What are restrictive practices?
A restrictive practice is any practice or intervention that limits a person’s human rights or freedom of movement. In disability support, some people may require the use of a restrictive practice as part of their provisions of support.
However, restrictive practices are only ever used as a last resort.
Types of restrictive practices
Restrictive practices are an extreme form of behaviour support. For an action to qualify as a restrictive practice, it must be done to influence, control, or limit a person's behaviour.
Under the NDIS, there are five common types of restrictive practices:
1. Seclusion
Seclusion means involuntary confinement or isolation, i.e. the person is in a room or space alone and is not allowed to leave.
This is an example of a restrictive practice: locking Corbyn in their room and preventing them from leaving until they are calm.
This is not a restrictive practice: Corbyn locking themself in the bathroom and refusing to leave until they choose to.
2. Chemical restraint
With this type of practice, the person is given medications or chemical substances to stop or moderate their behaviour.
This is an example of a restrictive practice: Keira was experiencing distress after moving into an NDIS group home and was constantly trying to leave. Keira’s GP prescribed a small dose of medication to keep Keira calm.
This is not a restrictive practice: Keira has been prescribed antipsychotics for the treatment of schizophrenia, which is closely monitored and reviewed by their GP and psychiatrist.
Note: always follow the person’s individual plan and medication requirements to ensure safe medication administration.
3. Mechanical restraint
The use of devices or equipment to stop or reduce the person’s behaviour, often making it difficult for the person to move or access a certain part of their body.
This is an example of a restrictive practice: Ahmed needing restrictive clothing, such as a onesie, to stop them from pulling out their feeding tube.
This is not a restrictive practice: Ahmed requesting a bed rail because they are worried about falling at night.
4. Physical restraint
The use of physical force to prevent or restrict the person’s movement, i.e. they cannot move a part of their body freely.
This is an example of a restrictive practice: holding Tinashe’s hand to stop them from hitting themselves.
This is not a restrictive practice: holding Tinashe’s hand to help them learn a new skill, such as guiding their hand to use a knife when preparing their favourite meal.
5. Environmental restraint
Limiting the person’s access to parts of their environment, such as their home or community, or preventing them from engaging in or having certain activities.
This is an example of a restrictive practice: locking the front and back doors of Ashley’s home, as they are known to run out of the house and onto the road.
This is not a restrictive practice: locking the doors of Ashley’s house for security reasons.
Restrictive practices under the NDIS
Why would restrictive practices be needed? Typically, they are only ever used to keep a person with disability or the people around them safe.
If a person with disability requires a restrictive practice, this will be included in their individual care plan, which support workers must follow. Other positive behaviour management strategies are also usually in the person’s plan. These must be used first before the restrictive practice, meaning all other support avenues have been exhausted, and there is a risk of harm.
It’s important to note that restrictive practices rarely result in lasting positive change, do not meet the person’s needs or improve their quality of life, and do not address the reasons for the behaviour. In some cases, these practices can even make the person’s behaviour worse.
That’s where positive behaviour support comes in.
What is positive behaviour support?
Increased advocacy and pushes for person-centred approaches have led to the development of positive behaviour support. It is an evidence-based, value-based, and rights-based approach that focuses on improving a person with disability’s quality of life.
The key theme of positive behaviour support is understanding the reasons behind the person’s behaviour and how support workers (or those supporting them) can use positive strategies to meet their needs. Strategies include teaching the person new skills, making changes to their environment, or following guidance from the person’s support team.
Usually, if a person with disability requires behaviour support, the NDIS will work with them and their support team to develop a behaviour support plan. The main purpose of such a plan is to improve a person’s quality of life.
A behaviour support plan provides strategies to address behaviours. The plan will usually:
- Include ways to help the person, meet their needs, and change things for the better
- Describe any behaviours of concern: actions that might not be safe for the person or other people, e.g. hitting themselves or others or breaking things
- Help people understand the reasons for the person’s behaviour
- Teach the person and the people who support them new skills and how to do things differently
- Help the person have a good life
- Have steps to follow to keep the person and others safe
- Include the use of restrictive practices (if required)
Final thoughts
While restrictive practices may sometimes be necessary to ensure a person with disability’s safety, they should always be used as a last resort. Positive behaviour support and behaviour support plans are key in ensuring that support workers follow a person-centred, human-rights approach. In doing so, people with disability can continue to have full choice and control over their supports and lives.
