People with Disabilities Subject to Restrictive
Interventions and Compulsory Treatment and
NDIS:How Will Clinical Services...
Content
•

Role of the Senior Practitioner –Disability

•

Restrictive interventions

•

Compulsory Treatment

•

Chemical...
Guiding Legislation in Victoria
• Disability Act 2006
• Only applicable to funded disability services (i.e. NOT schools, h...
Role of the Senior Practitioner
Protects:
• The rights of people with a disability
• Especially those with restrictive
int...
Powers of the Senior Practitioner

(section 27(2)&(3))

•

Request information from a
disability service provider relating...
When Can You Use Restrictive Interventions?
(section 140)
•

To prevent the person from causing physical harm to themselve...
(c) if the use and form of restraint or seclusion—

(i) is included in the person's behaviour support plan; and

(ii) is i...
Restrictive Interventions

•

Chemical Restraint

•

Mechanical Restraint

•

Seclusion

•

Physical Restraint

•

Other
Compulsory Treatment of People with Disabilities
(Part 8)

Compulsory treatment allows for the
detainment of a person for ...
Criteria for a Supervised Treatment Order
Criteria as set out in section 191 (6)
a) The person has previously exhibited a ...
Disability Act 2006 – Section 148
148. Reports

WHY

(2) A report required and other very good reasons to be explained nex...
How do services report?
Restrictive Intervention Data System - RIDS e-BSP
Person with a
Disability

CSOs

DHS

Accomm.
Acc...
The Problems with Restrictive
Interventions:

 There is no evidence to support
their use
 Have short term impact
 Don‘t...
Restrictive Interventions – Chemical Restraint
"chemical restraint" means the use, for the
primary purpose of the behaviou...
Treatment for mental illness or chemical restraint?
Chemical restraint reduction strategy 2007-2012
Institutions

Kew
Residential
Services
(CDDHV)
[A]

Wider Disability Popul...
Chemical restraint use in shared support accommodation
(Hayward et al., 2012)

Antipsychotics are the most common
chemical...
What we know about Mental Ill-Health in
Intellectual Disability
•

Adults with ID experience high rates of mental ill-heal...
Provision of Mental Health Services to People with
Disabilities
―The separation of mental health from intellectual disabil...
What do we know about Dual Disability?
Morgan, V. A., Croft, M. L., Valuri, G. M., Zubrick, S. R., Bower, C., McNeil, T.
F...
Cumulative Risk Factors in Behaviours of Concern and Mental Ill-Health

(From: Allen, 2008)
Barriers to Treatment of People with Dual Disability
•

Lack of expertise and experience in both mental health and disabil...
23
Prescribing Guidelines people with an Intellectual
Disability
Deb et al. (2009). International guide to prescribing psycho...
Review of 200 random RIDS clients
200
180
160
140
120

Yes

100

No
Unable to Determine

80
60
40
20
0
Pharmacist

Psychia...
Payment for Psychiatric Reviews
•

Short term discretionary funding through justice plans etc

•

Paid as part person‘s IS...
NDIS
•

There will be no diminution of existing clients‘ choice and control over their
supports or support arrangements.

...
Bouras & Holt (2009)
Effective dual disability service includes:
•

organising services around client wishes /needs,

•

g...
A Functioning System
•
•
•
•
•

A unified agency or brokerage model ?
Inpatient and outpatient settings
Funding likely to ...
Conclusion

•

The history of treatment of those with intellectual disability has deprived a
vulnerable group of good care...
References
•
•

•
•
•
•
•
•
•
•
•
•
•

•
•

•

Allen, D. (2008). The relationship between challenging behaviour and mental...
Further Information
Office of Professional Practice
Senior Practitioner – Disability
T. 9096 8427
E. seniorpractitioner@dh...
Mandy Donley - Dept of Human Services - People with Disabilities Subject to Restrictive Interventions and Compulsory Treat...
Mandy Donley - Dept of Human Services - People with Disabilities Subject to Restrictive Interventions and Compulsory Treat...
Upcoming SlideShare
Loading in …5
×

Mandy Donley - Dept of Human Services - People with Disabilities Subject to Restrictive Interventions and Compulsory Treatment and DisabilityCare Australia: How Will Clinical Services Respond?

