Any restriction has to be the least you can do, for the shortest time.
What counts as restraint and use of force?
The Use of Force Act defines four kinds of force (s1(6), (7)). The Code calls them restrictive interventions. These are deliberate acts that restrict a patient's movement, liberty or freedom to act, to take control of a dangerous situation and reduce the danger (Code 26.36).
- Physical restraint. Physical contact intended to prevent, restrict or subdue movement of any part of the body. Holding someone to give a depot injection counts (Use of Force guidance).
- Mechanical restraint. A device intended to prevent, restrict or subdue movement, used mainly for behavioural control.
- Chemical restraint. Medication intended to prevent, restrict or subdue movement, including rapid tranquillisation.
- Isolation. Any seclusion or segregation imposed on a patient.
The legal tests for any restraint
- Necessary. Only to prevent harm, and for no longer than necessary (Code 26.37).
- Proportionate. In proportion to the harm, and the least restrictive option (Code 26.37).
- Never punishment. Not to punish, and not to cause pain, suffering or humiliation. No deliberate pain to force compliance, except to deal with an immediate risk to life (Code 26.36, 26.41, 26.62).
- Human rights. Restraint that isn't medically necessary may breach article 3, and lesser intrusions can still breach article 8 (Code 26.47, 26.48).
- Planned where possible. Where risk is known, plan any restriction in advance in the positive behaviour support plan (Code 26.38).
What is the Mental Health Units (Use of Force) Act 2018?
It's often called Seni's law, after Olaseni Lewis, who died following the use of force in a mental health unit. Most of it came into force on 31 March 2022. The police body camera duty followed on 18 August 2022.
It applies to mental health units in England, in the NHS and in independent hospitals providing NHS-funded care. It covers everyone there for assessment or treatment of mental disorder, detained or informal, of any age (s1; guidance). Emergency departments, s136 suites outside a unit, outpatient clinics and transport vehicles are outside it (guidance).
What the Use of Force Act requires
- A responsible person. One per provider, covering all its units: a permanent, board-level member of staff, such as the chief nurse or medical director (s2; guidance).
- A use-of-force policy. Published after consultation, setting out the steps to reduce force, and reviewed every year (s3; guidance).
- Information for patients. About their rights around the use of force, given soon after admission unless they refuse it (s4).
- Training. Covering de-escalation, trauma, the risks and impact of force, discrimination, and the legal and ethical issues, with refreshers at least yearly (s5; guidance).
- Records. Every use of force that isn't negligible, with the reason, type, duration, staff involved, the patient's characteristics and the outcome. Records are kept for three years (s6).
- Deaths and serious injuries. Investigated with regard to the relevant guidance (s9).
- Police body cameras. Officers called to help in a unit must wear one and keep it recording, where reasonably practicable (s12).
When is force negligible?
Negligible force is exempt from the full record (s6(2)), but the guidance keeps the category narrow. It must be light or gentle, the minimum needed for care, written into the care plan, and consented to or in the person's best interests. It should still be recorded proportionately. The guidance's example is a flat, non-gripping guiding hand the person could reject at any time.
- Never negligible. Rapid tranquillisation, any mechanical restraint, and force the patient resists or anyone complains about.
- Also never. Force that causes any injury, even a scratch or bruise, uses more staff than the care plan allows, leaves the patient upset, or removes clothing or belongings.
If you're unsure, ask someone more senior. If there's still doubt, record it (guidance).
Physical restraint: the rules
- Protect the airway. Never restrain in a way that affects airway, breathing or circulation. Never cover the mouth or nose, and put no pressure on the neck, rib cage or abdomen (Code 26.70).
- No planned prone restraint. Unless there are cogent reasons, never deliberately hold someone face down, on any surface (Code 26.70).
- Monitor throughout. One member of staff watches airway and vital signs, with resuscitation equipment to hand (Code 26.71).
- Trained techniques only. Use only methods you've been trained in, and keep talking to de-escalate throughout (Code 26.65, 26.66).
- Record it. The decision, the reasons, how it was done and the patient's response (Code 26.72).
Rapid tranquillisation
- What it's for. Calming or light sedation to reduce risk, when other approaches have failed. It's a short-term measure, distinct from treating the illness (Code 26.91 to 26.93).
- Oral first. Always consider oral medication before an injection (Code 26.94).
- Prescribe carefully. Follow NICE guidance (NG10) and your trust policy. State the monitoring needed and, for an injection, the preferred site, so prone restraint isn't needed (Code 26.95 to 26.98).
- Legal authority. Restraint to inject needs authority under the or the . Never give rapid tranquillisation to an informal patient who has capacity and refuses (Code 26.99).
- Past three months. For a detained patient, the drugs must be on the T2 or T3, unless section 62 applies (Code 25.18, 26.95).
- Not a staffing tool. Never use it instead of adequate staffing (Code 26.102).
