The news that people with learning disabilities are being prescribed anti-psychotic medication inappropriately reminds me of the ‘chemical cosh’ situations of the bad old days. We need to ask questions as to why these medicines are used.
A study published in the British Medical Journal this month has revealed that a worrying number of people with learning disabilities have been prescribed medicines designed for mental health problems that they did not have. Of over 33,000 subjects reviewed, some 9,000 had been prescribed anti-psychotic medication; 71% of these had never been diagnosed with psychotic illness.
Prescribing of this type of medication is significantly higher in people with learning disabilities than in the general population, with frequent use of more than one drug in place. Moreover, medicines are used for long periods without review and without clear understanding of side effects and contraindications.
Use over time
Once prescribed, the risk is that the side effects of drugs like these can create longer-term health problems for the user. Without the ability to recognise physical or mental changes and report them, these can go unchecked for many years. There is no evidence to suggest that the use of anti-psychotic and sedative drugs has any effect on the management of challenging behaviour, other than the initial anxiety reduction and general lethargy they create.
There are reasons, of course, for the use of this type of medication in cases of challenging behaviour. When faced with a difficult patient whose behaviour is impacting on others or causing them potential harm, the immediate sedative effect of drugs like these will provide a quick solution. Many families rely on the GP to help them with what can be a desperate situation. They have few other options and the GP has few other resources.
Positive Support versus Chemical sedation
The treatment of choice should be around dealing with the causes of the behaviour and using a team approach based on positive support. Unless we are able to quickly refer people with challenging behaviour for help and support through alternative means, we are placing them and their carers in a situation where they have no option but to accept drug treatment.
The study suggested that the cost of providing person-centred therapeutic support for challenging behaviour was expensive and unavailable, but the continued use of repeat prescriptions of expensive medications must be equally costly.
Of course, it’s not safe to suddenly stop taking drugs that have been used for some time with people who have challenging behaviour and this course of action should be avoided. However, research published as far back as 2000 found that people on long-term regimes of drug therapy for challenging behaviour could have their medicines reduced without risk of deterioration.
NHS England has promised ‘rapid and sustained action’ to tackle the over-prescribing of psychotropic drugs to people with learning disabilities. In the meantime, reviewing the prescription, effectiveness and use of all medications for service users in our care should be central to the care plan. Look at asking the GP to review anyone you know who has been using psychotropic or sedative drugs for a long period, particularly if they came into your care with this prescription.
Read the report on prescribing psychotropic medication for people with learning disabilities here.
Ginny Tyler – QCS Expert Learning Disabilities Contributor