894 views
592 views

Published on

Mandy Donley, Practice Leader Integrated Health Care, Senior Practitioner - Disability, Office of Professional Practice, Department of Human Services delivered this presentation at the Inaugural Integrating Mental Health into the National Disability Insurance Scheme.

This conference focuses on the latest plans to integrate mental health services into a new funding scheme and how its implementation will affect the future direction of disability policy reform for people with mental illness in Australia.

For more information about the event, please visit the conference website: http://www.healthcareconferences.com.au/mentalhealthndis

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
894
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
16
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Mandy Donley - Dept of Human Services - People with Disabilities Subject to Restrictive Interventions and Compulsory Treatment and DisabilityCare Australia: How Will Clinical Services Respond?

  1. 1. People with Disabilities Subject to Restrictive Interventions and Compulsory Treatment and NDIS:How Will Clinical Services Respond? Mandy Donley, Practice Leader-Disability,RN, CredMHN Office of Professional Practice Department of Human Services
  2. 2. Content • Role of the Senior Practitioner –Disability • Restrictive interventions • Compulsory Treatment • Chemical restraint • Dual Disability • NDIS • For consideration
  3. 3. Guiding Legislation in Victoria • Disability Act 2006 • Only applicable to funded disability services (i.e. NOT schools, hospitals, aged care etc.) • Created the position of Senior Practitioner • Defines restrictive interventions • Sets out legal boundaries for when you can limit a person‘s Human Rights • • • • Victorian Charter of Human Rights and Responsibilities Act 2006 Sets out 20 human rights that are protected in Victoria ‗Right Bearers‘ and ‗Duty Bearers‘ Act compatibly or give proper consideration to a human right • United Nations Convention on the Rights for Persons with Disabilities • Reaffirms people with disabilities must enjoy all human rights and freedoms • Staff need to recognise, interpret and apply rights and obligations
  4. 4. Role of the Senior Practitioner Protects: • The rights of people with a disability • Especially those with restrictive interventions and compulsory treatment (section 23(2)(a)) Ensures: • That appropriate standards in relation to restrictive interventions and compulsory treatment are complied with (section 23(2)(a)) Develops: • Guidelines and standards (section 24(1)(a)) • Links with professional bodies and academic institutions (section24(1)(f)) Provides: • Education and information to disability services (section 24(1)(b) • Information about rights (section 24(1)(c)) • Advice to improve practice (section 24(1)(d)) • Direction in relation to restrictive interventions and compulsory treatment (section 24(1)(e)) Evaluates and Monitors: • The use of restrictive interventions (section 24(1)(h))
  5. 5. Powers of the Senior Practitioner (section 27(2)&(3)) • Request information from a disability service provider relating to a RI or CT • Authorise by written order the use of an RI Investigate, audit & monitor the use of RI & CT • Discontinue or alter practice • To observe or carry out a practice • Inspect or take copies of documents relating to a person subject to a RI or CT • Provide assistance if required to discontinue or alter practice • See any person involved in the development of a RI or CT • Visit premises where a disability service is being provided • See any person who is subject to restrictive intervention (RI) or compulsory treatment (CT) •
  6. 6. When Can You Use Restrictive Interventions? (section 140) • To prevent the person from causing physical harm to themselves or any other person (section 140(a)(i)) • To prevent the person from destroying property where to do so could involve the risk of harm to themselves or any other person (section 140(a)(ii)) • If the use and form of the restraint and seclusion is the option which is the least restrictive of the person as possible in the circumstances (section 140(b))
  7. 7. (c) if the use and form of restraint or seclusion— (i) is included in the person's behaviour support plan; and (ii) is in accordance with the person's behaviour support plan; and (iii) is only applied for the period of time that has been authorised by the Authorised Program Officer; and
  8. 8. Restrictive Interventions • Chemical Restraint • Mechanical Restraint • Seclusion • Physical Restraint • Other
