Chemical restraint of adults with intellectual disability and challenging behaviour in Queensland,Australia: Views of statutory decision makers

Abstract

Background:

Psychotropic medication is widely prescribed to treat mental illness. However, it is controversial when used as a chemical restraint (CR) to manage challenging behaviours (CBs) of adults with intellectual disability (ID). CR has potentially negative consequences and affects human rights.

Method:

Qualitative research conducted between 2014 and 2015 explored the views of ‘guardian’ decision makers appointed under unique Queensland legislation oversighting the use of CR.

Results:

Findings included (1) negative conceptualization of CR, (2) concerning relationships with prescribers and disability sector staff, (3) challenges to information seeking about people with ID prescribed CR and (4) problematic implementation of positive behaviour support plans.

Conclusion:

According to guardians, CR may be used in lieu of community supports, and prescribers sometimes diagnose mental illness to avoid CR legislative requirements. Guardians, prescribers and professionals would benefit from training that addresses the intersection between physical and mental health, CB and CR.

Keywords

psychotropic chemical restraint restrictive practices intellectual disability

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References

Ahmed

Fraser

Kerr

, et al. (2000) Reducing antipsychotic medication in people with a learning disability. British Journal of Psychiatry 176: 42–46.

Ali

Blickwedel

Hassiotis

(2014) Interventions for challenging behaviour in intellectual disability. Advances in Psychiatric Treatment 20: 184–192.

Allen

(2008) The relationship between challenging behaviour and mental ill-health in people with intellectual disabilities: a review of current theories and evidence. Journal of Intellectual Disabilities 12(4): 267–294.

Ashcraft

Anthony

(2008) Eliminating seclusion and restraint in recovery-oriented crisis services. Psychiatric Services 59(10): 1198–1202.

Australian Government Department of Social Services (2014) National framework for reducing and eliminating the use of restrictive practices in the disability service sector. Available at: https://www.dss.gov.au/our-responsibilities/disability-and-carers/publications-articles/policy-research/national-framework-for-reducing-and-eliminating-the-use-of-restrictive-practices-in-the-disability-service-sector (accessed 10 July 2016).

Australian Law Reform Commission (2014) Equality, Capacity and Disability in Commonwealth Laws: Discussion paper. Sydney: Australian Law Reform Commission.

Barbour

(2005) Making sense of focus groups. Medical Education 29(7): 74–750.

Benson

Brooks

(2008) Aggressive challenging behaviour and intellectual disability. Current Opinion in Psychiatry 21(5): 454–458.

Bigwood

Crowe

(2008) “It’s part of the job, but it spoils the job”: a phenomenological study of physical restraint. International Journal of Mental Health Nursing 17(3): 215–222.

10.

Braun

Clarke

(2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77–101.

11.

Brylewski

Duggan

(2004) Antipsychotic medication for challenging behaviour in people with learning disability. Cochrane Database of Systematic Review 3: 1–24.

12.

Buckmaster

(2017) The national disability insurance scheme: a guide. Available at: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1617/Quick_Guides/NDIS (accessed 12 January 2018).

13.

Cain

Davidson

Dosen

, et al. (2010) An international perspective of mental health services for people with intellectual disability. In: Bouras

Holt

(eds) The Maudsley Series: Mental Health Services for Adults with Intellectual Disability: Strategies and Solutions. Hove: Psychology Press, pp. 37–53.

14.

Carr

(2007) The expanding vision of positive behaviour support: research perspectives on happiness, helpfulness and hopefulness. Journal of Positive Behaviour Interventions 9(1): 4–16.

15.

Carter

(2006) Challenging behaviour and disability: a targeted response. Available at: https://www.communities.qld.gov.au/resources/disability/centre-of-excellence/carter-report-full.pdf (accessed 10 July 2016).

16.

Chandler

Willmot

White

(2014) Rethinking restrictive practices: a comparative analysis. QUT Law Review 14(2): 90–122.

17.

Chan

LeBel

Webber

(2012) The dollars and sense of restraints and seclusion. Journal of Law and Medicine 20(1): 73–81.

18.

Commonwealth of Australia (2009) Shut Out: The Experiences of People with Disabilities and Their Families in Australia. Canberra: Commonwealth of Australia.

19.

Costello

Bouras

Davis

(2007a) The role of training in improving community care staff awareness of mental health problems in people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 20(3): 228–235.

20.

Costello

Holt

Cain

, et al. (2007b) Professional training for those working with people with intellectual disabilities and mental health problems. In Bouras

Holt

(eds.) Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities. Cambridge: Cambridge University Press, pp. 400–410.

21.

Currier

(2003) The controversy over “chemical restraint” in acute care psychiatry. Journal of Psychiatric Practice 9(1): 59–70.

22.

Deb

Unwin

(2007) Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature. Current Opinion in Psychiatry 20(5): 461–466.

23.

Deb

Clarke

Unwin

(2006) Using Medication to Manage Behaviour Problems Among Adults with a Learning Disability: Quick Reference Guide (QRG). London: University of Birmingham, MENCAP, The Royal College of Psychiatrists.

24.

Deb

Kwok

Bertelli

, et al. (2009) International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World Psychiatry 8(3): 181–186.

25.

Disability Services Act (2006) (Qld). Available at: https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/D/DisabServA06.pdf (accessed 10 July 2016).

26.

Edwards

Alexander

Mutch

(2014) Psychotropics and challenging behaviour in people with an intellectual disability. The Medical Journal of Australia 200(8): 456.

