Restrictive Practices Under the NDIS

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Published: 09 September 2021

Content warning: Please be aware that this Article contains discussions related to abuse, which some people may find distressing.

‘They were just managing her. And they actually said that – “we don’t have a program for [daughter]. We are just managing her. We are maintaining her, containing her and restraining her. That’s all we do here.”’

‘They want us to have a normal home but they lock the doors. That’s not normal when you live at home.’

‘… There would be fifteen people standing around [her] taking it in turn to hold her down. And they would be doing it for up to an hour.’

(DHHS 2009)

The above quotes, which were included in the 2009 research report Experiences of Restrictive Practices: A View From People With Disabilities and Family Carers, detail real experiences faced by people living with disabilities, as told by care recipients and their families.

These are just a few of the many stories illustrating the potential harms of restrictive practices.

What are Restrictive Practices?

As part of their Zero Tolerance initiative, the NDS has released a series of seven films on restrictive practices. View them here.

Under the National Disability Insurance Scheme Act 2013, a restrictive practice is defined as ‘any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with disability’ (NDIS 2020a).

Escalating situations might require the use of regulated restrictive practices. The goal of restrictive practices is to prevent an emergency or protect the participant, as well as those around them, from severe behaviours that are potentially harmful (NDIS 2020a).

These behaviours are known as changed behaviours and are generally a signal that the person is experiencing stress, wants to communicate something or has an unmet need (DSA 2021).

Note: Changed behaviours are sometimes referred to as ‘behaviours of concern’ or ‘challenging behaviours'. However, the term 'changed behaviours' is preferred as it avoids negatively stigmatising people who display behaviours that indicate a need for support (DSA 2021).

Examples of changed behaviours that could pose a risk of harm to the participant or others include:

  • Breaking an object
  • Hitting or harming another person
  • Hitting or harming themselves
  • Yelling at another person
  • Attempting to flee.

(NDIS 2021; Disability Support Guide 2020)

While restrictive practices were once the first-line response to changed behaviours, this is no longer the case. Nowadays, restrictive practices are recognised as potentially harmful breaches of human rights (NDIS 2019a).

For this reason, restrictive practices must only be used if there are no other suitable options remaining, and for the shortest amount of time possible (NDIS 2020a).

A positive behaviour support plan that has been developed by an NDIS behaviour support practitioner and based on a behaviour support assessment that has been undertaken may include regulated restrictive practices if required (Disability Support Guide 2020; ACSA 2020).

A PBS plan that contains a restrictive practice should be reviewed at least every 12 months (Disability Support Guide 2020). Such inclusions must clearly identify any restrictive practices and include:

  • Plans for eliminating and reducing the use of the restrictive practice
  • Plans for monitoring and reviewing.

The requirements surrounding restrictive practices are outlined in two modules of the NDIS Practice Standards: Practice Standard Module 2: Specialist Behaviour Support and Practice Standard Module 2A: Implementing Behaviour Support Plans.

Types of Restrictive Practices

The National Disability Insurance Scheme (Restrictive Practices and Behaviour Support) Rules 2018 identifies five restrictive practices requiring regulation and oversight by the NDIS Commission. These are:

Seclusion Confining a person in a room or physical space by themselves (at any hour of the day or night) and preventing them from leaving voluntarily, or implying that they cannot leave voluntarily.
Chemical restraint Using medications or chemical substances to influence a person’s behaviour. This does not include medications that have been prescribed by a medical practitioner to treat a mental or physical condition.
Mechanical restraint Using devices such as gloves, helmets, straps and restrictive clothing to restrict a person’s movement, for the purpose of influencing their behaviour. This does not include devices used for therapeutic or non-behavioural purposes, e.g. a wheelchair.
Physical restraint Using physical force to prevent, restrict or subdue the movement of a person’s body, for the purpose of influencing their behaviour.
Environmental restraint Restricting a person’s free access to environments, items or activities.

(Adapted from NDIS 2020a, b)

mechanical restraint hand restraints
Mechanical restraint involves the use of devices to restrict a person’s movement, for the purpose of influencing their behaviour.

