Psychotropic drugs are over-used in Australia to control concerning behaviour in people with disability, most of whom have no say in their treatment, the disability royal commission heard.

The commission this week opened hearings into the way people with intellectual disability are treated when they display so-called ‘behaviours of concern’ such as verbal, physical or sexual aggression, self injury and destruction of property.

In his opening statement on Tuesday Chair Ronald Sackville said there appeared to be widespread agreement that psychotropic medications had an important role to play in treating mental illness but could be detrimental if they weren’t appropriately administered.

“There is a clear distinction between using psychotropic drugs appropriately to treat mental illness and administering them to control the behaviour of people with intellectual disability or autism who do not necessarily have any mental illness,” he said.

“In practice, as we shall hear, the distinction is blurred and psychotropic drugs are often used to control challenging behaviour of people with intellectual disability and not truly for the purpose of treating mental illness, although the medical records may suggest otherwise.”

Pschycotropics used as chemical restraints

He said although there are no national statistics, the data that’s available suggests psychotropic drugs are being over-used.

According to the NDIS Qaulity and Safeguards Commission, there were 177,611 reports of unauthorised use of chemical restraints on NDIS participants in 2019-2020, he said.

Senior Counsel Assisting Kate Eastman SC said the use of psychotropic medication as a chemical restraint raised many concerns, including over-reliance on drugs as first resort and the risk of misuse, overdosing and side effects.

The research suggests that up to 60 per cent of people with intellectual disability are prescribed psychotropic medication to manage challenging behaviour, she told the commission.

Loss of research funds

The commission also heard during the week that there has been international concern about over-prescription of psychotropic medication for at least 30 years, and that there is no strong evidence base for the use of many of the psychotropics given to people with intellectual disability.

It also heard that monitoring of psychotropic medications is poor and that there are no standards and and scant guidance on how to go about it.

The Commission heard there is a need for ongoing research into prescribing practices, including off-label and PBS implications and the methods to support and encourage de-prescription of psychotropic medications. 

However, some researching funds had been lost during the rollout of the NDIS.

Steps were being taken to agree on principles for nationally consistent authorisation of restrictive practices, NDIS commissioner Graeme Head told the commission.

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1 Comment

  1. Absolutely past time that this issue had some light shone on it. It is crucial however to remember that to a large degree, chemical restraint is used because staff are frequently underskilled and undertrained in non-chemical methods of responding to and managing what can often be extreme and high risk client behaviours. This occurs in an industry largely and increasingly staffed by people from the CALD cohort, who are at best ‘variably’ trained and rarely supervised by staff often lacking in the necessary knowledge and skills themselves. It is not reasonable to withdraw chemical restraint until effective and safe (for staff, client and others) non-chemical management methods are developed and taught and supervised by experienced and qualified, knowledgeable supervisors. At the moment there is a gross shortage of evidence based knowledge about effective and safe methods of managing challenging behaviours in the disabled cohort. It is unreasonable to expect that clients, staff and carers will suddenly and miraculously develop the knowledge, skill and insight that we would wish for this group. It is a likelihood that there will be clients for whom we can find no safe and successful non-chemical management strategy, just as we have found in Aged care and psychiatry.
    In an industry where much of the worker and first level supervision has Cert 3 or 4 level training at best, and where the industry accepts training from providers who are under financial pressure to deliver training in fewer and fewer hours, I can see no easy road ahead for clients and their carers.

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