Physical intervention

If a situation presents imminent or grave danger, staff may need to take immediate action, including physical intervention.

What is physical intervention?

The purpose of physical intervention is to take immediate control of a dangerous situation, in order to end or significantly reduce the risk of harm to the person and others around them. Physical intervention involves some form of physical contact and application of force to guide, restrict or prevent movement. This can include touching, guiding or escorting all the way up to holding, chemical or mechanical restraint and seclusion.

Any form of physical intervention must always be:

    • Reasonable, necessary and proportionate
    • Conducted by appropriately trained and competent staff
    • Combined with strategies to continuously de-escalate
    • The least restrictive possible
    • For the minimum amount of time
    • Continually monitored for signs of medical/physical distress in the patient
    • Formally recorded as soon as possible after the event.

Risks of inappropriate physical intervention

There are serious risks in the inappropriate use or poor application of physical intervention, even where it only involves what is thought of as minimal force. For example, when used against a vulnerable person (for example an older person), something as seemingly harmless as holding a wrist may lead to serious injuries such as bruising, skin tears and fractures.

When it should be considered

Physical interventions should be considered in an emergency situation: where there is immediately apparent risk to the health, safety and wellbeing of the patient or service user, staff or third parties.

A rapid assessment of risk should be carried out before any decision is made for physical intervention, and the rationale for all actions should be recorded. In an emergency situation, the recording can be made retrospectively.

This risk assessment should include an immediate judgment as to whether the patient or service user has an acute illness which could be potentially life threatening and must receive urgent attention. In this case, emergency physical intervention may be essential in order for a clinical procedure to take place.

In emergency situations, staff may need to take immediate action to prevent harm. Not to act in these circumstances could constitute a breach of their duty of care under common law.

Using ‘reasonable force’

There is no legal definition of reasonable force, but the factors to be considered are proportionality, necessity and reasonableness. All staff undertaking physical interventions must understand the law on the use of reasonable force during a physical intervention and what actions are justifiable.

Assessing mental capacity

According to the Mental Capacity Act 2005 (MCA), staff must presume the individual has capacity unless there is a good reason to suspect it is lacking – for example if someone is behaving oddly or dangerously. If there is reason to believe that capacity is lacking, there might be a need for an MCA assessment. A physical intervention may be acceptable if the person lacks capacity and the decision is made in their best interest

However, in an emergency situation a full assessment may be impractical and staff should not wait to take action. As long as an action can be justified on the grounds that it was necessary to preserve health or life and proportionate to the risk, and that there was reason to suspect capacity was lacking, then it is appropriate and legal. A retrospective assessment should then be completed once the situation is under control.

Roles and responsibilities

An organisation’s physical intervention policy should state who is and is not permitted to do what; who is responsible for decision-making; and who should take the lead. It should outline a process for planning and undertaking physical interventions, highlight the risks of harm (e.g. positional asphyxia), and explain the need for constant physical monitoring, post-incident support and debriefing. Safety considerations include the designation of appropriate areas or rooms to enable de-escalation, observation and physical interventions.

Staff who have not been specially trained should not be involved in the application of restrictive physical interventions. Organisations should periodically review staffing levels to ensure that adequate numbers of trained, competent staff are available at all times to safely manage a situation. Finally, organisations need to centrally record and analyse restraint incidents, to help avoid the inappropriate use of restraint, reduce levels of restraint and develop new, safer techniques.

National standards and guidance

Any application of physical intervention must comply with the relevant national standards:

National standards on physical restraint and deprivation of liberty
Mental Capacity Act Code of Practice
Deprivation of Liberty Safeguards from the Mental Capacity Act 2005 (as amended by the Mental Health Act 2007)

Guidance relating to specific sectors is also available from a number of stakeholders.

More information about physical intervention can be found in the full guidance document.