The care and control procedure is a formal, documented sequence of actions used to safely handle, restrain, and manage a person who poses a risk to themselves or others, commonly applied in healthcare, security, and custodial settings. It balances the duty to protect with the individual’s dignity and legal rights, and it must be followed exactly to minimize harm.
Background and Purpose
The term “care and control” emerged from institutional care practices, particularly in mental health and disability services, where physical intervention was historically used without clear guidelines. Over time, high-profile incidents and legal challenges led to stricter regulations. Today, the procedure is not about punishment—it is a last-resort response to prevent injury during a crisis. Its core purposes are to:
- Protect the individual from self-harm
- Protect staff, other patients, or the public
- Prevent damage to property
- Ensure any physical contact is proportionate and time-limited
In many jurisdictions, care and control is governed by mental health law, workplace safety standards, and human rights frameworks. For example, the UK’s Mental Health Act Code of Practice and the US’s CMS regulations both require that restrictive interventions be used only when less restrictive options have failed.
Key Principles and Legal Framework
Every care and control procedure must operate within a clear legal and ethical framework. The five core principles are:
- Least restrictive option—try verbal de-escalation first
- Proportionality—the force used must match the level of risk
- Duty of care—staff must act in the person’s best interest
- Human rights—respect dignity, privacy, and autonomy
- Accountability—all actions must be documented and reviewed
Legally, the procedure must be authorized by policy and, in some settings, by a medical order. For example, in a hospital, a doctor or senior nurse may need to approve the use of restraint. Unlawful or excessive force can lead to criminal charges, civil lawsuits, or professional disciplinary action.
Step-by-Step Procedure
A standard care and control procedure typically follows these steps, though exact details vary by organization:
- Risk assessment—quickly evaluate the situation, the person’s state, and environmental hazards.
- Verbal de-escalation—use a calm, non-threatening tone; offer choices; listen actively.
- Call for help—if the situation escalates, summon trained staff immediately.
- Team approach—ideally, at least two trained staff members are present; one acts as the lead communicator.
- Physical intervention—use approved holds or restraints (e.g., standing or seated holds) that avoid pressure on the neck, chest, or joints.
- Monitor the person—continuously check breathing, circulation, and level of distress. Watch for signs of distress like skin color changes or difficulty speaking.
- Release and debrief—as soon as the person is calm, release them. Then hold a debrief with staff and, if appropriate, the individual to review what happened and plan next steps.
Every step must be recorded in an incident report, including the time, duration, names of staff, and any injuries.
Common Problems and Misconceptions
A frequent misconception is that care and control is the same as seclusion or restraint used as punishment. In fact, seclusion (isolating a person in a locked room) is a separate, more restrictive intervention with its own rules. Another common problem is the use of prone restraint (lying face down), which is now banned or heavily restricted in many places because of the risk of positional asphyxia. Staff may also face the challenge of “restraint fatigue”—when physical holds are used too often because of understaffing or lack of training, leading to injury.
Another issue is documentation. Incomplete or vague records can lead to legal challenges. For example, if a staff member writes “patient became aggressive” without detailing the de-escalation attempts, the procedure may be deemed unjustified.
Training and Certification
Proper training is essential. Most organizations require staff to complete a certified course in care and control or physical intervention, such as the Mandt System or CPI (Crisis Prevention Institute) training. These courses typically cover:
- Verbal de-escalation techniques
- Safe physical holds and escapes
- Risk assessment and decision-making
- Legal and ethical considerations
- Post-incident support and documentation
Training must be refreshed regularly—often annually—to maintain certification. Untrained staff should never attempt physical intervention unless there is immediate danger and no one else is available.
Costs and Resources
Implementing a care and control procedure involves several costs:
- Training fees (per staff member, often $100–$300 per course)
- Staff time for training and refreshers
- Restraint equipment (e.g., soft cuffs, protective suits) if used
- Administrative time for documentation and review
- Legal and insurance expenses
These costs are often justified by reduced injuries, lower staff turnover, and fewer lawsuits. However, some organizations invest in prevention programs, such as trauma-informed care, which can reduce the need for physical interventions altogether.
Alternatives and Prevention
The best care and control procedure is one that is rarely needed. Evidence-based alternatives include:
- De-escalation training—teaches staff to defuse tension verbally
- Environmental design—creating calm, low-stimulation spaces
- Person-centered care plans—identifying triggers and early warning signs
- Trauma-informed approaches—understanding how past trauma affects behavior
- Medication review—ensuring the person’s condition is optimally managed
Many organizations now adopt a “positive behavior support” model, which focuses on teaching new skills and changing environments rather than reacting to crises.
Template
Incident Report – Care and Control
| Field | Details |
|---|---|
| Date and time | _________________________ |
| Location | _________________________ |
| Individual’s name (or ID) | _________________________ |
| Staff involved | _________________________ |
| Reason for intervention | _________________________ |
| De-escalation attempts | _________________________ |
| Type of physical intervention used | _________________________ |
| Duration of intervention | _________________________ |
| Monitoring notes | _________________________ |
| Injuries or incidents | _________________________ |
| Debrief completed? (Y/N) | _________________________ |
| Signature of lead staff | _________________________ |
Sample (fictional): Date: 12/03/2025, Time: 14:20, Location: Ward 3, Individual: J.S., Staff: Nurse A. Smith, Reason: Attempted to hit another patient, De-escalation: Spoke calmly for 5 minutes, Intervention: Standing hold for 2 minutes, Monitoring: No distress, Debrief: Yes.
Frequently Asked Questions
Is care and control the same as restraint?
Care and control is a broader concept that includes restraint as one possible component. Restraint refers specifically to physical, chemical, or mechanical methods that restrict a person’s movement. Care and control also includes verbal de-escalation, monitoring, and post-incident support.
Can I refuse to participate in a care and control procedure?
If you are a staff member, you generally cannot refuse if you are trained and the situation meets your organization’s criteria, because you have a duty of care. However, you should always follow your training and never use more force than necessary. If you are a patient or service user, you have the right to be involved in discussions about your care, but in an emergency, staff may act without your consent to prevent harm.
What is the difference between seclusion and care and control?
Seclusion is the involuntary confinement of a person alone in a room from which they cannot leave. It is a more restrictive intervention and usually requires stricter authorization and monitoring. Care and control typically involves staff being physically present and using holds or restraints, not isolating the person.
How long can a person be held in care and control?
There is no universal time limit, but the intervention must be as short as possible and reviewed continuously. Many policies require a reassessment every 5–10 minutes, and a doctor’s review within a certain period (e.g., 1 hour) if restraint continues. Prolonged restraint is a sign that the plan is not working.
What should I do after a care and control incident?
Immediately after ensuring safety, complete the incident report, offer support to the individual and staff, and hold a debrief. The debrief should discuss what happened, what worked, what didn’t, and how to prevent future incidents. It is also important to check for any physical injuries and seek medical attention if needed.
If you are dealing with a specific legal or medical situation, consult a qualified professional—this article is for general information only.