Restrictive practices decisions
Sometimes, disability service providers may need to use restrictive practices to keep you or others safe from harm. These practices can limit your rights or freedom of movement, so they must follow strict rules that are outlined in the Disability Services Act 2006.
What are restrictive practices?
Restrictive practices are actions that limit the rights or freedom of movement of a person with an intellectual or cognitive disability (including an acquired brain injury). These include:
- Containment: preventing you from leaving a premises
- Seclusion: confining you alone in a space you cannot leave
- Chemical restraint: using medication to control your behaviour
- Mechanical restraint: using devices to restrict your movement
- Physical restraint: using physical actions to control your behaviour
- Restricted access to objects: limiting your access to certain items.
What is containment?
Containment means physically stopping you from leaving a premises where you receive disability services. Examples include locking doors, windows or gates to prevent you from leaving.
Containment doesn't apply if you're restricted for your own safety due to a skills deficit, such as poor road safety awareness.
Containment is considered a form of ‘environmental restraint’ by the NDIS Quality and Safeguards Commission.
What is seclusion?
Seclusion means being confined alone in a room or area where you are physically prevented from leaving. Examples include:
- Being locked in a room by yourself
- Staff and other residents moving to a secure room while you are restricted to another part of the building.
What is chemical restraint?
Chemical restraint involves using medication or chemical substances to control your behaviour. This doesn't include medication prescribed to treat a diagnosed mental or physical condition.
Chemical restraints can be given as a fixed dose (which means the same time every day) or on an as-needed basis (PRN – pro re nata, which means ‘as needed’).
What is mechanical restraint?
Mechanical restraint involves using devices to prevent, restrict or subdue your movement. Examples include:
- Straps to restrain parts of your body
- Helmets, gloves or splints to stop you from self-harming.
Mechanical restraint does not include:
- Using a device to help you travel safely in a car
- Using a device to help you sit up in a chair due to a physical condition
- Using bed rails to prevent you getting an injury when you are sleeping.
What is physical restraint?
Physical restraint involves someone using a part of their body to restrict your movement in response to your behaviours that may cause harm to you or others. Examples include:
- Holding your hand down to stop you from hitting yourself
- Grabbing your hand to release a grip when you are pulling someone’s hair.
What is restricted access to objects?
Restricted access to objects means limiting your access to certain items in your environment. Examples include locking cupboards or doors to stop you from accessing knives or sharp objects, so that you don’t harm yourself or others.
Restricted access to objects is considered a form of ‘environmental restraint’ by the NDIS Quality and Safeguards Commission.
When can we make decisions about restrictive practices?
We can make decisions about restrictive practices if the Queensland Civil and Administrative Tribunal (QCAT) appoints us to do so on your behalf.
However, we don't need QCAT’s appointment to approve the short-term use of containment or seclusion.
Service providers must ask us for approval to:
- Use restrictive practices (excluding containment and seclusion) if QCAT appoints us as your guardian for restrictive practices matters.
- Contain or seclude you for a short-term period.
We only approve restrictive practices if they are reasonable, justifiable and absolutely necessary.
How do we make decisions for you?
When making decisions about restrictive practices, we follow Queensland laws and principles designed to protect your rights. These principles are consistent with the Human Rights Act 2019 and the United Nations Convention on the Rights of Persons with Disabilities.
Our approach is guided by the following principles:
- Your views, wishes, and preferences matter: We consider these wherever possible and when you're able to share them.
- Safety with minimal restriction: Any restrictive practice must be the least restrictive option necessary to keep you and others safe.
- Understanding and support: Service providers must explore ways to better understand your behaviours and how they can support you differently.
- Reducing restrictive practices: Service providers must actively work towards reducing and eventually eliminating the need for restrictive practices.
What is our decision-making framework for restrictive practices?
Our decision-making framework ensures restrictive practices are only used as a last resort. We follow these key principles:
- Preventing serious harm: Restrictive practices should only be used to prevent serious harm to you or others.
- Least restrictive and time-limited: They must be the least restrictive option and used for the shortest time possible.
- Respect and dignity: Restrictive practices must not cause humiliation, degradation, or replace proper care, adequate resources, or a safe environment.
- Human rights focus: They must respect your human rights and be clearly justifiable.
- A plan for change: There must be a plan in place to reduce and eventually eliminate the use of restrictive practices.
These principles comply with Queensland laws and the United Nations Convention on the Rights of Persons with Disabilities.
How can restrictive practices be reduced or eliminated?
Disability service providers should aim to reduce and eventually stop using restrictive practices. They must develop strategies based on a Functional Behaviour Assessment and include these in your Positive Behaviour Support Plan (PBSP).
Restrictive practices should only ever be used as a last resort and for the shortest time necessary.
How do we advocate for you if restrictive practices are used?
If QCAT approves the use of restrictive practices, such as containment or seclusion, they may appoint us to assist and make representations on your behalf. Our role is to ensure your rights are upheld and that the use of restrictive practices complies with Queensland laws and principles.
When appointed by QCAT, we:
- Understand your views: We listen to your wishes, views and preferences, ensuring they are considered in decisions about your care.
- Monitor your wellbeing: We ensure you have access to proper healthcare, community participation and support services.
- Review behaviour support plans: Service providers must submit your PBSP to us at least 10 business days before the relevant QCAT hearing. This allows us to review the plan and ensure it aligns with your rights and needs.
Our advocacy is guided by the Restrictive Practices Decision-Making Framework, which ensures that:
- Restrictive practices are only used as a last resort
- They are the least restrictive option necessary to prevent harm
- They are part of a plan to reduce and eventually eliminate their use.