What Counts as a Regulated Restrictive Practice?

Regulated restrictive practice include: chemical restraint, environmental restraint, mechanical restraint, physical restraint, or seclusion. Whether something you do counts as one of them usually turns on why you do it, not what it looks like, and the same action can be a regulated restrictive practice in one situation and ordinary support in another. The NDIS Commission's Regulated Restrictive Practices Guide sets out the definitions is a document worth reading for all implementing providers.

A restrictive practice is any practice that restricts a person's rights or freedom of movement. The five below are the ones regulated by the NDIS Commission and where specific obligations exist regarding behaviour support plans, authorisation, and reporting use. If a practice isn't one of these five, it doesn't attract the same obligations, but providers should still consider whether it can be reduced or removed through other positive behaviour support strategies.

Chemical restraint

Medication or another substance used for the primary purpose of influencing a person's behaviour, rather than to treat a diagnosed physical or mental health condition. The same drug can be chemical restraint for one person and ordinary treatment for another, depending on the reason it is used.

What it is:

• A sedative or antipsychotic given mainly to subdue or settle behaviour
• PRN (as needed) medication used to manage agitation or a behaviour of concern
• A dose increased to control behaviour rather than to treat a clinical condition

What it isn't:

• Medication prescribed for a diagnosed physical or mental health condition and taken for that purpose
• Pain relief, or medication given for a medical or dental procedure
• Medication that happens to affect behaviour but is prescribed to treat a condition

Environmental restraint

Restricting a person's free access to parts of their environment, such as rooms, outdoor areas, objects, or activities, in order to influence or change their behaviour. The distinction that matters is whether a restriction targets a particular person's behaviour or applies as ordinary household safety for everyone.

What it is:

• Locking the fridge or pantry to stop a particular participant accessing food
• Locking away a someone's belongings, or closing off rooms or outdoor areas, to manage their behaviour
• Removing or disabling items a person would normally use for the purpose of controlling what they do

What it isn't:

• General safety measures any home has, e.g. a locked chemical cupboard or a pool fence
• Storage arrangements that aren't aimed at managing a person's behaviour
• A person choosing where to keep or how to use their own things

Mechanical restraint

The use of a device to restrict a person's movement for the primary purpose of influencing their behaviour. Many of these devices have legitimate therapeutic uses, so the same equipment can be a support in one case and a restraint in another.

What it is:

• A lap belt or harness used to keep a person seated so they don't get up
• Bed rails used to stop a person getting out of bed to manage their behaviour
• A device applied in response to behaviour, to prevent a person doing something

What it isn't:

• A postural support belt or moulded seat fitted for safe positioning
• Bed rails or equipment prescribed for falls prevention or a clinical need
• Devices used for a genuine therapeutic or medical purpose

Physical restraint

The use of physical force to restrict a person's movement for the primary purpose of influencing their behaviour. What separates it from the ordinary hands-on contact involved in support work is whether the purpose is to control behaviour.

What it is:

• Holding a person, or holding their limbs, to stop them moving during an escalation
• Using body weight or force to prevent a person leaving or acting
• Blocking or pinning a person to control their behaviour

What it isn't:

• Guiding or steering a person by the arm away from a hazard
• Brief, reflexive redirection as part of ordinary care
• Physically assisting a person to move or transfer as part of their support

Seclusion

The sole confinement of a person in a room or space they can't freely leave, at any hour of the day or night. It doesn't depend on a locked door, as a person who reasonably believes they are not allowed to leave is being secluded just as much as someone is physically locked in.

What it is:

• Keeping a person alone in a room or area they are not free to leave
• Confining a person during an escalation until they settle, without them being free to go
• A 'time out' the person is not allowed to end

What it isn't:

• A person choosing to spend time alone and free to leave when they want
• Resting or sleeping in their own room by choice
• Quiet time a person can end whenever they choose

Know the purpose

The question to ask: is the practice being used to influence a person's behaviour, or does it serve a genuine therapeutic, medical, or safety purpose that would apply to anyone? At audit, it's not enough to say a practice was for the person's own good, and you should be able to demonstrate the purpose it actually serves. If a practice is functioning to manage behaviour, it's considered a restrictive practice, whatever the original intention.

Using any of these five in delivering supports makes you an implementing provider, and brings you under the Module 2A practice standard.

When it isn't clear

Some practices sit close to the line, such as a routine that limits choice, a door that is sometimes locked, or a medication that serves more than one purpose. If you're not certain whether something you do is a regulated restrictive practice, you should speak with a behaviour support practitioner, the Commission, or your auditor. Using a regulated restrictive practice that isn't authorised and set out in a behaviour support plan is a reportable incident.