  9. 9. Compulsory Treatment of People with Disabilities (Part 8) Compulsory treatment allows for the detainment of a person for the purpose of Treatment Supervised Treatment Orders (s191 193): Civil order made by Victorian Civil and Administrative Tribunal (VCAT) Residential Treatment Orders (s 152): The person has been charged and is subject to an order allowing compulsory treatment in a Residential Treatment Facility Supervised Treatment Orders • ID, residential service, Plan approved by Senior Practitioner • Violent and dangerous behaviour causing significant harm • Can‘t be reduced in less restrictive ways • Benefit to the person • Can‘t consent • Necessary to detain Residential Treatment Orders • Sentencing, Corrections, Crimes (MIUT), Serious Sex Offenders Monitoring Acts, Transfer from prison • ID, serious risk of violence, less restrictive, facility can provide services, Senior Practitioner notified
  10. 10. Criteria for a Supervised Treatment Order Criteria as set out in section 191 (6) a) The person has previously exhibited a pattern of violent or dangerous behaviour causing serious harm to another person or exposing another person to a significant risk of serious harm b) There is significant risk of serious harm to another person which cannot be substantially reduced by using less restrictive means c) The services to be provided to the person in accordance with the Treatment Plan will be of benefit to the person and substantially reduce the significant risk of serious harm to another person d) The person is unable or unwilling to consent to voluntarily complying with a Treatment Plan to substantially reduce the significant risk of serious harm to another person e) It is necessary to detain the person to ensure compliance with the Treatment Plan and prevent significant risk of serious harm to another person.
  11. 11. Disability Act 2006 – Section 148 148. Reports WHY (2) A report required and other very good reasons to be explained next) It’s legislation ( under sub-section (1) must— WHEN (a) be provided reported in after first week of the current month Prev. month within 7 days the the end of the interval advised under sub-section (1); (b) contain the information required in a report under section 147; (c) include a record of all instances in which restraint or seclusion has been applied during the period for which the report is prepared; Episodes of restrictive intervention for the previous month, WHAT (d) including emergencies not the Seniorin a current BSP, along specify any details required by defined Practitioner in respect of each instance included under paragraph (b); with each reported person’s current BSP (e) have attached a copy of the person's current behaviour management plan if the use of restraint or seclusion is being continued.
  12. 12. How do services report? Restrictive Intervention Data System - RIDS e-BSP Person with a Disability CSOs DHS Accomm. Accomm. Day Program E-Business Person’s record ------------------------------------------------------------------------------------------------------- E-BSP E-BSP e-BSPs ----------------------------------- ------ ------------------------------------------------------------------- Security Layer TEMPLATES Episodes of RI 01/03/2013 ----------------01/04/2013 ----------------: RIDS e-BSP
  13. 13. The Problems with Restrictive Interventions:  There is no evidence to support their use  Have short term impact  Don‘t teach adaptive skills  Limit human rights and dignity  Don‘t address the function of the behaviour  Have inherent risks for people with disabilities themselves  May result in injury to others There is evidence for:  Functional assessment of behaviour  Improving adaptive skills  Positive Behaviour Support
  14. 14. Restrictive Interventions – Chemical Restraint "chemical restraint" means the use, for the primary purpose of the behavioural control of a person with a disability, of a chemical substance to control or subdue the person but does not include the use of a drug prescribed by a registered medical practitioner for the treatment, or to enable the treatment, of a mental illness or a physical illness or physical condition (Disability Act 2006, section 3)
  15. 15. Treatment for mental illness or chemical restraint?
  16. 16. Chemical restraint reduction strategy 2007-2012 Institutions Kew Residential Services (CDDHV) [A] Wider Disability Population Mental Health/Disability Services Project (CFBS) [D] Clinicians Roundtable (RANZCP) [I] Individual Client reviews (x15) Dr Sullivan [E] Medication Matrix (CDDHV) [B] Independent Psychiatric Review (34) [C] Anti-libidinal Medications Project (CFBS) [F] Capacity Building for Area Mental Health Services (CFBS) [G] Education for Disability Support Workers (VDDS) [H] Education Modules for Psychiatrists (x3) (RANZCP) [J]
