Clinical Scorecard: A Longitudinal Study on the Use of Restrictive Interventions Among Women with Mental Health Disorders, Learning Disabilities, or Autism in England's Mental Health Services

At a Glance

Key Highlights

• Rates of restrictive interventions involving women increased by approximately 12% per year from 2017 to 2025.
• Increases were most pronounced for chemical restraint, seclusion, and segregation; physical and mechanical restraint rates remained stable.
• Restrictive interventions declined among women under 18 but increased across all adult age groups, indicating widening age-related divergence.

Guideline-Based Recommendations

Diagnosis

• Recognize the heightened risks of re-traumatisation and stigma associated with restrictive interventions among women.
• Consider gendered and intersectional factors when assessing risk and need for restrictive interventions.

Management

• Prioritize least-restrictive and trauma-informed care approaches in clinical practice.
• Legislative frameworks alone are insufficient; operational changes in clinical practice and organizational culture are necessary to reduce restrictive interventions.
• Implement coordinated, rights-based strategies to minimize use of restrictive interventions.

Monitoring & Follow-up

• Mandate recording and publication of restrictive intervention data to improve transparency and accountability.
• Use gender-disaggregated data to monitor trends and inform policy and practice.
• Develop comparable monitoring systems internationally to support research and reduction efforts.

Risks

• Restrictive interventions carry substantial psychological and physical harm risks, especially for women with histories of interpersonal trauma or sexual violence.
• Use of restrictive interventions can re-enact past trauma, undermining trust, recovery, and engagement with services.
• Under-reporting and weak transparency mechanisms impede accountability and obscure gendered impacts.

Patient & Prescribing Data

Women detained under the Mental Health Act with mental health disorders, learning disabilities, or autism

Chemical restraint use has increased significantly, highlighting the need for careful consideration of pharmacological interventions within restrictive practices.

Clinical Best Practices

• Adopt trauma-informed care principles to minimize re-traumatisation during restrictive interventions.
• Engage in continuous staff training to shift organizational culture towards least-restrictive practices.
• Incorporate gender-sensitive approaches in care planning and intervention decisions.
• Use data-driven monitoring to identify trends and target interventions effectively.
• Collaborate across services to address the complex needs of women with intersecting vulnerabilities.

References

• Mental Health Units (Use of Force) Act 2018 (Seni’s Law)
• Equality Act 2010
• UN Convention on the Rights of Persons with Disabilities