programme focused on reducing restrictive practices.
Training must also be appropriate to the environment, individuals being supported and relevant organisational procedures.
At Frontline Training, we recognise the importance of developing practical knowledge and professional confidence while promoting safety, dignity and respect.
Our approach to training reflects the belief that prevention, effective communication and informed decision-making should be central to managing challenging situations.
Conclusion: Prevention before intervention
Restraint may sometimes be necessary to prevent serious harm, but its use should never be considered an ordinary or inevitable part of providing care.
A professional, person-centred approach requires healthcare organisations to invest in prevention, understand individual needs and equip staff with appropriate training.
The future of safer practice lies not simply in improving physical intervention skills, but in reducing the circumstances in which those interventions become necessary.
Ultimately, successful restraint training should not just help people restrain more safely. It should help them restrain less.