Restrictive practices in community services for people with intellectual disabilities at risk of behaviours that challenge: insights and omissions of the Disability Royal Commission

Abstract

People with intellectual disabilities commonly experience violent, abusive, and restrictive contexts, particularly those who are at risk of behaviours that challenge, behaviours that often are a sign of trauma, fear, pain, and loss of power. For example, the use of physical restraint and psychotropic medication to manage behaviours labelled as challenging is prevalent in services for people with intellectual disabilities, and has a negative impact on their wellbeing and quality of life. The Australian Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability has recommended a reduction in the use of restrictive practices, and that they only be used as a last resort. However, there is a risk that a narrow focus on behaviours labelled as challenging and their management through legislation, procedures, and authorisation by writing behavioural support plans fails to properly address the concerns of people with intellectual disabilities at risk of behaviours that challenge. There might not be enough incentive for the system-wide change required to properly meet the needs of this specific group. The closure of group homes, as recommended by the Commission, is appealing, given that abusive and restrictive practices are repeatedly uncovered in these settings. However, this might add to the precarious situation unless significant social change is made. Instead, perhaps more feasible, a plan to enable group homes become truly a home, safe and with highly skilled support available, should be developed. A framework based on the concept of capable environments might aid in this endeavour.