Psychotropic medications: a quick guide for guardians
Written by Rachel Zarb
Psychotropic medication is a term used to refer to any drug capable of affecting the mind, emotions, or behaviour. This includes anti-psychotics, anti-depressants and mood stabilisers.
When these medications are primarily used to control challenging behaviours’ or ‘behaviours of concern’, they are considered to be a restrictive practice, known as a chemical restraint.
A restrictive practice is any action that has the effect of restricting the rights or freedoms of a person with disability. Restrictive practices must only be used as a last resort to protect the person or others from harm.
Administering a psychotropic medication is considered a restrictive practice when the medication is used as a chemical restraint to influence a person’s behaviour or movement, rather than being used to treat a condition.
For example, a psychotropic medication used to treat depression is not considered a chemical restraint. However, a psychotropic medication that is primarily used to sedate a person to prevent them from displaying challenging behaviours such as aggression, is a chemical restraint.
Findings from the Royal Commission
In September 2020, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the Royal Commission) held a public hearing to examine the use of psychotropic medication to address behaviours of concern exhibited by people with disability.
The Royal Commission heard the experiences of 30 witnesses, including several people with lived experience, and came to a number of findings in their 2 June 2021 report.
The key issue was the overuse of psychotropic medications to treat challenging behaviours. Many witnesses expressed grave concern that chemical restraint is often the first option chosen to control these behaviours, instead of the last.
Of particular concern was that medications were being administered by disability support staff with no medical training to manage situational crises. In addition, many medical practitioners either do not have the training or experience to distinguish between using psychotropic medication to treat mental illness, and using chemical restraints as a means of addressing challenging behaviours.
The Royal Commission recommended a number of changes to the legal and policy framework around the use of psychotropic medications as chemical restraints. This includes collecting data nationally on why and to what extent they are used for people with cognitive disability.
To see the full report, please visit the Royal Commission’s website.
Your role as guardian
As a guardian, you must always act in the best interests of the person you are appointed to represent. This includes enabling them to experience the same rights and freedoms as all people.
The use of restrictive practices impacts greatly on a person’s rights and therefore should be avoided where possible.
If the person you represent is on psychotropic medications, or you are approached by a medical practitioner to provide consent, you should make enquiries as to the purpose of the medication. Is it to treat a diagnosed condition, or is the medication purely used to control challenging behaviours?
Questions to ask are:
- How serious is the behaviour and does it pose a threat to the person or to others?
- What are the recommendations from a behaviour support plan or specialist assessment?
- How will the medication benefit the person and is it the least restrictive option?
- What alternate strategies, including positive practices have been used to ensure that the chemical restraint is used as a last resort?
- What is the dosage of the medication and is it proportionate to the behaviour, i.e. not more excessive than what it needs to be?
- What are the side effects and how will it interact with the person’s other medications?
- How will the medication and behaviours be monitored and reviewed?
As the person’s legal guardian, you can give or withhold consent to the use of psychotropic medication as a chemical restraint if you have been appointed with the restrictive practices function – this is a specific decision-making authority contained in guardianship orders.
There are different types of restrictive practices, so the guardianship order will usually name the practice you are authorised to give or withhold consent to, for example, “Restrictive Practice – Chemical Restraint”.
If you don’t have the function, you will need to apply to have the guardianship order reviewed.
Ultimately, your decision to give or withhold consent to the use of psychotropic medication as a chemical restraint should be guided by professional advice. However, it’s your job to ask questions and advocate as far as possible that all other positive behaviour support strategies have been attempted to keep the person or others safe.
Permission for something to happen or agreement to do something.
Contact the Guardian Support Unit
If you have any further question related to the use of restrictive practices, please contact the Guardian Support Unit on 1300 361 389 or firstname.lastname@example.org.
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