Concern over use of drugs to restrain disabled
Chemical restraint is the most commonly used
intervention in disability services
Kate Hagan, The Age, June 12, 2012 (LINK)
More than 1800 people with disabilities were drugged to control their behaviour last year, in what advocacy groups say is a widespread and worrying practice.
The use of "chemical-restraint'' is by far the most commonly used intervention in Victorian disability services, according to a report by the Office of the Senior Practitioner, Victoria, to be released this week (Report Link).
"Chemical-restraint'' refers to the use of medications when the primary purpose is to control a person's behaviour, and excludes medications used to treat a diagnosed mental illness.
Service providers are required to report to the Senior Practitioner - who works to protect the rights of the disabled - every time chemical or mechanical restraint or seclusion is used on a person receiving a government-funded disability service.
Victorian Public Advocate Colleen Pearce said inappropriate restrictive interventions were a significant issue facing people with cognitive impairments. "We are really concerned about the widespread use of restrictive interventions, especially chemical restraints,'' she said.
"We'd like to see more frequent auditing [including] on-site, unannounced pharmacological reviews by clinically trained staff. We want to understand why is it that such large numbers of people are subjected to this.''
The Senior Practitioner's 2010-11 Report (Report Link)
said 1836 people were chemically restrained in that year, accounting for 96 per cent of those subjected to restrictive interventions.
A total of 118 people were subjected to ''mechanical-restraint'', mostly involving ''body-suits, splints and belts and straps worn on a regular basis", and about 50 people were secluded.
The report noted that the number of people with autism subjected to restraint and seclusion had increased over the past three years despite a decrease in interventions on people without the disorder.
Victorian Advocacy League for Individuals with Disability executive officer Kevin Stone said the rising number of people with autism being restrained highlighted a failure in the system.''
Unfortunately this system has a one-size-fits-all approach that can exacerbate the behavioural issues that some people with autism have. If the system's only response is to restrain them, that's a major failing.''
Acting Senior Practitioner Frank Lambrick said his office had begun collecting data on restrictive interventions in 2007, and they had decreased by 8 per cent since then.
Mr Lambrick said the quality of ''behaviour support plans'' - detailing a patient's problematic behaviour and strategies to address it - was improving, and his office was providing education and advice to disability workers to reduce restrictive interventions.
The report found that people were at higher risk of chemical restraint in response to an incident in residential institutions, criminal justice services or shared supported accommodation. It was used less frequently in day services and respite care
. Of the people who were chemically restrained, 87 per cent received medication on an ongoing basis and 13 per cent in response to an incident.
Women with Disabilities Victoria executive director Keran Howe said chemical restraint should be used as a last resort.
''At times we have had concerns that may not have been the case. We need to be really careful we are not masking problems,'' she said.
A spokesman for the Department of Human Services said the Disability Act required that chemical restraints be used only as a last resort and when approved by authorised clinicians.
"The Senior Practitioner has recommended the adoption of guidelines based on best practice overseas to improve accurate diagnosis of intellectual disability and mental illness and reduce the use of psychotropic medication,'' he said.
LISA Comment: Whilst we agree there is far too much use of medication in behaviour management, there is quite a fine-line between mental illness and not mental illness behaviours of concern
In general, there is a lack of meaningful behaviour management prior to the use of medication. One of the main causes of questionable behaviour with residents in supported accommodation is boredom - lack of engagement.
All of us get bored at times. Kids get up to mischief without sufficient parent engagement - we are referring to those with regular intellectual ability being self motivated.
Those with almost any level of limited intellectual ability have limited selfmotivation, culminating in questionable behaviours if left to themselves for long periods.
The Department of Human Services, Disability Services, Victoria, have extensive behaviour management programs in the form of, 'Person Centred Active Support' and, 'Positive Behaviour Support' to provide consistent interaction, developmental and social activities for the residents of their supported accommodation services.
As traditional institutional care was rarely more than minder-care, it has never been seen as the role of staff to meaningful engage with the residents - being mainly a 'them and us' culture. So the medical profession have resorted to medicating the resident to make life easier for minder-care staff. An independent source stated, "Many staff only engage with residents to give them directions."
That said, DHS Victoria makes little effort to provide proper behaviour management for those with exceptionally challenging behaviour, by specially selected and remunerated staff with outcome expectations set on them to achieve results.
Whilst it is almost always considered, that difficult and confronting behaviours need to be moderated for the wellbeing of direct care staff, these staff go off duty. Whereas, other residents in the home get no such breaks.
It is also rarely considered that the person with the difficult behaviours is indirectly disadvantaged through reduced quality of life - not being taken here and there as their behaviour is unacceptable to the general public.
Were a person's adverse behaviour is that of making excessive noise, it might be their human right to do so, but the human right of others not to suffer this.
In conclusion, adverse behaviour would have to be considered as mental illness, and treatable with medication, where reasonable behaviour management has failed.