What Would You Do safety - fear - choice.

This situation should be approached as a safeguarding, risk-management and person-centred care issue, rather than simply telling the resident to remove the furniture. The key question is: how can staff reduce the genuine risk created by barricading the door while respecting the resident’s fear, dignity, autonomy and right to feel safe?
What I would do
1. Validate the fear without validating the belief.
I would remain calm and say something such as:
“I can see that you are frightened, and I believe that you genuinely feel unsafe. I am not going to dismiss what you are experiencing. Let us work together to find a way for you to feel safe without putting you at greater risk.”
I would not tell her that the people she hears are definitely real, but equally I would not tell her that she is imagining things. Staff should acknowledge the distress rather than argue about the reality of the perception.
2. Establish the immediate risk
I would assess:
Is there an actual person in the property?
Is there evidence of an intruder or abuse?
Is the resident at immediate risk of harm?
Could the furniture prevent staff or emergency services from entering?
Could it obstruct evacuation in the event of a fire?
Is she at risk of falling or injuring herself while moving furniture?
Is this behaviour new or increasing?
Are there changes in medication, physical health, cognition, sleep, infection, pain, or mental wellbeing?
If there is a genuine immediate threat, emergency procedures should take priority.
3. Do not automatically remove the furniture
This is important.
Staff should not simply force the furniture away because they consider the behaviour unreasonable.
Under the Mental Capacity Act 2005, a person must be presumed to have capacity unless it is established otherwise. A person is also entitled to make a decision that others consider unwise. The MCA requires support to be given to enable the person to make the decision wherever possible.
Therefore, the first question should be:
Does the resident have capacity to decide whether to barricade her door?
Capacity is decision-specific, not a blanket judgement about the person.
4. If she lacks capacity, consider the MCA properly
If she lacks capacity regarding this particular decision, any decision made on her behalf must be in her best interests and must be the least restrictive option.
The MCA also places strict limits on restraint: where restraint is used, there must be a reasonable belief that it is necessary to prevent harm, and the response must be proportionate to the likelihood and seriousness of that harm.
Therefore, removing the furniture should not automatically be the first solution.
The team should consider:
“What is the least restrictive intervention that protects her from harm while maintaining her sense of security?”
5. Develop a safer alternative to the barricade
For example, staff could explore:
increased reassurance and observation at bedtime;
keeping the door closed but not physically barricaded;
a staff presence/check-in shortly after she settles;
an agreed night-time safety plan;
a personal alarm or call system;
checking the environment for genuine sources of noise;
reviewing lighting, shadows, neighbouring noise and other environmental triggers;
arranging a GP/mental-health review where appropriate;
reviewing medication for possible side effects or changes;
involving family/advocate where appropriate;
agreeing what staff will do when she believes somebody is in the property;
documenting triggers, time, presentation and what intervention helped.
The objective is to replace the function of the barricade, rather than simply remove the object.
6. Consider safeguarding
The repeated belief that someone is entering the property should not simply be dismissed as a mental-health issue.
Staff should establish whether there is any possibility of actual abuse, exploitation, harassment, domestic abuse, environmental danger or an unidentified person entering the property.
The Care Act 2014 statutory guidance states that safeguarding should promote the adult's wellbeing and that professionals should establish with the person what being safe means to them. It specifically emphasises empowerment, prevention, proportionality, protection and partnership.
That is particularly relevant here: “safety” should not be imposed on the resident without understanding what makes her feel unsafe.
7. Consider reasonable adjustments
If the behaviour is connected to a disability or mental-health-related difficulty, the Equality Act 2010 may also be relevant. Service providers may have duties to make reasonable adjustments where a disabled person would otherwise be placed at a substantial disadvantage.
The adjustment might not be “allow her to barricade the door.” It could instead be an alternative safety arrangement that recognises her particular needs.
8. Record and escalate
Every incident should be clearly documented:
what the resident reported;
what staff observed;
whether there was evidence of an intruder;
the resident's emotional state;
risks identified;
capacity considerations;
what alternatives were offered;
the resident's response;
what action was taken;
whether the manager/GP/social worker/mental-health professional was informed.
Because this is repeated behaviour, I would request a formal review involving the appropriate professionals rather than allowing individual carers to make different decisions each night.
The fundamental principle
The answer is not:
“She is frightened, therefore we must allow her to barricade the door.”
Nor is it:
“Barricading is dangerous, therefore staff must remove it.”
The professional approach is:
“I recognise that the barricade is currently serving a protective purpose for her. I need to understand that purpose, assess the actual risk, establish capacity where relevant, and work with her to find a safer and less restrictive way of achieving the same feeling of security.”
That approach is consistent with the Mental Capacity Act 2005, its Code of Practice, and the Care Act 2014 safeguarding principles, particularly empowerment, proportionality, prevention, protection and least restriction.

