Why Restrictive Physical Interventions Should Be Used as a Last Resort

James Hourihan, Author

All professionals who work with people, from healthcare staff and social care workers to teachers, should know when, or if it is appropriate to use restrictive physical interventions (RPI). RPIs limit an individual’s movement or freedom with the intention to keep the person and those involved in a crisis situation safe – and not as a form of punishment or control.

However, due to their potentially coercive and restrictive nature, guidance from The Department of Health (2014, p.9) states that physical interventions should be used as a “last resort” only when all other alternatives have been exhausted, with the aim of developing a more positive organisational culture across health and care settings. 

When Should Restrictive Physical Interventions Be Used?

The Timian Programme advice is that RPIs should only be used if there is an immediate risk of harm to either themselves or another person. It is also important that the individual displaying challenging behaviours has been given an opportunity to de-escalate first. This may involve providing reassurance, allowing them space and time away from other people, or engaging them in distraction techniques such as introducing a new activity.

If these approaches do not work and critical situations become too volatile, then restrictive physical interventions (in accordance with best practice guidelines) can be considered as an option. 

However, there are also risks associated with these restrictive practices. In one study, physical intervention made clients more frustrated and caused them to re-experience past trauma, whereas staff found the use of PI upsetting, leading to feelings of guilt and self-reproach (Fish R, Culshaw E. The last resort? Staff and client perspectives on physical intervention. J Intellect Disabil. 2005 Jun). 

It is also worth noting that RPIs do not address underlying issues that may have caused challenging behaviour – so it is vital to ensure that suitable strategies are put in place to prevent similar occurrences from arising again in future.

The Benefits Of Non-Restrictive Interventions  

Wherever possible, it is best practice to avoid any form of restrictive intervention when working with vulnerable individuals and use non-restrictive strategies such as verbal support or de-escalation techniques. 

There are several key benefits of non-restrictive alternatives:

  • Help promote positive behaviour changes in individuals
  • Improve communication 
  • Build meaningful relationships between staff and service users/patients/students/clients etc.
  • Reduce anxiety levels
  • Ensure safety and respect of everyone at all times

In conclusion, while restrictive physical interventions may sometimes be necessary in potentially dangerous situations, always consider less-restrictive strategies before resorting to such measures. 

As positive behaviour management trainers, we understand how essential it is that staff understand different types of interventions, so that they can make informed decisions about what course of action is most suitable for each individual situation and achieve better outcomes. 

Get In Touch

If you’re looking to create a safe, supportive environment for your staff and the people they support, book one of our BILD Act Training Courses today to get started, or call 0800 987 4075 for more information 

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Further Reading From Timian