27.

El-Badri

Mellsop

(2008) Patient and staff perspectives on the use of seclusion. Australasian Psychiatry 16(4): 248–252.

28.

Ellingson

(2009) Engaging Crystallization in Qualitative Research: An Introduction. London: SAGE Publications.

29.

Evans

Howlett

Kremser

, et al. (2012) Service development for intellectual disability mental health: a human rights approach. Journal of Intellectual Disability Research 56(11): 1098–1109.

30.

Gaskin

McVilly

McGillivray

(2013) Initiatives to reduce the use of seclusion and restraints on people with developmental disabilities: a systematic review and quantitiative synthesis. Research in Developmental Disabilities 34(11): 3946–3961.

31.

Guardianship and Administration Act (2000) (Qld). Available at: https://www.legislation.qld.gov.au/legisltn/current/g/guardadmina00.pdf (accessed 11 July 2016).

32.

Huang

O’Brien

HRC

Kalinowski

, et al. (2007) Multidisciplinary approach to optimizing pharmacological and behavioural interventions for persons with developmental disabilities who are on psychotropic medications. Journal of Developmental and Physical Disabilities 19: 237–250.

33.

Krose

Rose

Heer

, et al. (2012) Mental health services for adults with intellectual disabilities – what do service users and staff think of them? Journal of Applied Research in Intellectual Disabilities 26(1): 3–13.

34.

Larue

Dumais

Boyer

, et al. (2013) The experience of seclusion and restraint in psychiatric settings: perspectives of patients. Issues in Mental Health Nursing 34(5): 317–324.

35.

Lowe

Allen

Jones

, et al. (2007) Challenging behaviours: prevalence and topographies. Journal of Intellectual Disability Research 51(8): 625–636.

36.

McGillivray

McCabe

(2004) Pharmacological management of challenging behaviour of individuals with intellectual disability. Research in Developmental Disabilities 25(6): 523–537.

37.

Merineau-Cote

Morin

(2014) Restraint and seclusion: the perspective of service users and staff members. Journal of Applied Research in Intellectual Disabilities 27(5): 447–457.

38.

Queensland Civil and Administrative Tribunal (2012) Restrictive practice types. Available at: http://www.qcat.qld.gov.au/matter-types/guardianship-for-adults-matters/guardian-for-restrictive-practices/restrictive-practice-types (accessed 11 July 2016).

39.

Queensland Government (2009) A guide for families: Positive behaviour support and the use of restrictive practices. Available at: https://www.communities.qld.gov.au/resources/disability/key-projects/positive-behaviour-support/a-guide-for-families-positive-behaviour-support.pdf (accessed 11 July 2016).

40.

Queensland Government, Office of the Public Advocate (Qld) (2015) Submission to the national disability insurance scheme: proposal for a national disability insurance scheme quality and safeguarding framework: restrictive practices. Available at: http://www.justice.qld.gov.au/__data/assets/pdf_file/0011/369398/submission-ndis-qsf-restrictive.pdf (accessed 11 July 2016).

41.

Royal Australian and New Zealand College of Psychiatrists (2011) Prescribing Psychotropic Medication to People with an Intellectual Disability: Final Report and Recommendations. Melbourne: The Royal Australian and New Zealand College of Psychiatrists.

42.

Sturmey

(2009) Restraint, seclusion and PRN medication in English services for people with learning disabilities: An analysis of the 2007 national audit survey. Journal of Applied Research in Intellectual Disabilities 22: 140–144.

43.

Thakker

Bamidele

Ali

, et al. (2012) Mental health and challenging behaviour: An overview of research and practice. Advances in Mental Health and Intellectual Disabilities 6(5): 249–258.

44.

Thomas

Corkery-Lavender

Daffern

, et al. (2011) Disability, mental health and medication: Implications for practice and policy. Available at: http://www.dhs.vic.gov.au/about-the-department/documents-and-resources/reports-publications/disability,-mental-health-and-medication-implications-for-practice-and-policy (accessed 11 July 2016).

45.

Torr

(2013) Intellectual disability and mental ill health: a view of Australian research. Journal of Mental Health Research in Intellectual Disabilities 6(2): 159–178.

46.

Torr

Lennox

Cooper

, et al. (2008) Psychiatric care of adults with intellectual disabilities: changing perceptions over a decade. Australian and New Zealand Journal of Psychiatry 42(10): 890–897.

47.

Tsiouris

Kim

Brown

, et al. (2013) Prevalence of psychotropic drug use in adults with intellectual disability: positive and negative findings from a large scale study. Journal of Autism and Developmental Disorders 43: 719–731.

48.

Tyrer

Oliver-Africano

Ahmed

, et al. (2008) Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. Lancet 371: 57–63.

49.

United Nations (2006) Convention on the rights of people with disabilities. Available at: www.un.org/disabilities/convention/conventionfull.shtml (accessed 11 July 2016).

50.

Walbank

(2013) Submission to the Review of Restrictive Practices Department of Communities, Child Safety and Disability Services. Queensland: Carers Queensland Inc.

51.

Webber

Donley

Tzanakis

(2008) Chemical Restraint: What Every Disability Support Worker Needs to Know. Melbourne: State Government of Victoria.

52.

Werner

Stawski

(2012) Mental health: Knowledge, attitudes and training of professionals on dual diagnosis of intellectual disability and psychiatric disorder. Journal of Intellectual Disability Research 56(3): 291–304.