Seclusion and long-term segregation
Seclusion is supervised confinement away from other patients, to contain severe disturbance likely to harm others. Calling it something else doesn't change what it is (Code 26.103, 26.104). Use it only for detained patients, never as punishment, for staff shortages, or solely to manage self-harm. If an informal patient needs it, assess for detention at once (Code 26.106 to 26.108).
| Seclusion | Long-term segregation | |
|---|---|---|
| Monitoring | Within sight and sound at all times, a record every 15 minutes, and a review by two nurses every 2 hours | A written record at least hourly |
| Medical or AC review | Within an hour unless a psychiatrist authorised it, every 4 hours until the first MDT review, then at least twice a day | By an at least once every 24 hours |
| MDT review | As soon as practicable, then every 24 hours | At least weekly, including the |
| Independent review | After 8 hours continuous, or 12 hours intermittent within 48 hours | By an external hospital every 3 months, once it reaches 3 months |
Long-term segregation is for a sustained risk to others that's a constant feature of the presentation. An MDT and the commissioner decide on it, and the treatment plan should aim to end it (Code 26.150 to 26.156).
Mechanical restraint
Mechanical restraint is only for exceptional cases, where other restriction can't be used safely, and never instead of adequate staffing (Code 26.76). It should be agreed in advance by the MDT, with an IMHA if the patient has one, and written into the positive behaviour support plan (Code 26.77).
The patient stays under continuous observation, with a nurse review every 15 minutes, a doctor's review an hour in, and then at least every 4 hours (Code 26.80 to 26.82). Never tie anyone to part of a building or its fixtures (Code 26.85).
Restraint outside the Mental Health Act: the MCA
For someone who isn't detained and lacks capacity, the Mental Capacity Act allows restraint only if you reasonably believe it's necessary to prevent harm to them. It must also be proportionate to the likelihood and seriousness of that harm (MCA s6(1) to (3)).
Restraint includes using or threatening force against resistance, and restricting movement whether or not they resist (MCA s6(4)). It can't stretch to a deprivation of liberty, which needs or the Court of Protection (MCA s4A). Since the Supreme Court's judgment in June 2026, whether restrictions amount to one is judged on all the circumstances. See deprivation of liberty.
For an informal patient who needs restraining, consider whether the MCA applies, or whether a holding power and an assessment for detention are needed (Code 26.73).
After an incident
- Debrief. Offer a post-incident review to everyone involved, the patient included, for support and learning (Code 26.167).
- Listen rather than justify. Explore what helped and what didn't. Simply defending the decision can be counterproductive (Code 26.169).
- Update the plan. Record their account, review the positive behaviour support plan, and remind them they can make an advance statement about future restraint (Code 26.170).
- Concerns. Tell them how to complain and reach advocacy. The safeguarding lead should be told whenever a patient raises concerns about restraint (Code 26.171).
The rules in brief
- The Code (chapter 26) expects restrictive interventions to be necessary, proportionate and as brief as possible, with a plan to reduce them.
- The Mental Health Units (Use of Force) Act 2018 requires each unit to have a responsible person, a use-of-force policy, patient information and staff training. Every use of force that isn't negligible must be recorded.
- Seclusion and long-term segregation have their own review timetables in the Code.
- Rapid tranquillisation follows your trust policy and NICE.
- Outside the MHA, restraint under the MCA must be needed to prevent harm to the person and proportionate to it (s6).
Read more: MHA Code of Practice 2015, chapter 26: Safe and therapeutic responses to behavioural disturbance · Mental Health Units (Use of Force) Act 2018 - statutory guidance 2021
Questions trainees ask
What does the Use of Force Act require?
Each mental health unit needs a responsible person, a use-of-force policy, information for patients and staff training, and must record every use of force that isn't negligible.
What is Seni's law?
It's the common name for the Mental Health Units (Use of Force) Act 2018, after Olaseni Lewis, who died following the use of force in a mental health unit. Most of it has been in force since 31 March 2022.
What is chemical restraint in mental health?
Medication intended to prevent, restrict or subdue movement of the body, such as rapid tranquillisation. It counts as use of force under the 2018 Act, and rapid tranquillisation is never treated as negligible.
What is mechanical restraint in mental health?
A device used to prevent, restrict or subdue movement, mainly for behavioural control. The Code allows it only exceptionally, with MDT agreement, continuous observation and regular medical review.
Is prone restraint allowed?
Not as a planned technique. The Code says there must be no planned or intentional face-down restraint on any surface unless there are cogent reasons.
Can informal patients be restrained?
Only with lawful authority, such as the for someone who lacks capacity, and only when necessary and proportionate. Seclusion is for detained patients, so an informal patient who needs it should be assessed for detention.
Does the Use of Force Act apply in A&E?
No. The statutory guidance puts emergency departments, s136 suites outside a mental health unit, outpatient clinics and transport vehicles outside it.
What does section 12 of the Use of Force Act say?
Police officers called to help staff in a mental health unit must take a body camera and keep it recording, where reasonably practicable. A failure doesn't of itself make them liable, but courts take it into account.
Test yourself
Quick-fire
The duty to record use of force on mental health units comes from
Show the answer
The Use of Force Act 2018