By Tia Martin, Co-Founder & Director, PBS UK
In short: Restrictive practice is not only restraint or seclusion. It also includes everyday blanket rules, such as “staff don’t do hugs” or “no kitchen after 8pm”, that started as boundaries and quietly became restrictions. Positive Behaviour Support asks whether each rule is individual, necessary, proportionate and reviewed, and whether we would accept it in our own lives.
I am frequently reminded of the privilege that comes with being an unsupported person: I don’t rely too heavily on other people to make decisions about my life. I can make choices that other people think are unwise. I can spend too much money, stay up too late, eat something that isn’t good for me or trust the wrong person. I also get to make mistakes and move on from them, without a permanent record being created for every future acquaintance to read before they enter my home. People generally start from an assumption that I am capable. My worst days don’t typically precede me into a room. Sometimes, even when I don’t manage something particularly well the first time, I get to try again.
These things are so ordinary that it is easy not to recognise them as privileges at all. For many people who receive social care support, the balance can be reversed. Risk becomes something to eliminate rather than navigate. Previous mistakes become evidence of future incapacity. A decision made after one incident becomes a rule that lasts for years. Sometimes that rule spreads beyond the individual altogether and becomes part of “how we do things here”. And somewhere along the way, a boundary becomes a restriction.
What is restrictive practice?
Restrictive practice is any act, rule or arrangement that limits a person’s movement, liberty or freedom to act independently. The Department of Health’s Positive and Proactive Care guidance sets out that restrictive interventions should be a last resort, individualised and the least restrictive option available.
Most people picture physical restraint or seclusion. But restrictive practices in social care are often quieter and harder to see:
- Blanket rules that apply to everyone, whatever their individual needs
- Locked kitchens, rooms or cupboards
- Restricted access to the internet, a phone, money or belongings
- Rules about who people can touch, photograph or contact
- Routines set around staffing rather than around the person
This article is about that second, quieter kind.
PBS is about good lives, not safe compliance
Positive Behavioural Support (PBS) is fundamentally concerned with quality of life. Its starting point is a belief that people should have access to good lives: lives containing relationships, autonomy, meaningful activity, choice, belonging and opportunities to develop… but also mistakes. It is not a framework through which we minimise every possible risk or teach people to safely accept the boundaries we have constructed around them and yet, we’re increasingly needing to navigate this discussion. I understand this, because often services are under pressure to ‘do’ something about risk. However, guidance on PBS has explicitly recognised that environments characterised by institutional blanket rules, restricted access to preferred activities, insufficient positive social interaction and choices that are not offered or honoured can themselves contribute to behaviour that challenges.
Blanket restrictions: when a boundary becomes “how we do things here”
Restrictive practice does not always look dramatic. Sometimes it sounds entirely reasonable:
- “Staff don’t do hugs.”
- “Residents aren’t allowed photographs of staff.”
- “We don’t give out the Wi-Fi password.”
- “Nobody is allowed in the kitchen after 8pm.”
- “That’s just our policy.”
Each of these examples may have originated in a genuine attempt to keep somebody safe. But calling something a “boundary” does not automatically make it benign. We need to ask whose boundary it is, what risk it addresses, whether it is proportionate and whether we would accept an equivalent restriction in our own lives. Often, people might be unsure about where the boundaries actually came from at first. Over time, the restriction has become normalised until it just feels like part of how we do things here and, when asked, no-one necessarily knows where the restriction originated or how it aligns with a person’s best interests.
“Staff don’t do hugs”: professional boundaries or restrictive practice?
Take hugging as an example. Physical touch is, for many people, an important part of connection. We hug to greet one another, celebrate, comfort, reassure and say goodbye. Of course, not everybody likes hugs, and nobody should be expected to hug another person when they don’t want to, but that is precisely the point. The appropriate principle is consent, not prohibition.
Despite this we regularly encounter services where rules like “staff don’t hug” have become universally applied. Often there is a history behind it. Perhaps somebody has previously struggled to understand physical boundaries. Perhaps a hug became too intense, lasted too long or happened at an inappropriate time. The solution appears simple: no hugs, it sounds safe. What we often forget to do is consider how that looks from the other side.
A person is told that staff do not hug. Yet they can see perfectly well that staff do hug. Staff hug one another when they arrive at work. They hug when somebody is leaving. They hug on birthdays. If a colleague receives bad news, someone might put an arm around them without convening a multidisciplinary meeting to assess whether this represents an unacceptable blurring of professional boundaries. So the rule is not really: “Staff don’t hug.” It is: “Staff don’t hug you.”
Whatever our intention, we should be willing to consider what that communicates. To live in a world where other people visibly offer one another ordinary affection but consistently withdraw it from you risks communicating something powerful: you are different. Perhaps even: you are someone from whom other people need protecting. That is othering, and it is the opposite of neurodiversity-affirming practice.
Research examining touch in learning disability services has raised this tension. Collett (2023) describes how guidance around touch has historically been criticised for being risk-averse and control-orientated, potentially overlooking the social and communication needs of people with learning disabilities. The answer is clearly not boundaryless practice. Safeguarding, power imbalances and professional boundaries in care are all very important. But safeguarding cannot mean systematically removing the ordinary human experiences that make relationships meaningful.
Consent, not prohibition: what is okay for one person might not be okay for another
One concern that comes up repeatedly is “If I hug one person, everyone will expect me to hug them.” But we routinely expect people who do not receive support to understand that relationships differ. One friend might greet me with a hug. Another doesn’t like physical contact. One colleague might be comfortable discussing their family; another keeps their private life private. We navigate these differences throughout our lives. Yet when somebody has a learning disability, we can become strangely reluctant to believe they might learn the same thing. Instead of teaching discrimination, context and consent, we remove the opportunity entirely.
