Is It a Restrictive Practice? Using the NDIS Decision Trees

The NDIS definitions of restrictive practice sound clear until you try to apply them. Is a locked cupboard a restrictive practice? A weighted blanket? Medication for anxiety? The NDIS Commission's decision trees help you tell.

If you support a person with disability, whether as a parent, support worker, allied health professional, or family member, you have probably encountered the term restrictive practice. The official definitions sound clear enough until you try to apply them. Is locking the cupboard at night a restrictive practice? What about giving a child a weighted blanket? What about a medication prescribed for anxiety that also helps with behaviour?

The answers are not always obvious. The NDIS Quality and Safeguards Commission publishes a Regulated Restrictive Practices Guide that includes decision trees for each of the five regulated categories. The decision trees are the most practically useful part of the guide, because they walk you through the questions that actually determine whether a practice is regulated, ordinary community practice, or something else entirely.

This post explains how the decision trees work, the five categories they cover, and the most common confusions in each.

The five regulated categories

Under the NDIS framework, there are five categories of regulated restrictive practice. Each is defined in the NDIS Act 2013 and the NDIS (Restrictive Practices and Behaviour Support) Rules 2018. They are chemical restraint, environmental restraint, mechanical restraint, physical restraint, and seclusion.

A practice is regulated when it has the effect of restricting the rights or freedom of movement of a person with disability, for the primary purpose of influencing their behaviour. Each category has its own decision tree because the questions you need to ask differ.

Chemical restraint

The core question for chemical restraint is: what is the primary purpose of the medication?

Chemical restraint is the use of medication or a chemical substance for the primary purpose of influencing a person's behaviour. It does not include medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, physical illness, or physical condition.

The decision tree walks you through this in stages. Is the medication being used to influence behaviour? If no, it is not chemical restraint. If yes, is the medication prescribed by a medical practitioner for a diagnosed mental disorder, physical illness, or physical condition? If yes, it is not chemical restraint, even if it also affects behaviour. If no, it is chemical restraint, and must be documented, reported, and addressed within a Behaviour Support Plan.

The category that confuses people most often is psychotropic medication used in autism, intellectual disability, or other conditions where behaviour is part of the clinical picture. The same medication (say, risperidone) might be a chemical restraint in one context and not in another, depending on the prescribing purpose.

Diazepam prescribed to keep someone calm and reduce behaviours of concern is chemical restraint. Diazepam prescribed as a muscle relaxant after seizure activity is not. The medication is the same. The purpose is what determines the answer.

This is why the NDIS Commission encourages the use of a Medication Purpose Form, completed by the prescribing doctor, that records what the medication is actually for. If the prescribing clinician documents a diagnosed condition and intended therapeutic effect, the framework treats the medication accordingly.

Environmental restraint

The core question for environmental restraint is: is the person restricted from free access to any part of their environment, including items or activities, for the purpose of influencing their behaviour?

If yes, the next question is whether the restriction is ordinary community practice or something more. Locking the front door at night, for instance, is ordinary community practice when the person inside can still leave and the lock exists for general safety. A locked fridge in a shared accommodation, on the other hand, that prevents one resident from accessing food they would otherwise reach for, is environmental restraint.

The decision tree distinguishes the two by asking whether the restriction applies specifically to the person with disability and is intended to influence their behaviour. If the practice is universal (everyone in the house has the same access) and reflects ordinary community standards, it is not regulated. If the practice is specific to the person and targets their behaviour, it is.

Environmental restraint is broad and easy to overlook. Restricting access to a phone, a particular room, a fridge, the outdoors, or specific items can all fall into this category depending on context. The Commission provides an example: locking the front and back door because a person is known to run out of the house onto the road. That is environmental restraint, because the lock is specifically about influencing one person's behaviour and limiting their movement.

Good practice involves reducing the impact of the restriction wherever possible. In the cutlery example used in the Commission's guide, giving the person their own key to the locked drawer reduces the rights impact, even where the lock itself remains.

