What Are Restrictive Practices?
Restrictive practices are methods used in some health and care settings to limit a person’s movement, decision-making, or freedom. They include physical restraint, seclusion (isolating someone from others), and the administration of medication without consent. These practices are typically used in mental health settings during crisis situations where there is a perceived significant risk of harm to the person or others. However, their use can lead to severe psychological harm and often raises ethical concerns.
Restrictive practices may be legal under the Mental Health Act, but that does not always mean they are ethically sound or beneficial. In many cases, these interventions can feel punitive rather than supportive, especially for autistic people or those with a learning disability. Healthcare professionals and mental health nurses must carefully weigh the need for safety with a person’s right to dignity, autonomy, and trauma-informed care. Growing awareness of the mental health impact of restrictive practices has led to a strong push across the sector to reduce their use and replace them with person-centred care and timely therapeutic interventions.
The Immediate Psychological Impact
The use of restrictive practices can trigger strong emotional reactions and leave lasting psychological harm. For many people in mental health settings, especially those already facing significant distress, being restrained, secluded, or medicated against their will can feel deeply violating. These experiences are not only disempowering—they can also create or intensify mental health challenges, making it harder for a person to engage with mental health services and receive the support they need. The immediate impact is often invisible but profound, setting the stage for long-term difficulties in recovery and connection.
Trauma and PTSD
Restrictive interventions can be deeply traumatic, especially for those with a history of abuse, neglect, or mental health conditions like post-traumatic stress disorder. The sudden loss of control, combined with physical or emotional pain, can mirror past traumas and re-traumatise a person in care. For some, even a single incident of physical restraint or seclusion can result in flashbacks, sleep disturbances, or severe psychological distress, further complicating recovery and eroding a sense of safety in care environments.
Anxiety and Fear
Experiencing or witnessing the use of restrictive practices can increase anxiety levels significantly. The fear of being restrained again, or seeing others go through it, can lead to hypervigilance and distrust. In many health and care settings, people may begin to associate mental healthcare with fear rather than support. This heightened state of anxiety often interferes with the effectiveness of trauma-informed care plans and discourages people from seeking help in future crises.
Loss of Trust
Trust is essential for therapeutic relationships, yet restrictive practices can damage it instantly. When a person is restrained or medicated against their will, it can feel like a betrayal, especially if it comes from someone they believed was there to help. This loss of trust can lead to withdrawal, refusal to engage with mental health nurses or psychiatric nurses, and resistance to future mental health services. For many, rebuilding that trust takes time, patience, and a genuinely person-centred and supportive environment.
Impact on People’s Dignity and Autonomy
Restrictive practices can strip away a person’s sense of dignity and autonomy in deeply personal ways. When someone is subjected to physical restraint, secluded from others, or given medication without consent, their ability to make choices about their own body and well-being is removed. In mental health settings, where people are already navigating complex emotional experiences, this loss of control can feel dehumanising. It conveys that their voice doesn’t matter, undermining confidence, self-worth, and the therapeutic process.
For people with a learning disability or those who are non-verbal or autistic, the use of restrictive practices can be especially damaging, as it often ignores the importance of communication, routine, and predictability in creating a positive environment. Repeated restrictions, even when well-intentioned, can result in serious harm to a person’s mental health and emotional well-being. Upholding people’s human rights, preserving autonomy, and offering emotional support through trauma-informed care are ethical responsibilities and fundamental to delivering person-centred care in healthcare settings.
Long-Term Mental Health Consequences
The long-term mental health impact of restrictive practices can extend far beyond the moment of intervention. While such measures are often used to manage immediate risk, they can create deeper, more enduring psychological wounds. For many, the experience becomes embedded in memory, influencing how they relate to mental health services, healthcare professionals, and even their own sense of self. Without timely therapeutic interventions and a supportive environment, these effects can lead to a cycle of distress, disengagement, and further crisis.
Depression and Low Self-Esteem
Being subjected to restrictive practices can contribute to long-term feelings of worthlessness and hopelessness, particularly when the experience is repeated or inadequately explained. People may begin to internalise these interventions as a reflection of their value or ability to cope, resulting in low self-esteem and depression. This can be especially pronounced in settings where person-centred care is lacking, and where people are not given the emotional space to process what has happened to them.
Increased Occurrences of Mental Health Crises
Rather than reducing risk over time, restrictive interventions can increase the likelihood of further mental health crises. When a person does not feel safe or supported in their environment, they may be more likely to escalate into distress or self-harm, leading to a vicious cycle of intervention and re-traumatisation. The absence of trauma-informed care plans or positive cultures in some mental health settings only amplifies this cycle, leaving people without the tools they need to manage their experiences constructively.
Worsening of Existing Mental Health Conditions
For those already diagnosed with complex mental health conditions, the use of restrictive practices can make symptoms worse. People may develop heightened symptoms of anxiety, paranoia, or post-traumatic stress disorder, particularly if their autonomy has been repeatedly undermined. Without responsible person oversight and careful attention to ethical considerations, such practices can directly contribute to the deterioration of a person’s mental well-being over time.
Social Isolation and Loneliness
Experiencing restrictive interventions can also affect how people relate to others. Feelings of shame, mistrust, and emotional withdrawal often follow, making it difficult to reconnect with peers, families, or support networks. This usually leads to social isolation and loneliness, compounding a person’s vulnerability. This isolation not only hinders recovery but can also place a person at significant risk of future mental health deterioration, especially in the absence of community-based emotional support and person-centred planning.
Human Rights and Push for Policy Changes and Reforms
Restrictive practices raise critical concerns around people’s human rights, particularly the right to dignity, freedom, and autonomy. In many cases, these interventions occur under conditions that would not be considered ethically sound circumstances outside of mental health or health and care settings. For autistic people, those with a learning disability, or people experiencing acute mental health challenges, being restrained or secluded can feel like punishment rather than care. When this becomes routine rather than a last resort, it reflects a systemic failure to uphold the standards of ethical mental health practice.
There is increasing recognition across the sector that restrictive interventions should only ever be used when necessary, for the shortest possible time, and with apparent oversight by a responsible person. This shift is reflected in ongoing efforts to revise the Mental Health Act and align practices with the principles of trauma-informed care, person-centred support, and the least restrictive option. Campaigners, professionals, and people with lived experience have been at the forefront of these reforms, calling for better safeguards and cultures within mental health services that truly prioritise the rights and voices of the people they support.
Policy reform alone is not enough. The fundamental transformation lies in promoting positive environments, empowering healthcare professionals through training in trauma-informed care plans, and embedding reflective, person-centred care into everyday mental healthcare delivery. This includes giving mental health nurses, psychiatric nurses, and all staff in healthcare settings the resources and confidence to de-escalate situations without defaulting to restriction.
Nurseline Community Services Advocates for Reducing Restrictive Practices
At Nurseline Community Services, we are committed to reducing restrictive practices by creating safe, therapeutic environments rooted in trauma-informed care and person-centred support. Our approach focuses on proactive strategies that prevent crisis escalation and avoid the need for restrictive interventions altogether. Working alongside mental health nurses, psychiatric nurses, and a dedicated multidisciplinary team, we help people feel seen, heard, and supported—especially during the most vulnerable moments of their care journey.
We believe that supporting someone’s mental health should never come at the cost of their dignity or autonomy. That’s why we advocate for alternatives grounded in timely therapeutic interventions, positive environments, and a deep understanding of how past trauma, systemic barriers, and unmet needs shape mental health challenges.
Through our work, we aim to promote positive cultures in mental health services, protect people’s human rights, and ensure that every person receives care in a way that is ethical, compassionate, and free from harm.
