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2 Mar 2026, by Amy Sarcevic
Psychotropic medications have long been used in residential aged care homes (RACH), but updated rules around ‘why, how, and to whom’ they are administered have left some providers unclear on their appropriate usage.
RACH Chief Medical Officer Dr Simon Grof say that, while the sentiment behind the new “rights-based” approach to psychotropic administration is clear, its enactment in real-life settings remains complex.
So much so, that in his role at Jewish Care, Grof has seen discrepancies in how psychotropics are managed between different healthcare touchpoints.
“I’ve seen patients with dementia who have mild behavioural dysfunction being discharged from emergency departments with a psychotropic script, and when that patient returns to their facility, staff are not clear on why or when the medication should be administered, if at all,” he said ahead of the Aged Care Reform Forum.
Formerly, this lack of clarity might not have mattered from a legal standpoint, as guidelines around psychotropic administration were more relaxed and largely left to the discretion of RACH staff.
However, these “restrictive practices” were scrutinised during the Royal Commission into Aged Care Quality and Safety, where it was alleged they were being overused and not always carried out in residents’ best interests.
Indeed, a review found that 13-42 percent of people in Australian RACH were prescribed psychotropics, with The Australian Government’s Aged Care Clinical Advisory Panel estimating that only 10 percent of uses were justified.
Now, the intent of psychotropic administration matters from a legal perspective, and RACH providers must uphold rigorous guidelines to ensure they are only used in justified contexts.
Complex definition
However, psychotropic medications vary widely and Grof says there is often confusion around which patient presentations warrant which drug variety.
In Australia, three psychotropic medications are commonly used. Some, like risperidone, are prevalent in residential aged care. Other varieties are used to aid sleep or treat depression in the broader population.
“It’s a wide-ranging medication in terms of functionality,” Grof said. “Broadly speaking, it’s any drug that can affect the mind, emotion and behaviour.
“But it’s not necessarily the medication that matters – it’s more about the intent of prescribing it to affect someone’s behaviour or way of being.”
The complication is that providers must discern when the psychotropic is being used as a chemical restraint.
Usually, this definition is met when the medication is prescribed for the primary purpose of influencing a care recipient’s behaviour. But Grof says some forms of usage fall into a grey area.
“If you diagnose a medication for a mental disorder or end of life care, then it’s not considered a chemical restraint, but, truthfully, I find the whole thing difficult to explain, and I deal with this nearly every day. So, for providers on the floor, and visiting GPs, it can be even more difficult.
“Sometimes the providers are incorrectly hearing a medication is prescribed for, let’s say, nausea, but it does have some sedative effects and they’re asking the general practitioner, hey, you need to fill out a restrictive practice form because it’s a chemical restraint. And the GP will say, ‘no, I’m prescribing it for nausea. I shouldn’t have to say what I’m not doing it for.’ So, it gets a bit messy at times.”
Gaining consensus
To get everyone on the same page, Grof says it pays to remember why the legislation was introduced.
“It’s all about that shared decision-making and informed consent. Making sure that, if you’re prescribing a psychotropic and using it as a chemical restraint, then you’ve exhausted all other non-pharmacological options.
You’ve informed the individual, you’ve informed their substitute decision maker, if appropriate; you’ve communicated clearly and documented thoroughly.
“Digging deeper, making sure we are working for the person in front of us, and that we’ve gone through all the necessary checks and balances to make sure that we’re doing this in their best interests. At the end of the day, we’re all here for the same reason – the residents. We now just need to make sure we are using a more rigorous clinical governance lens.”
Grof also says open dialogue between prescribers and providers can go a long way – something he tries to facilitate in his role as an RACH Chief Medical Officer.
“For me, it’s a matter of communication and respect between all parties. I try to bridge that gap by educating GPs about system-wide clinical issues and then acting as that middle person to smooth the waters if any issues arise.”
Further insight
Sharing more of his views and advice on psychotropic usage in RACHs, Dr Simon Grof will present at the upcoming Aged Care Reform Forum, hosted by Informa Connect.
This year’s event will be held 28-29 April at the Crown Conference Centre Melbourne.
Learn more and register your tickets here.
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