Most restrictive practices don’t look dramatic. A lock on the fridge. A pair of padded gloves. A rule that a person can only go into the backyard with a worker.
Families are often surprised to learn these count. That’s why the NDIS defines each type of restrictive practice so carefully. The definitions decide which rules apply, so it helps to know them.
This guide sets out the 5 regulated types simply, with examples from homes and services around Sydney. It also covers what does not count, because that’s where most of the confusion sits. For the bigger picture, start with our guide to restrictive practices in the NDIS.
Key points
- The 5 types are seclusion and chemical, mechanical, physical and environmental restraint.
- Purpose decides most cases: is the main aim to influence the person’s behaviour?
- Environmental restraint, such as a locked pantry, is the type families meet most often at home.
- Safety measures that apply to everyone usually don’t count.
How many types of restrictive practices are there?
There are 5 types of regulated restrictive practices in the NDIS: seclusion, chemical restraint, mechanical restraint, physical restraint and environmental restraint. They are defined in the NDIS (Restrictive Practices and Behaviour Support) Rules 2018. Each type must be in a behaviour support plan and authorised where required before a provider uses it.
The word that ties all 5 together is purpose. Most of the definitions turn on whether the main purpose is to influence the person’s behaviour. A device or a medicine can be a restrictive practice in one situation and not in another. The reason it’s used makes the difference.
What is seclusion?
Seclusion is keeping a person alone in a room or space they cannot freely leave, at any time of the day or night. It still counts if the door isn’t locked but the person is told, or led to believe, that they can’t come out. Seclusion carries a high risk of harm.
Examples of seclusion include:
- locking a person in their bedroom after an incident
- keeping a person in a fenced yard on their own with the gate locked
- telling a person to stay in a “time out” room until staff say they can leave
Leaving a person alone for privacy, when they can walk out whenever they like, is not seclusion. Neither is a person choosing to spend time in a quiet room.
What is chemical restraint?
Chemical restraint is using medicine with the main purpose of influencing a person’s behaviour. It does not include medicine prescribed by a doctor to treat a diagnosed mental disorder, physical illness or physical condition. The reason the medicine is given decides whether it counts.
Examples of chemical restraint include:
- a “when needed” medicine given to settle a person who is distressed or agitated
- regular medicine prescribed to reduce aggression, where no diagnosed condition is being treated by it
This type causes the most confusion. A person with a diagnosed condition may take medicine that also changes their behaviour. If the doctor prescribed it to treat that condition, it’s not chemical restraint. Only the prescribing doctor can say why a medicine was prescribed, so ask them to put the reason in writing.
What is mechanical restraint?
Mechanical restraint is using a device to prevent, restrict or subdue a person’s movement, with the main purpose of influencing their behaviour. It does not include devices used for therapy or safety that have nothing to do with behaviour, such as a seatbelt in a car.
Examples of mechanical restraint include:
- arm splints that stop a person biting their hands
- padded mittens that stop scratching or skin picking
- a harness or buckle cover used because a person keeps unclipping their seatbelt
Compare that with a wheelchair lap belt an occupational therapist has prescribed for posture. The belt limits movement, but its purpose is support and positioning. That’s not a mechanical restraint.
What is physical restraint?
Physical restraint is using physical force to prevent, restrict or subdue a person’s movement, with the main purpose of influencing their behaviour. A quick, reflexive hands-on action to guide someone away from immediate danger, such as a moving car, is usually not counted as physical restraint.
Examples of physical restraint include:
- holding a person’s arms by their sides during an incident
- two workers holding a person to stop them leaving
- pinning a person against a wall or on the floor
Some physical holds are on the list of practices that should never be used in the NDIS Commission’s Regulated Restrictive Practices Guide. These include holding a person face down or face up on the floor, and any hold that restricts breathing. They carry a serious risk of injury or death.
What is environmental restraint?
Environmental restraint is restricting a person’s free access to all parts of their environment, including items or activities. It’s the most common type in homes and group homes. Many families use it without realising it is a regulated practice when a provider is involved.
Examples of environmental restraint include:
- a locked pantry, fridge or kitchen
- locked cupboards holding clothes, games or a TV remote
- a locked front gate or a door alarm
- limits on internet, phone or TV access to manage behaviour
The test is access. If the person can’t get to something they would otherwise be free to use, it’s likely an environmental restraint. A locked medicine cabinet in a shared home can be the exception. Where it’s locked for everyone’s safety, and the person doesn’t need to reach it, it may not count.
What does not count as a restrictive practice?
A practice usually doesn’t count as a regulated restrictive practice if its main purpose isn’t to influence behaviour. Safety measures that apply to everyone, therapy devices and medicine prescribed for a diagnosed condition generally fall outside the definitions. When in doubt, ask a registered behaviour support practitioner.
Common examples that usually don’t count:
- a car seatbelt worn for road safety
- a locked front door at night that the person can open, or that applies to everyone in the house
- a prescribed posture belt on a wheelchair
- a quiet room the person can choose to use and leave
- medicine for epilepsy, reflux or a diagnosed mental health condition
There’s also a grey zone. A gate that’s locked “for safety” might really be there because a person keeps leaving after an argument. That’s when the purpose needs an honest look. In our view, if a restriction is mainly there because of behaviour, it should be treated as a restrictive practice and planned for.
Why do the definitions matter?
The definitions matter because a practice that fits one of the 5 types must follow the NDIS rules. That means a behaviour support plan, authorisation where required, monthly reporting and a plan to reduce it. Getting the type wrong can leave a person restricted with no safeguards around them.
The type also shapes the plan. A locked pantry calls for different steps than a “when needed” medicine. We look at each restriction on its own and set a clear path to reduce it. Our guide to reducing restrictive practices explains how that works.
Frequently asked questions
Is a locked front door a restrictive practice?
Usually not, if the door is locked for everyone’s safety and the person can still open it or ask to go out. It may be an environmental restraint if it’s locked mainly to stop one person leaving because of their behaviour. The reason for the lock is what matters.
Is a weighted blanket or vest a restrictive practice?
A weighted blanket or vest that an occupational therapist recommends for sensory needs, and that the person can take off, is usually not a restriction. If it’s used to stop a person moving, or they can’t remove it, it may be a mechanical restraint. Check with the person’s practitioner.
Is a door alarm a restrictive practice?
It can be. A door alarm that only alerts staff, while the person stays free to leave, may not be a restriction. If the alarm is used to stop or follow a person every time they try to go out, it may be an environmental restraint. The purpose and how it’s used both count.
Is time out a restrictive practice?
It depends on whether the person can leave. A short break that a person can end themselves is not seclusion. If the person is kept in a room or space and can’t come out until staff say so, it may be seclusion. Seclusion of children is a serious matter and needs careful review.
Who decides which type a practice is?
A registered NDIS behaviour support practitioner assesses each practice and names its type in the behaviour support plan. In NSW, the authorisation panel reviews that decision before a practice is approved. If you think a practice has been missed or named wrongly, raise it with the practitioner or the provider.
Get help with restrictive practices
My Behaviour Support is a registered NDIS provider based in Narellan, working with people of all ages across South West and Western Sydney. Our Director, Domenic Barca, is a Proficient Behaviour Support Practitioner with a background in psychology and social work. Our practitioners assess restrictive practices, write behaviour support plans and help support teams reduce restrictions step by step. Read about our Reducing Restrictive Practices service.
If you’re not sure whether something in your home or service counts, we can look at it with you. Make a referral or call us on 0415 930 548.
