What Defines a Restrictive Practice?
A restrictive practice is an intervention that restricts the rights, freedom of movement, or access of a person, typically in a care setting. Their use is a serious matter, with regulations from bodies like the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission emphasizing their use only as a last resort. The primary goal is to prevent harm to the individual or others, not to punish or discipline. Overreliance on these practices is discouraged, with a strong focus on alternative, less restrictive, positive behavior support strategies.
The 5 Types of Restrictive Practices
There are five main types of regulated restrictive practices recognized in aged care, disability, and other health settings.
1. Chemical Restraint
This involves the use of medication or a chemical substance with the primary purpose of influencing a person's behavior. It is distinct from medication prescribed for the treatment of a diagnosed physical or mental illness.
Examples of chemical restraint:
- Administering a sedative to calm a person who is agitated, without it being part of their prescribed medical treatment.
- Increasing the dose of an antipsychotic medication to manage disruptive behavior, rather than for a diagnosed mental health condition.
2. Environmental Restraint
Environmental restraint involves restricting a person's free access to their environment, including activities, items, or physical spaces, to influence behavior. This may involve physical barriers or limits on a person's access.
Examples of environmental restraint:
- Locking a fridge or pantry to prevent a resident from accessing certain food items.
- Using key-coded doors that restrict a resident's independent movement within a care facility.
- Removing the battery from an electric wheelchair to limit a person's mobility.
3. Mechanical Restraint
This is the use of a device to prevent, restrict, or subdue the movement of a person's body or a part of their body. The device is used for the primary purpose of behavioral control.
Examples of mechanical restraint:
- Using bed rails to prevent a person from getting out of bed.
- Employing a lap sash or bed belt to restrict movement.
- Using specialized chairs that restrict a person's ability to stand or move freely.
4. Physical Restraint
Physical restraint is the use of physical force to prevent, restrict, or subdue a person's movement. This includes holding, blocking, or pinning a person down.
Examples of physical restraint:
- A staff member holding a person's arm or body to redirect them.
- Physically blocking a resident's path to prevent them from entering or leaving an area.
- Using a team of staff to hold a person immobile on the ground to manage a crisis.
5. Seclusion
Seclusion is the solitary confinement of a person in a room or physical space where voluntary exit is prevented. This is typically done to influence behavior and can be enforced through a locked door or by implying the person is not allowed to leave.
Examples of seclusion:
- Placing a person alone in a room with a locked door from which they cannot exit.
- Forcing a student into an empty classroom and holding the door shut to prevent them from leaving.
- Telling a resident they must stay in their room and cannot leave, even if the door is open.
Comparison of Restrictive Practices
| Feature | Chemical Restraint | Physical Restraint | Mechanical Restraint | Environmental Restraint | Seclusion |
|---|---|---|---|---|---|
| Mechanism | Medication or drug | Physical force (body) | Device or equipment | Altering the environment | Solitary confinement |
| Purpose | Influencing behavior | Restricting movement | Restricting movement | Restricting access/movement | Influencing behavior |
| Example | Sedating an agitated person | Holding a person down | Using a bed rail | Locking a fridge | Locking a person in a room |
| Risks | Medication side effects, loss of autonomy, potential for overdose | Physical injury, bruising, psychological trauma | Physical injury, falls, psychological distress, entrapment | Loss of freedom and choice, distress, frustration | Trauma, isolation, psychological harm |
| Regulation | Requires careful prescription, authorization, and monitoring | Strictly regulated, prone restraint often banned | Requires justification and authorization; often requires specific protocols | Needs authorization and consideration of impact on others | Heavily regulated and discouraged, particularly in schools |
| Alternatives | Behavior support plans, de-escalation techniques, addressing underlying causes | De-escalation, Positive Behavioral Interventions and Supports (PBIS) | Environmental modifications, alarms, personalized care plans | Addressing underlying needs, providing choice, communication support | Least restrictive alternatives, de-escalation, addressing sensory needs |
Ethical and Legal Considerations
The use of any restrictive practice must be a last resort, lawful, and the least restrictive option possible. Care providers are required to explore alternative strategies first and only use restrictive practices when there is a significant risk of harm. These interventions must be used for the shortest possible duration and only as part of an approved, documented plan.
The impact of restrictive practices on an individual's human rights is a serious concern. They can be degrading, re-traumatizing, and can have long-term negative effects on a person's health and well-being. The shift in care standards is toward a positive behavior support framework, which seeks to understand and address the underlying causes of a person's behavior.
Positive Behavior Support as an Alternative
Instead of relying on restrictive practices, the modern approach is to implement positive behavior support (PBS). PBS focuses on proactively identifying and addressing the environmental and personal factors that lead to challenging behaviors. By creating supportive environments and teaching new skills, providers can reduce and eventually eliminate the need for restrictive interventions.
Conclusion
In summary, the 5 types of restrictive practices—chemical, physical, mechanical, environmental, and seclusion—are serious interventions used in regulated care settings to manage behavior and prevent harm. Their use is governed by strict laws and guidelines emphasizing that they should be a last resort, used only for the shortest time possible, and always accompanied by a comprehensive, person-centered behavior support plan. Understanding these practices and prioritizing positive, preventative approaches is critical to upholding the rights and dignity of individuals in care.
Visit the NDIS Quality and Safeguards Commission for more on regulated restrictive practices.
Prevention and Oversight
To prevent the inappropriate use of restrictive practices, care facilities must focus on comprehensive staff training, regular monitoring, and review. This includes education on de-escalation techniques, understanding trauma-informed care, and knowing when and how to implement a restrictive practice safely and ethically. Oversight committees are often put in place to ensure compliance and promote the reduction of restrictive practices over time.