The important question is not “Do staff hug?”. It is “Does this person, in this context, want a hug, and does the other person want to give one?” Sometimes the answer will be yes. Sometimes it will be no. Both are okay. The useful skill is learning to ask, recognise another person’s answer and cope when that answer is different from the one we hoped for.
A personal boundary says: “I don’t want to be hugged.” A restriction says: “You aren’t allowed to hug people.” The first protects my autonomy and teaches consent. The second limits your freedom and places you in the ‘other’ category.
Positive risk taking: would I accept this in my own life?
Hugging is only one example. Think about internet access. A person makes an unsafe choice online, so their access is removed or they are subsequently allowed online only while somebody watches them. How many of us have clicked a dubious link, trusted the wrong person, bought something ridiculous, shared too much information or believed something online that wasn’t true?
We generally respond by learning. We change passwords, block somebody, learn about scams, adjust privacy settings or ask for advice. We don’t usually conclude that one poor decision demonstrates an enduring inability to use the internet. The same questions can be asked about photographs, relationships, food, money, going out alone, mobile phones, social media and countless other ordinary aspects of life. (We explore a related tension in balancing choice and broadening experiences.)
There may, of course, be circumstances where restrictions are necessary. Supporting someone to live a self-determined life does not require us to pretend risk doesn’t exist. But restrictions should be individualised, necessary, proportionate and reviewed. They should not become permanent because they are easier for an organisation to manage.
How blanket restrictions build a closed culture
The Care Quality Commission has identified blanket restrictions as a potential feature of closed cultures. That is important because restrictive cultures do not necessarily begin with somebody deciding to create one.
They accumulate. A rule is introduced after an incident. Another makes staffing easier. Something else becomes “policy”. Nobody quite remembers why another restriction exists, but removing it feels risky. Eventually a person’s life can become surrounded by rules that everyone can explain individually but nobody has stepped back to examine collectively.
Perhaps one of the simplest questions we can ask is: Would I accept this restriction in my own life?
If the answer is no, that doesn’t automatically mean the restriction is unjustified. People’s circumstances and risks differ. But it should make us stop and think.
Relationships are not an optional extra
PBS prioritises relationships (Price et al., 2026) because relationships are part of quality of life, not merely a vehicle through which we deliver interventions. People need to belong. They need to be known, liked, valued and missed. They need relationships in which interactions are not always instructional, therapeutic or concerned with risk.
There will always be some power imbalance in paid support. Pretending otherwise does not remove it. What we can do is continually examine how we use that power. Are we supporting someone to understand consent and context, or simply teaching them that other people’s “no” matters while theirs is negotiable? Are we helping someone develop the skills to navigate ordinary relationships, or protecting them from ever having the opportunity? Are we managing a genuine risk, or managing our own anxiety about risk? And are we supporting someone to have a life that we would recognise as a good life if it were our own?
Towards least restrictive practice and lives worth living
Safety, professionalism and safeguarding are all crucial considerations. But so are touch, relationships, autonomy, mistakes, learning and second chances. The goal cannot simply be to keep people safe within increasingly narrow lives. It must be to support people to live lives worth living, with the same messy combination of relationships, choices, risks, mistakes and human connection that the rest of us so easily take for granted.
Frequently asked questions
What is restrictive practice in social care?
Restrictive practice is anything that limits a person’s movement, liberty or freedom to act independently. It covers physical, chemical and mechanical restraint and seclusion, but also blanket rules, locked areas and restricted access to belongings, the internet or relationships.
What are blanket restrictions?
Blanket restrictions are rules applied to everyone in a service regardless of individual risk, such as fixed bedtimes, locked kitchens or a “no hugs” policy. Because they are not based on an individual assessment, they are rarely the least restrictive option.
Is a “no hugs” policy a professional boundary or restrictive practice?
A professional boundary in care is about consent and context for an individual relationship. A rule that no one in a service may ever be hugged, while staff hug each other, is a blanket restriction and can communicate that the person is “other”.
How do blanket restrictions relate to closed cultures?
The CQC treats blanket restrictions as a possible warning sign of a closed culture. Restrictive cultures usually build up one reasonable-sounding rule at a time, which is why every restriction needs a clear reason, an owner and a review date. Our free incident review guidance and recording templates can help teams look at the evidence behind a rule.
Reviewing restrictive practice in your service
If you would like help reviewing blanket rules and building least restrictive practice across a team or organisation, PBS UK works with care providers and social services providers to review restrictions, and offers positive behaviour support training for staff teams. Get in touch with our team to talk it through.
References
- Care Quality Commission (CQC). How CQC identifies and responds to closed cultures. CQC.
- Collett, J. (2023). Expressive touch in health and social care: A review of touch guidance to explore the extent to which social and communication needs of adults with learning disabilities are considered. British Journal of Learning Disabilities. https://doi.org/10.1111/bld.12523
- Department of Health (2014). Positive and Proactive Care: Reducing the Need for Restrictive Interventions. London: Department of Health.
- Gore, N.J. et al. (2013). Definition and scope for positive behavioural support. International Journal of Positive Behavioural Support, 3(2), 14-23.
- Price, H., Bishop, K., Cooper, A., Scott-Harman, S., Lyon, K., Amaranath, S., Middleton, E., Ridley, J., Severs, P. and Corbett, S. (2026). A practitioners’ definition of Positive Behaviour Support. Tizard Learning Disability Review, ahead-of-print. https://doi.org/10.1108/TLDR-09-2025-0037
