Restrictive Practices Under the NDIS
Published: 09 September 2021
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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.
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:
(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:
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.
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)
The following types of restrictive practice are prohibited:
(NDIS 2020a; NDIS 2021)
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:
(NDIS 2020a)
Restrictive practices can have severe consequences on the health and wellbeing of people living with disabilities (NDS 2017).
They may:
(NDIS 2020a)
Restrictive practices should never be used:
(NDS 2017)
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:
(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).
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).
Question 1 of 3
True or false: Restrictive practices are authorised by state and territory legislation rather than the NDIS Commission.