Restrictive practices or restrictive interventions are when clinicians or a health service prevent a patient doing what they want to do, in order to protect the patient or others or to promote recovery.
Restrictive practices are at times unavoidable when providing psychiatric care. There exist literature and policy frameworks that suggest that restrictive practices should be illegal or are avoidable. More commonly, restrictive practices are conflated with seclusion and restraint, which are examples of restrictive practices, but are neither the totality of restrictive practices or even clearly representative of the most extreme restrictive practices (for example, indefinite detention in a secure facility compared with an episode of seclusion).
Common aspirational attitudes and legislative approaches to restrictive practices fail to acknowledge the full spectrum of restrictive practices, and alienate clinicians who must engage with restrictive practices to ensure that patients are safe and to promote recovery. We aim to acknowledge the reality of the necessity of restrictive practices, to define them across a spectrum of interventions, and ultimately to promote an open dialogue between patients, clinicians and other stakeholders regarding these practices at an individual and organisational level. We believe that open disclosure promotes an environment where restrictive practices can be considered carefully on an individual basis; can be monitored appropriately; can close the gap between clinical theory and practice; promote the patient’s participation in decisions pertaining to them; and improve the therapeutic alliance.
We aim to follow the least restrictive practices that are appropriate to the care needs of the patient, and we acknowledge that this is dynamic and requires regular review.
Dr Lake and the team at the Roy Fagan Centre developed a framework for recognising and documenting restrictive practices in our local setting of an acute/subacute psychogeriatric facility. This document provides an interface for collaborating with the patient and their families, to promote less restrictive practices, and can be used to meet legislative requirements, for example the notification of guardians; clinical documentation; and mental health act reporting.