Login
Disability Royal Commission and restrictive practices: Where to next?
For governments asked to respond to the Disability Royal Commission by the end of March, deciding what action to take on restrictive practices will be a challenge, writes Sonya Parsons.
Sonya Parsons
The use of restraints on people with disabilities conjures up images from One Flew Over the Cuckoo’s Nest. And while the Disability Royal Commission heard stories of similarly horrific treatment – people with disabilities sedated for operational convenience and children with disabilities at schools routinely secluded for long periods of time – this treatment comes under “restrictive practices”.
For state and federal governments, asked to respond to the royal commission by 31 March 2024, deciding what action to take on restrictive practices will be a challenge. Effecting changes to laws recommended by a royal commission can be reasonably straightforward. Creating institutional change is much harder.
Behaviours seen to be in need of control include: verbally, physically or sexually aggressive behaviour, with such behaviour being potentially directed to educators, carers, family members or even self-harm.
As the royal commission has shown us, the behaviours of people with disabilities are often an important form of communication, particularly for those with cognitive disabilities. In many cases, behaviours seen as negative are the person’s easiest – or only – way of expressing distress about their environment or engagement with others.
Restrictive practices are mainly used in care facilities such as mental health facilities or group homes and in some schools. These involve the use of mechanical, physical, chemical, or environmental practices or seclusion designed to control behaviour either for the safety and ease of the person and/or their carer or educator.
Mechanical restrictive practices can include actions such as taking someone’s power from their wheelchair or removing a communication device such as an iPad. Physical restrictive practices can include physically holding a person. Chemical restrictive practices are used with people with disabilities who may exhibit aggression.
The commonly prescribed drug risperidone, for example, is used to treat irritability associated with autism. Seclusion might involve removing a child who is seen as disruptive from a classroom and placing them in a room on their own for periods of time.
The NDIS Quality and Safeguards Commission is currently cracking down on ensuring that restrictive practices rules are followed by NDIS providers, issuing fines to non-compliant providers.
In October 2023, the commission reported issuing 40 infringement notices to NDIS providers, carrying penalties of a combined total of $778,800. NDIS commissioner Tracy Mackey noted that the NDIS Commission was committed to reducing and eliminating the use of restrictive practices on NDIS participants.
While there are a range of laws that govern the use of chemical restrictive practices in particular, the Disability Royal Commission wants to see more done. Its research report on restrictive practices sought the elimination of these practices as being at odds with international human rights norms, and discriminatory.
Ultimately, the royal commission stopped short of recommending that all restrictive practices be banned immediately. It recommended stronger legal frameworks for the use of restrictive practices and that various forms – such as chokeholds – be prohibited in educational settings.
Restricted practices operate on a spectrum, and the use of some restrictive practices is entrenched. The royal commission’s research report also noted that change in socio-cultural attitudes and norms would be required to reduce conceptions of people with disabilities as “lesser”.
The debate will continue over whether restrictive practices should be used at all. If they are to be phased out, it will take a serious investment in service providers, educators and the broader community understanding and accepting the alternatives and being committed to change.
Sonya Parsons is a human rights and social impact partner at Mills Oakley.