Prohibited Restrictive Practices

The following types of restrictive practice are prohibited:

  • Certain types of physical restraint that are associated with a high risk of injury and death, including:
    • Prone restraint (forcing a participant face-down)
    • Supine restraint (forcing a participant face-up)
    • Pinning a participant down
    • Basket holding (wrapping arms around a participant’s upper and/or lower body)
    • Takedown techniques (forcing a participant to fall to the floor)
    • Physically restraining a participant in a way that impairs respiratory or digestive functioning
    • Pushing a participant’s head forward onto their chest
    • Inflicting pain, hyperextending joints or putting pressure on the chest or joints
  • Using restrictive practices as punishment
  • Taking away basic needs or supports.

(NDIS 2020a; NDIS 2021)

When are Restrictive Practices Permitted?

Note: Restrictive practices are not authorised by the NDIS Commission; instead, providers must follow authorisation processes in accordance with their relevant state or territory’s legislation (NDIS 2020b).

There are strict conditions under which restrictive practices are permitted. All of the following requirements must be met in order for a restrictive practice to be used:

  • The restrictive practice is clearly identified in the participant’s behaviour support plan
  • The restrictive practice is authorised in accordance with processes set out in the relevant state or territory legislation
  • The restrictive practice is being used as a last resort in order to protect the participant or others from harm, and the provider has already considered and applied evidence-based, person-centred and proactive strategies
  • The restrictive practice being used is the least restrictive option possible, considering the circumstances
  • The restrictive practice is being used to decrease the risk of harm to the participant or others
  • The restrictive practice is proportionate to the potential negative consequences or harm
  • The restrictive practice is used for the shortest length of time possible.

(NDIS 2020a)

Issues Relating to Restrictive Practices

Restrictive practices can have severe consequences on the health and wellbeing of people living with disabilities (NDS 217).

They may:

  • Fail to properly address underlying behavioural factors
  • Cause new changed behaviours to arise
  • Trigger those who have a history of trauma or abuse
  • Cause trauma or psychological distress
  • Result in loss of dignity for the person being restrained
  • Limit a person’s personal freedom and ability to engage in daily activities
  • Decrease meaningful interactions with carers and support workers
  • Lead to an over-reliance on restrictive practices, causing the person to seek restraint or feel anxious without restraint.

(NDIS 2020a)

ndis participant looking sadly out of window

Misuse of Restrictive Practices

Restrictive practices should never be used:

  • Without proper authorisation
  • Without the knowledge that what is being performed is restrictive
  • For a prolonged period of time
  • Without regular reviews
  • For any reason other than keeping people safe
  • To control a person or make them act in a specific way
  • To abuse or neglect someone
  • To compensate for a lack of training or knowledge
  • Without considering less restrictive options.

(NDS 2017)

Unauthorised Restrictive Practices

Read: Incident Management: NDIS Provider Governance and Management

The unauthorised use of a restrictive practice is a reportable incident under the NDIS, meaning that the NDIS Commission must be notified if the unauthorised use of a restrictive practice occurs (NDIS 2019b).

A restrictive practice is unauthorised if at least one of the following is true:

  • The restrictive practice has not been authorised by the relevant state or territory legislation
  • The restrictive practice is used within a state or territory that does not have an authorisation process for that particular practice, and it is not being used in accordance with a behaviour support plan
  • The participant does not have a behaviour support plan or interim behaviour support plan
  • The restrictive practice is not included in the participant’s behaviour support plan or interim behaviour support plan
  • The restrictive practice is being used in a way that is inconsistent with the requirements or directions set out in the participant’s behaviour support plan.

(NDIS 2019b)

Any restrictive practice that results in serious injury to the participant is also a reportable incident that the NDIS Commission must be notified of (NDIS 2019b).

Reporting Requirements for Restrictive Practices

Providers using restrictive practices are required to make monthly reports to the NDIS Commission. This can be done through the NDIS Commission Portal (NDIS 2019a).

Additional Resources


References

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