Chemical restraint of people with disabilities and elderly people

By Blair Morris

By Blair Morris. This article is part of our October theme on disability rights. To read more on this topic, click here.

Medicating people with disabilities and elderly people is a contentious issue, particularly in situations that involve aggression. Some experts argue that medication can have a calming effect, and may help to “normalise” the individual. On the other hand, critics argue that medication only masks the symptoms; it does not address them.

The issue becomes even thornier when the evidence suggests that mental health workers may be over medicating their patients. This evidence has come in the form of a recent examination of 44 Sydney aged-care homes, in which it was found that 28 per cent of residents were being given psychotropic drugs. This is a four per cent increase from six years earlier.

There is surprisingly little discussion of the ethics of forcing mood altering substances on people in the first place

Restraint, whether it is chemical, physical, or environmental, is a limitation of a person’s autonomy and freedom of movement. Chemical restraint, as defined by the Disability Act 2006 (Vic), is “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.” In fact, any medication that is used for behavioural control is categorised as chemical restraint. Unfortunately, this potentially creates a situation in which chemical restraint can be used as a method of restricting an individual’s freedom.

This form of subjugation is most commonly used on people with disabilities. An estimated 15 per cent of people with disabilities exhibit aggressive behaviours towards themselves or others. Of these few, anywhere between 44 to 80 per cent are prescribed medication for chemical restraint.

The strongest argument against chemical restraint is that it does not treat the cause of the aggression, it only placates the individual

At face value, it seems necessary to prescribe medication to aggressive, mentally unstable persons. There are medical benefits that support its use, most prominent of which is that it is effective in removing aggression. However, amongst all the literature and debate surrounding this topic, there is surprisingly little discussion of the ethics of forcing mood altering substances on people in the first place. Rather, the tone of the debate centres on methods of minimising harm, rather than questioning the act itself.

The list of arguments against chemical restraint is far reaching. From a medical perspective, side effects include headaches, constipation, sexual dysfunction, and low blood pressure, among others. However, the strongest argument against chemical restraint is that it does not treat the cause of the aggression, it only placates the individual. Put simply, chemical restraint masks the symptoms; it does not attempt to cure them.

There is documented evidence that alternatives to chemical restraints are much more effective at treating the mentally ill, without breaching individual liberties. A British review used the case study of a woman using the pseudonym “Gill,” to highlight the ineffectiveness of chemical restraint.

Gill had been diagnosed with a form of autism, and had for many years taken psychotropic medications to subdue her behaviour. One day, a specialist recommended to her carers that they gradually reduce her medications, until she was not on any drugs at all. Initially, Gill began exhibiting signs of aggressive behaviour. This aggression was negated by increased behavioural support from counsellors, who taught Gill coping methods and alternative techniques of problem solving. Eighteen months after Gill stopped taking her medications, her carers stated that she is “a different woman, happier, more relaxed and a pleasure to be with.”

One recommendation that is constantly repeated amongst experts is to simply teach coping methods to people with disabilities. The British study that used Gill as a case study also found that the vast majority of patients taking antipsychotic medications for behavioural control were able to reduce these to a minimum, or even withdraw completely, when a patient was given environmental, social, and personal support. Put simply, treating patients with counselling and ongoing therapeutical support has been proven to be as effective, if not more so, as psychotropic medication.

Although the primary reaction is to treat illness with pharmaceuticals, based on the opinions of experts surrounding this issue, the answer may lie simply with increased human interaction. This is in keeping with the practice guidelines accepted by the American Psychiatric Association, that state “medication should never be used as a substitute for meaningful psychosocial services.”

Another alternative is to examine people with severe speech defects, and whether their frustration and aggression stems from a failure to communicate. In this instance, a speech pathologist could teach the patient new ways to communicate, giving them a greater chance to blend in with society. This has the added benefit of allowing the patient to communicate any side effects their medications.

The mental health sector could also take cues from the workplace safety industry, and introduce spot-checks on facilities using chemical restraints. These unannounced pharmacological reviews would serve as a watchdog role, as well as act as an unbiased third party in instances of dispute. In Victoria, The Office of the Senior Practitioner has been recommended for this role.

Many alternative treatment options are available. However, as with most issues of public debate, educational awareness may prove to be the most effective measure against the use of chemical restraint. Showing the public the negatives of treating people with disabilities using an abundance of medication, as well as the positives of increased counselling and social support, may prove to be the strongest method of stemming the growing trend of chemical restraint.

Blair Morris is a graduate of Monash University, where he recently completed his Master of Counter Terrorism Studies. He has travelled through over 65 countries, and is a passionate defender of human rights.