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Mental Capacity Act practice guidance

Part 14


[MCA section 6; Code of Practice 6.40 6.48]

The MCA allows the use of restraint – ‘the use or threat of force’ – if:

  • staff ‘reasonably believe’ it is necessary to use this restraint to prevent harm to the person (not to others)
  • it is a proportionate response to the likelihood or seriousness of that harm.

No restraint is allowed under MCA section 5 that would deprive someone of their liberty. Examples of restraint could be a locked door, taking someone’s arm to lead them away, distracting someone from what they wanted to do or a one off use of sedation.

It might be a proportionate response to give someone a sedating injection to enable them to co-operate with an x-ray, but not proportionate to sedate them daily to stop them shouting out. It might be proportionate to lead someone firmly to the car to take them into residential care, but not to do it regularly to take them to a day centre.

Limits of the use of restraint

Follow Principle 4: ‘An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done or made, in his best interest’. This means that any restraint can only be authorised if it addresses risks posed to the person who lacks capacity. If someone’s behaviour is posing risks to other people, MCA will not allow use of restraint. It may be necessary to consider use of the Mental Health Act or criminal justice procedures. Local restraint policies must be followed.

Restraint is also the term used to describe use of chemical, mechanical or physical means of controlling someone for a significant period of time. This is a more serious matter than the examples above.

Section 6 allows for the restriction of someone’s movement under MCA. It does not allow for depriving someone of their liberty. (Part 32: Deprivation of Liberty Safeguards) So restraint using physical force, using seclusion, mechanical restraints or the forcible use of sedating medication would not be authorised under MCA s6 as these may amount to depriving someone of their liberty.

There are serious risks involved in using restraint which might involve physical force, chemical restraint or any sort of control measure. If such measures are needed they can only be used by suitably trained staff, who must follow the correct restraint policy and procedures for their employer.

Patients on a mental health unit who need to be restrained may need to be considered under the Mental Health Act.

If you are unsure if someone is being deprived of their liberty discuss this with the local MCA or Deprivation of Liberty Safeguards Lead. (Part 32: Deprivation of Liberty Safeguards)