  17. 17. Chemical restraint use in shared support accommodation (Hayward et al., 2012) Antipsychotics are the most common chemical restraint for adults with intellectual disabilities in supported accommodation in Victoria. Ziprasidone Aripiprazole Haloperidol Amisulpride Olanzapine Trifluoperazine Quetiapine Zuclopenthixol Pericyazine Paliperidone 80% 60% 40% 20% 5-14 15-24 25-34 35-44 45-54 55-64 PRN Routine PRN Routine PRN Routine PRN Routine PRN Routine PRN Routine 0% PRN Daily dosage of risperidone in adults with ASD as chemical restraint much higher than in those with psychosis (Hayward & Pridding, 2012) Risperidone Chlorpromazine 100% Routine The move to second generation antipsychotic use is represented in this data however first generation antipsychotics are still widely used. 65+
  18. 18. What we know about Mental Ill-Health in Intellectual Disability • Adults with ID experience high rates of mental ill-health: prevalence approx. 40% (Cooper & van der Speck, 2009) compared with Australian general population prevalence of 20% (ABS, 2007) • Elderly people with ID have a greater prevalence of psychiatric morbidity than younger adults (Cooper, 1997) • The overall prevalence of psychiatric disorders is greater in children with ID than for peers without ID (Whitaker & Read, 2006), young people with ID have been found to have levels of psychopathology 3 to 4 times higher (Einfeld et al., 2006) • Rate of mental illness is higher in children and adults with more severe intellectual disabilities (Whitaker & Read, 2006) 18
  19. 19. Provision of Mental Health Services to People with Disabilities ―The separation of mental health from intellectual disability services has led to a serious underestimation of the prevalence of dual [disability], with clinicians ill-equipped to treat individuals‖ (Morgan et al., 2008) Little robust evidence for chemical restraint use in adults with intellectual disability (Brylewski & Duggan, 2004; Tyrer et al. (2009) 19
  20. 20. What do we know about Dual Disability? Morgan, V. A., Croft, M. L., Valuri, G. M., Zubrick, S. R., Bower, C., McNeil, T. F., & Jablensky, A. V. (2012). Intellectual disability and other neuropsychiatric outcomes in high-risk children of mothers with schizophrenia, bipolar disorder and unipolar major depression. The British Journal of Psychiatry, 200(4), 282-289. Paper suggests shared vulnerabilities... Complex familial, inherited and social variables to analyse 20
  21. 21. Cumulative Risk Factors in Behaviours of Concern and Mental Ill-Health (From: Allen, 2008)
  22. 22. Barriers to Treatment of People with Dual Disability • Lack of expertise and experience in both mental health and disability professionals • Issues in practice implementation and systems - disability support professionals inadequately trained and supported • Generally, mental health professionals are unfamiliar and untrained to support and work with persons with IQ < 50 • Wide spectrum of mental health problems in people with intellectual disability = diagnostic overshadowing ―HIT THE BALL BACK‖ - ―REVOLVING DOOR‖ PROBLEM 22
  23. 23. 23
  24. 24. Prescribing Guidelines people with an Intellectual Disability Deb et al. (2009). International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities, World Psychiatry, 8: 181-186. Autism spectrum disorders: While autism is not correlated with increased prevalence of mental health problems compared to those with ID in general, there is a greater likelihood of being on psychotropic medication and less recovery for those with problem behaviours (Melville et al, 2008) Hayward, B, (2009). A Proposed Framework for the Medical Review of Children and Young People with Autism Spectrum Disorders and Behaviours of Concern, Paper presented at Child 2009, Royal Australian and New Zealand College of Psychiatrists - Faculty of Child and Adolescent Psychiatry, Queenstown, New Zealand, 6-9 September.
  25. 25. Review of 200 random RIDS clients 200 180 160 140 120 Yes 100 No Unable to Determine 80 60 40 20 0 Pharmacist Psychiatrist Independent Reviewer
  26. 26. Payment for Psychiatric Reviews • Short term discretionary funding through justice plans etc • Paid as part person‘s ISP • Paid out of the person‘s own pocket • Medicare ▪ 10 sessions through GP surgery ▪ Assessment for mental illness ▪ Review of medication prescribed for mental illness
  27. 27. NDIS • There will be no diminution of existing clients‘ choice and control over their supports or support arrangements. • There will be no diminution of Victoria‘s quality assurance system and safeguards. • The launch will build on Victoria‘s existing engagement with mainstream services through the work of the Office for Disability and capacity building initiatives. • There will be a seamless response for clients contacting either the National Disability Insurance Agency or Victorian Government Services, including Services Connect.
