Restrictive practice, capacity, consent, and advocacy

Safeguarding overlaps with restrictive practice, mental capacity, consent, and advocacy. Restraint that is unnecessary or disproportionate can be abuse. So can controlling care that ignores the person's rights, uses force for staff convenience, or restricts liberty without lawful authority.

In England and Wales, staff must work within the Mental Capacity Act 2005 when a person may lack capacity for a particular decision. Capacity is decision-specific; a person with capacity may make an unwise decision. Lacking capacity for one decision does not remove the duty to involve the person where possible or to respect their dignity, wishes, feelings and values.

When care arrangements amount to a deprivation of liberty in a care home, there must be lawful authority. In England and Wales care homes continue to use Deprivation of Liberty Safeguards arrangements. Scotland and Northern Ireland operate under different legal frameworks, so follow local law and policy there.

Advocacy is an important safeguard. Some adults need support to understand what is happening, to express their wishes, or to take part in a safeguarding enquiry. Family involvement does not always remove the need for independent advocacy or other communication support.

Safeguarding risks in restrictive practice

• Using restraint for staff convenience rather than because of a genuine risk.
• Removing a call bell, mobility aid or communication aid to make care easier.
• Using medicines to control behaviour without proper authority and review.
• Dismissing the adult's views because they lack capacity for one particular decision.

Restriction can be abuse when it is unnecessary, disproportionate, unlawful, or used for staff convenience rather than the person's safety and rights.