Restrictive Interventions in Inpatient Intellectual Disability Services: How to Record, Monitor and Regulate

This report is concerned with the standards of recording, monitoring, and regulation of restrictive interventions involving people with intellectual disabilities with mental health and/or behaviour that challenges within inpatient services. Restrictive interventions, a central concern for all stakeholders of intellectual disability services, has come under increased scrutiny following the abuse scandal at Winterbourne View. Current efforts to monitor them rely almost exclusively on the numbers of such incidents. This approach is fundamentally flawed because numbers alone do not assess the quality of a services’ overall restrictive interventions practice and cannot be used to infer good or poor standards of practice and abuse. Further, there are problems with the variable use of definitions, the failure to distinguish between various degrees of physical restraint, the impact of outliers, the failure to capture individual patient progress and the absence of meaningful benchmarking. Service providers and regulators must therefore rely on other methods to evaluate the use of restrictive interventions and move from basing their conclusions on just the total number of restrictive interventions to one of examining a wider range of quality parameters. With representative examples, this document makes recommendations on how restrictive interventions should be recorded, monitored, regulated and published.