Mechanical restraint

The core question for mechanical restraint is: is a device being used to prevent, restrict, or subdue a person's movement, for the primary purpose of influencing their behaviour?

Mechanical restraint does not include devices used for therapeutic or non-behavioural purposes. A wheelchair seatbelt that keeps a person safely positioned, a splint that supports healing after an injury, a postural support prescribed by an occupational therapist, none of these are mechanical restraint, even though they restrict movement.

The decision tree distinguishes by purpose. A splint or helmet used to prevent self-injurious behaviour like head-banging is mechanical restraint. A splint used after a wrist fracture is therapeutic. A weighted blanket prescribed by an occupational therapist for sensory regulation, with no behavioural-control purpose, is therapeutic. A weighted blanket pinned around someone to keep them in bed is mechanical restraint.

The category includes a sharp line around abuse. Some forms of mechanical restraint are not regulated practice, they are unlawful and constitute abuse. The Commission's guide lists handcuffs in any form, devices that restrain the legs or feet, and ropes used to tie hands or other body parts. Any device used with the intent to cause hurt or harm is abuse. These practices must be ceased and reported to the NDIS Commission within 24 hours.

Physical restraint

The core question for physical restraint is: is physical force being used to prevent, restrict, or subdue the person's movement, for the primary purpose of influencing their behaviour?

The decision tree carves out reflexive techniques that guide or redirect, which are not physical restraint. Briefly steering a person away from danger, guiding someone by the elbow across a road, or gently moving a hand away from a hot stove are reflexive responses, not regulated practice.

Physical restraint is when force is applied to stop or control movement for behavioural reasons. Holding someone down to stop them hitting another person is physical restraint. Restraining someone in a chair to prevent them leaving is physical restraint. Holding a child's hands to stop self-injury is physical restraint, even when the intention is protective.

Physical restraint is sometimes necessary as a last resort to prevent harm. When it is, it must be the least restrictive option, used for the shortest possible time, and addressed within a Behaviour Support Plan with a clear strategy to reduce and eliminate it.

Seclusion

The core question for seclusion is: is the person being confined alone in a room or space they cannot freely leave?

Seclusion is the sole confinement of a person with disability in a room or space from which they cannot voluntarily exit. It is the most serious of the five regulated categories, and the bar for ever using it is correspondingly high.

The decision tree is the most straightforward of the five. If the person is alone, and cannot leave, and this is being done to influence their behaviour, it is seclusion. There is little grey area.

Time-out in a child's bedroom, where the child can leave when ready and an adult is nearby, is not usually seclusion. Locking a child in a room alone where they cannot get out is seclusion, and it is regulated practice.

What to do if you think a practice is being used

If you are a family member or support person and you think a regulated restrictive practice is being used with someone you care about, you have the right to know. The practice should be documented in a current Behaviour Support Plan, the use of it should be tracked, and there should be a clear strategy in place to reduce it over time.

If a regulated restrictive practice is being used and it is not in a Behaviour Support Plan, this is an unauthorised restrictive practice. It is a reportable incident under the NDIS Commission framework, and the provider using it has a compliance obligation to report and address it.

At Ivy Psychology, our behaviour support practitioners work within the NDIS Quality and Safeguards Commission framework, including the development of Behaviour Support Plans and Regulated Restrictive Practice documentation. If you have questions about whether a practice in your family member's life is regulated, or about how to address it through a behaviour support plan, you are welcome to get in touch.

A final note

The decision trees exist because the abstract definitions are not enough to apply in real situations. The framework recognises that families and support workers regularly face decisions about access, safety, and behaviour that involve some restriction, and not all restriction is regulated practice. Using the decision trees, rather than guessing, is how the framework is intended to work.

If you are unsure about a specific situation, asking a behaviour support practitioner to walk through the relevant decision tree with you is usually quicker and more accurate than reading the guide alone. The clinical judgement matters as much as the document.