Restrictive practice and the NDIS

Key points:

• A restrictive practice is any type of support or practice that limits a person with disability and their rights or freedom of movement
• The use of restrictive practices is controlled by regulations at Federal and State and Territory levels
• Legislation for the authorisation of restrictive practice is different in each State and Territory.

What is a restrictive practice?

A restrictive practice is any type of support or practice that limits a person with disability and their freedom of movement or their rights, for example when a person with disability is being left in a room and unable to leave, over-medicated or intimidated to make them do something.

It is typically used to stop someone from displaying concerning or challenging behaviours, for example hurting another person or themselves, breaking furniture, or running away.

The use of restrictive practices is controlled by rules and regulations at Federal and State and Territory levels.

These regulations outline the use of restrictive practice, requirements for providers, and what is and is not allowed. This is to ensure the safety and wellbeing of a person with disability.

Regulated restrictive practice

There are a number of different types of restrictive practices that are allowed to be used in Australia.

The NDIS (National Disability Insurance Scheme) National Quality and Safeguards Commission (NQSC) regulates the use of restrictive practice for all services available through the NDIS.

The types of restrictive practices used and regulated in Australia include:

• Seclusion: Seclusion is the confinement of a person with a disability to a room or physical space. Usually, this will mean that the movement of a person will be restricted and they are not able to voluntarily leave.
• Chemical restraint: Chemical restraint is the use of medications or chemical substances in order to influence behaviour. Chemical restraints include the use of sedatives and anti-anxiety drugs. Chemical restraint does not include medication prescribed by a doctor for the treatment of a diagnosed mental disorder, physical illness or physical condition.
• Mechanical restraint: Mechanical restraint is the use of a device that prevents, restricts, or subdues movement. This includes things like padded gloves or waist straps. It does not include devices used for therapeutic or non-behavioural purposes.
• Physical restraint: Physical restraint is the use of physical force to prevent or restrict a person’s body or a part of their body. This may include holding somebody’s arms or other limbs. It does not cover the use of a hands-on technique to guide or redirect a person away from potential harm or injury.
• Environmental restraint: Environmental restraint is the restriction of a person’s free access to all parts of their environment, including items or activities. 

Behaviour support plans

Behaviour support plans are designed to help carers and providers understand and manage challenging behaviours in a positive way, they also aim to reduce and eliminate the use of restrictive practices by creating alternative behaviour management strategies.

The plan is developed in consultation with the person living with disability but also with input from their carers, family, and other support people.

According to the NQSC, a behaviour support plan will support a person through ‘evidence-informed, person-centred’ strategies reflected in the plan.

The goal of a behaviour support plan is to assist in building alternative positive behaviours to reduce and eliminate restrictive practices.

However, a behaviour support plan may still need to include the use of regulated restrictive practices in some cases and circumstances.

The NDIS Restrictive Practices and Behaviour Support Rules specify that any use of restrictive practices must be:

• Used only as a last resort in response to a risk of harm to the person with disability or others
• Authorised per State or Territory legislation or policy requirements
• In proportion to the risk of harm
• Used only for the shortest possible time

It is recommended by the NQSC that, at a minimum, any behaviour support plan that contains a regulated restrictive practice be reviewed every 12 months, or earlier if the participant’s circumstances change.

Authorisations to use restrictive practice

There are strict rules and regulations around the use of restrictive practices.

The NDIS Quality and Safeguarding Framework includes that only registered NDIS providers can deliver specialist behaviour support services and use restrictive practices.

It is managed by the National Disability Insurance Agency (NDIA).

Providers need to have the correct authorisation before using restrictive practices and they need to understand the relevant State and Territory legislative or policy requirements.

Unauthorised use of a restrictive practice by a NDIS provider is a reportable incident.

Because it is a reportable offence if a provider becomes aware that restrictive practice has been used by someone in their organisation, they are obligated to notify the NSQC within five business days.

Reporting requirements

Restrictive practices can represent a severe risk to the human rights of people with disability. To reduce the risk of a person with disability being harmed, there are reporting requirements to scrutinise the use of restrictive practice.

NDIS service providers using any regulated restrictive practice in their service must comply with reporting requirements.

In most instances, reporting is done monthly, however, providers in South Australia are required to report fortnightly on the use of restrictive practices under a short term approval.

Any unplanned, prohibited or unapproved use of a restrictive practice must also be reported through the reportable incident process within five business days of the provider being made aware of it occurring.

Practices that may be considered a criminal offence or ‘wrongful conduct’ include assault and wrongful imprisonment. They also include methods that may not be unlawful but are unethical.

Anyone who is concerned about the use of restrictive practice, including families, friends and carers of a person with disability, can contact the NSQC and make a complaint.

What more do you want to know about the use of restrictive practice? Tell us in the comments section below. 

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