Laura Jane Smethurst describes how to ensure that restraint is used safely, ethically and as a last resort when handling difficult behaviour

There are about 1.14 million people in the UK who have a learning disability, of whom more than 20% have a co-morbid mental health issue (Cooper et al 2007) often resulting in the need for help from mental health services. Within inpatient services, physical interventions are frequently used if de-escalation techniques have failed during episodes of challenging behaviour. The effects and ethical issues of these physical interventions on people with learning disabilities are often overlooked. This article considers four ethical principles – respect for autonomy, non-maleficence, beneficence and justice – and how physical restraint breaches these principles. The author concludes that restraint practices cannot be removed altogether and makes five recommendations to ensure safer practice.