A new report commissioned by the Disability Royal Commission has found that the use of forced restraints and restrictive practices against people with disability violates international human rights laws and can cause lifelong trauma.
Below, Croakey editor Jennifer Doggett provides an overview of the report and a call from a national peak disability rights and advocacy body for the Commission to recommend a ban on restrictive practices in its final report, due to be provided to the Government by 29 September 2023.
Jennifer Doggett writes:
Australian governments have been urged to ban the use of restrictive practices upon people with disability, with a new report finding that these practices violate international human rights laws, and cause life-altering effects and lifelong trauma.
The ‘Restrictive practices: A pathway to elimination’ report was co-authored by Dr Claire Spivakovsky from the University of Melbourne, Associate Professor Linda Steele from the University of Technology Sydney and Associate Professor Dinesh Wadiwel from the University of Sydney) in order to provide guidance to the Disability Royal Commission in relation to the Commission’s objective to reduce and eliminate restrictive practices.
The report was informed by an expert working group, drawn from disability groups representing First Nations people, women, children, young people and people from ethnic communities with disabilities. It describes how restrictive practices occur within, and are driven by, an extending and encompassing ecological systemic system of violence, coercion and control.
These practices can include chemical, mechanical, physical and environmental restraint and seclusion, guardianship, forced sterilisation, menstrual suppression and anti-libidinal medication, financial management, involuntary mental health treatment, and other non-consensual or coercive interventions said to be undertaken for protective, behavioural or medical reasons.
The Unauthorised Uses of Restrictive Practices in the National Disability Insurance Scheme report released earlier this year showed an increase in the number of reported uses of unauthorised restrictive practices from 290,000 in 2019-2020 to 1.4 million in 2021-22.
Recommendations
The report outlines an eight-point action plan for eliminating restrictive practices, including action at the societal, institutional, relationship and individual levels as follows:
Society
1 . Prohibit restrictive practices
2 . Change attitudes and norms – support awareness raising to address discriminatory attitudes and norms
3 . Acknowledge and address historical injustice – publicly acknowledge past wrongs, support truth telling
Institutions
4 . Deinstitutionalise and desegregate environments
Relationships
5 . Recognise the autonomy and leadership of people with disability; support exercise of legal capacity
6 . Utilise trauma-informed approaches – reform service systems to recognise and respond to people with disability using trauma-informed approaches
Individual
7 . Adequately resource independent living and inclusion – fully resource and realise Article 19 of the Convention on the Rights of Persons with Disabilities (rights to independent living and inclusion)
8 . Provide redress for victim-survivors – seek to rectify injustice through law reform and a national redress scheme.
End the violence
In a University of Melbourne media statement, report co-author, Dr Claire Spivakovsky, emphasised how restrictive practices strip people with disability of dignity.
“People who have been subject to these practices have described them as cruel, humiliating, dehumanising and traumatising – completely at odds with the international human rights obligations for the treatment of people with disability,” Spivakovsky said.
“If we are serious about ending violence against people with disability, then we need to stop the use of restrictive practices, not just reduce them.”
Spivakovsky argued that current national and international approaches aimed at reducing the use of restrictive practices – including positive behaviour support – show mixed or inconclusive findings about effectiveness.
“A significant driver for restrictive practices is that the disability, mental health, education, aged care and other sectors have not been adequately resourced or staffed to support the needs and rights of people with disability in appropriate and meaningful ways, and this is creating unsafe environments,” she said.
Additional calls to action
Responding to the report, People with Disabilities Australia (PWDA) released a media statement calling on the Disability Royal Commission to recommend a ban on restrictive practices in its final report.
“For too long, people with disability have experienced violent practices such as seclusion and restraint that is not only a traumatic violation of our human rights, but is also state-sanctioned within current state and territory laws,” said Nicole Lee, PWDA’s President.
PWDA welcomed the acknowledgement in the report of the past and present violence that people with disability face when subjected to restrictive practices and forced treatment, saying that this aligns with the lived experience of people with disability.
“The Report particularly highlights that restrictive practices create life-long trauma, a distrust in services, and have life-long impacts,” said Ms Lee.
Lee described the Report’s eight-point plan as a “comprehensive first step” and identified two additional important and urgent areas for action:
1) to abolish segregated, closed and involuntary treatment settings where restrictive practices are used
2) an acknowledgement of past wrongs and the introduction of a National Redress Scheme that supports people with disability who are past and present victim-survivors.
“Part of bringing deinstitutionalisation to reality is to unlock the doors on institutional settings, abolish forced treatment and stop separating us from our peers without disabilities – in schools, workplaces and the places we live and interact with the world around us,” said Lee.
“While we are locked behind closed doors, separated and segregated, a culture of silence, control and abuse continues.”
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