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medications 1June 8 2016

Doctors are being asked to review their prescribing of medicines for people with learning disabilities and/or autism, to help tackle the problem of ‘chemical restraint’.

NHS England has published a resource identifying the size and nature of the problem, as well as advice on how best to reduce inappropriate use of psychotropic drugs. It estimates 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant, or both, without clinical justification.

Working with the Challenging Behaviour Foundation (CBF), it has also invited representatives of national professional bodies to pledge “sustained action to tackle the over-prescribing of psychotropic drugs to people whose behaviour is challenging.”

Those lending support to the campaign by signing the Stopping Over-Medication of People with a Learning Disability (STOMPLD) pledge include representatives from the Royal College of General Practitioners, the Royal College of Psychiatrists, the British Psychological Society, the Royal College of Nursing, and the Royal Pharmaceutical Society.

“Multiple psychotropic drug use often starts at a specialist level, which is then passed onto primary care for long-term management. Research published last year found that, in too many cases, these prescriptions are repeated without adequate review,” said NHS England.

Professor Sir Bruce Keogh, NHS England’s National Medical Director, added: “Reducing use of powerful drugs whenever we can is a good thing. We have managed this successfully in dementia; it’s now time to bring similar benefits to patients who have a learning disability.”

Dr Matt Hoghton, Medical Director for the RCGP Clinical Innovation and Research Centre, said: “Working collaboratively between healthcare professionals and carers is really important in tackling the appropriate use of psychotropic drugs in our patients with learning disabilities, and signing this pledge today is an important commitment to ensuring they receive the best possible care.

“Whilst GPs rarely initiate these medications, they have a key role to play in reviewing and ensuring our patients with learning disabilities are only taking drugs if they need to, and that their records indicate why they are taking them, so this guidance is welcome.”

The STOMPLD initiative has flagged up recent data which indicates that:

• there is a much higher rate of prescribing of medicines associated with mental illness amongst people with a learning disability than the general population, often more than one medicine in the same class, and in the majority of cases with no clear justification;
• medicines are often used for long periods without adequate review; and
• there is poor communication with parents and carers, and between different healthcare providers.

Dr Ashok Roy, Chair of the RCPsych’s Intellectual Disability Faculty, said: “Overmedication has been found to be a problem faced by some people with learning disability who are prescribed psychotropic drugs without clear evidence of a mental illness, but more for the management of behaviour problems.

“This needs to change, and as part of this we will support evidence-based prescribing, improved monitoring, greater use of psychological and environmental interventions, and a program of medication reduction or discontinuation wherever possible.”

Professor Peter Kinderman, President of the British Psychological Society, added: “Used appropriately and well supervised, these drugs can play an important role in helping people get through what can be really tough points in their lives and the lives of their families.

“However, they should never be the first option without considering alternatives, or used continually without checking that the individual is still benefiting from them. The BPS is pleased to join this call to action and play our part in tackling this long-term inequality in care for people with learning disabilities.”

Links:

NHS England announcement

NHS England STOMPLD resource

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