What counts as chemical restraint
The NDIS (Restrictive Practices and Behaviour Support) Rules 2018 define chemical restraint as the use of medication or a chemical substance for the primary purpose of influencing a person's behaviour.
The key word is purpose. The same medicine can be chemical restraint for one person and treatment for another. It is not chemical restraint when a medical practitioner prescribes it to treat, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition.
PRN and routine medication
Medication can be given on a regular schedule (routine) or only when needed, often called PRN. Either can be chemical restraint if the main reason it is given is to change behaviour.
PRN medication needs particular care, because workers decide when to give it. If a PRN is used to calm or settle someone whose behaviour is of concern, the behaviour support plan should explain exactly when it can be used, what must be tried first, and how its use is recorded.
The medication purpose form
Providers who give medication need to know why it was prescribed. Only a medical practitioner can decide what to prescribe and for what purpose, so providers are expected to ask the prescriber when the purpose is unclear.
The NDIS Commission has an optional Medication Purpose Form for this. The doctor ticks whether the primary purpose is treatment of a diagnosed condition or to influence behaviour, and notes side effects. You can take it to each medical review or whenever a medication starts or changes. Some states have their own version, which providers can still use.
The rules if it is chemical restraint
If a medication is a chemical restraint, the same rules apply as for any regulated restrictive practice:
- Only a registered NDIS provider can use it. Unregistered providers must not
- It must be in a behaviour support plan written by an NDIS behaviour support practitioner, alongside positive strategies
- It must be authorised under the state or territory process where the person lives
- It must be the least restrictive option, used as a last resort and for the shortest time
- The implementing provider reports its use to the NDIS Commission every month, including months when it was not used
Questions families can ask
Chemical restraint can have real side effects, so it is fair to ask questions. Good ones include:
- What is this medication prescribed for, and has the doctor confirmed that in writing?
- Is it in the behaviour support plan, and has it been authorised?
- What is tried before a PRN is given, and who decides?
- How are side effects and changes in behaviour being recorded and shared with the doctor?
- What is the plan to reduce or stop it over time?