Eyitayo Lasaki

This situation should be approached as a safeguarding, risk-management and person-centred care issue, rather than simply telling the resident to remove the furniture. The key question is: how can staff reduce the genuine risk created by barricading the door while respecting the resident’s fear, dignity, autonomy and right to feel safe?
What I would do
1. Validate the fear without validating the belief.
I would remain calm and say something such as:
“I can see that you are frightened, and I believe that you genuinely feel unsafe. I am not going to dismiss what you are experiencing. Let us work together to find a way for you to feel safe without putting you at greater risk.”
I would not tell her that the people she hears are definitely real, but equally I would not tell her that she is imagining things. Staff should acknowledge the distress rather than argue about the reality of the perception.
2. Establish the immediate risk
I would assess:
Is there an actual person in the property?
Is there evidence of an intruder or abuse?
Is the resident at immediate risk of harm?
Could the furniture prevent staff or emergency services from entering?
Could it obstruct evacuation in the event of a fire?
Is she at risk of falling or injuring herself while moving furniture?
Is this behaviour new or increasing?
Are there changes in medication, physical health, cognition, sleep, infection, pain, or mental wellbeing?
If there is a genuine immediate threat, emergency procedures should take priority.
3. Do not automatically remove the furniture
This is important.
Staff should not simply force the furniture away because they consider the behaviour unreasonable.
Under the Mental Capacity Act 2005, a person must be presumed to have capacity unless it is established otherwise. A person is also entitled to make a decision that others consider unwise. The MCA requires support to be given to enable the person to make the decision wherever possible.
Therefore, the first question should be:
Does the resident have capacity to decide whether to barricade her door?
Capacity is decision-specific, not a blanket judgement about the person.
4. If she lacks capacity, consider the MCA properly
If she lacks capacity regarding this particular decision, any decision made on her behalf must be in her best interests and must be the least restrictive option.
The MCA also places strict limits on restraint: where restraint is used, there must be a reasonable belief that it is necessary to prevent harm, and the response must be proportionate to the likelihood and seriousness of that harm.
Therefore, removing the furniture should not automatically be the first solution.
The team should consider:
“What is the least restrictive intervention that protects her from harm while maintaining her sense of security?”
5. Develop a safer alternative to the barricade
For example, staff could explore:
increased reassurance and observation at bedtime;
keeping the door closed but not physically barricaded;
a staff presence/check-in shortly after she settles;
an agreed night-time safety plan;
a personal alarm or call system;
checking the environment for genuine sources of noise;
reviewing lighting, shadows, neighbouring noise and other environmental triggers;
arranging a GP/mental-health review where appropriate;
reviewing medication for possible side effects or changes;
involving family/advocate where appropriate;
agreeing what staff will do when she believes somebody is in the property;
documenting triggers, time, presentation and what intervention helped.
The objective is to replace the function of the barricade, rather than simply remove the object.
6. Consider safeguarding
The repeated belief that someone is entering the property should not simply be dismissed as a mental-health issue.
Staff should establish whether there is any possibility of actual abuse, exploitation, harassment, domestic abuse, environmental danger or an unidentified person entering the property.
The Care Act 2014 statutory guidance states that safeguarding should promote the adult's wellbeing and that professionals should establish with the person what being safe means to them. It specifically emphasises empowerment, prevention, proportionality, protection and partnership.
That is particularly relevant here: “safety” should not be imposed on the resident without understanding what makes her feel unsafe.
7. Consider reasonable adjustments
If the behaviour is connected to a disability or mental-health-related difficulty, the Equality Act 2010 may also be relevant. Service providers may have duties to make reasonable adjustments where a disabled person would otherwise be placed at a substantial disadvantage.
The adjustment might not be “allow her to barricade the door.” It could instead be an alternative safety arrangement that recognises her particular needs.
8. Record and escalate
Every incident should be clearly documented:
what the resident reported;
what staff observed;
whether there was evidence of an intruder;
the resident's emotional state;
risks identified;
capacity considerations;
what alternatives were offered;
the resident's response;
what action was taken;
whether the manager/GP/social worker/mental-health professional was informed.
Because this is repeated behaviour, I would request a formal review involving the appropriate professionals rather than allowing individual carers to make different decisions each night.
The fundamental principle
The answer is not:
“She is frightened, therefore we must allow her to barricade the door.”
Nor is it:
“Barricading is dangerous, therefore staff must remove it.”
The professional approach is:
“I recognise that the barricade is currently serving a protective purpose for her. I need to understand that purpose, assess the actual risk, establish capacity where relevant, and work with her to find a safer and less restrictive way of achieving the same feeling of security.”
That approach is consistent with the Mental Capacity Act 2005, its Code of Practice, and the Care Act 2014 safeguarding principles, particularly empowerment, proportionality, prevention, protection and least restriction.

Eyitayo Lasaki