  28. 28. Bouras & Holt (2009) Effective dual disability service includes: • organising services around client wishes /needs, • good interagency communication, • high level of awareness of mental health issues by support staff and primary care staff, • multidisciplinary composition, • ability to provide consultation, assessment and treatment, • provision of community-based interventions, • access to local specialist and generic community and inpatient assessment, treatment, forensic, and rehabilitation facilities, • adequate resources, • clear coordination of inputs, staff training, and measurement of outcomes.
  29. 29. A Functioning System • • • • • A unified agency or brokerage model ? Inpatient and outpatient settings Funding likely to be justified Individual care packages likely cost more than Secure Extended Care Unit placements Multiple partnerships - Policy and legislative development - Relationship development - Staffing - Capacity building 31
  30. 30. Conclusion • The history of treatment of those with intellectual disability has deprived a vulnerable group of good care • Dual disability exposes gaps in both health and disability • The forensic / justice / complex care system is plugging the gap, but... ... Poor service delivery is costly and inhumane ... A fundamental change is urgently needed Will NDIS help or hinder?
  31. 31. References • • • • • • • • • • • • • • • • Allen, D. (2008). The relationship between challenging behaviour and mental ill-health in people with intellectual disabilities, Journal of Intellectual Disabilities, 12(4): 267-294. Australian Bureau of Statistics (2007). National Survey of Mental Health and Wellbeing: Summary of Results. ABS Cat No. 4326.0. Canberra: ABS Borthwick-Duffy, S. (1994). Prevalence of destructive behaviours: a study of aggression, self-injury and property destruction, in T. Thompson & D.B. Gray (eds) Destructive Behaviour in Developmental Disabilities, Thousand Oaks, CA: Sage. Bouras, N. & Drummond, C. (1992). Behaviour and psychiatric disorders of people with mental handicaps living in the community, Journal of Intellectual Disability Research, 36: 349-357. Brylewski, J. & Duggan, L. (2004). Antipsychotic medication for challenging behaviour in people with learning disability, Cochrane Database of Systematic Reviews, CD000377. Cooper, S. (1997). Epidemiology of psychiatric disorders in elderly compared with younger adults with learning disabilities, British Journal of Psychiatry, 170: 375-380. Cooper, S. & van der Speck, R. (2009). Epidemiology of mental ill health in adults with intellectual disabilities, Current Opinion in Psychiatry, 22: 431-436. Deb, S. et al. (2001a). Mental disorder in adults with intellectual disability I: prevalence of functional psychiatric illness among a communitybased population aged between 16-24 years, Journal of Intellectual Disability Research, 45(6): 484-505. Deb, S et al. (2001b). Mental disorder in adults with intellectual disability II: the rate of behaviour disorders among a community-based population aged between 16-24 years, Journal of Intellectual Disability Research, 45(6): 506-514. Einfeld, S.L. et al. (2006). Psychopathology in young people with intellectual disability, Journal of the American Medical Association, 296(16): 1981-1989. Felce, D. & Hastings, R.P. (2009). A general practice-based study of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities, Journal of Intellectual Disability Research, 53(3): 243-254. Holden, B. & Gitlesen, J.P. (2003). Prevalence and psychiatric symptoms in adults with mental retardation and challenging behaviour, Research in Developmental Disabilities, 24: 323-332. Melville et al. (2008). The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities, Journal of Autism and Developmental Disorders, 38: 1676-1688. Morgan, V.A. et al. (2008). Intellectual disability co-occurring with schizophrenia and other psychiatric illness: population-based study, British Journal of Psychiatry, 193: 364-372. Tyrer, P. et al. (2009). Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID). Health Technology Assessment, 13(21): 1-76. Whitaker, S. & Read, S. (2006). The prevalence of psychiatric disorders among people with intellectual disabilities: an analysis of the literature, Journal of Applied Research in Intellectual Disabilities, 19: 330-345.
  32. 32. Further Information Office of Professional Practice Senior Practitioner – Disability T. 9096 8427 E. seniorpractitioner@dhs.vic.gov.au The Disability Act 2006 and the Charter of Human Rights and Responsibilities Act 2006 can be accessed online at: www.legislation.vic.gov.au

×