Concern Over Use of Drugs to Restrain Disabled

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 to be released this week . ”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 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 ”bodysuits, 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.

Kate Hagan
The Age
Tuesday 12th June, 2012

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