Reducing restrictive practice in adult services: not only an issue for mental health professionals

Reducing 'restrictive practices' is an issue of national importance, pertinent to all NHS sectors, yet there is poor awareness of the issue in mainstream adult services. Such practices potentially restrict a person's rights to choice, self-determination, privacy and freedom. Challenging behaviour is often the result of unmet needs, communication difficulties or diagnostic overshadowing, but there is a common misconception that patients exhibit such behaviours because of their impaired intellectual abilities or mental health problems. This article seeks to raise awareness of restrictive practices and suggest the way forward. It highlights the importance of good de-escalation skills, which, if adopted early in therapeutic relationships, may help reduce the occurrence of challenging behaviours and situations. Behavioural support plans that adopt a biopsychopharmacosocial approach (BPPS) detail a range of interventions for managing challenging behaviours. Tailored support that follows a BPPS approach could reduce incidents of challenging behaviour, reduce costly observation, improve the patient experience and protect the patient's liberty.