New guidance has been launched to support prescribing healthcare professionals to review inappropriate prescriptions for people under their care who have a learning disability and/or autism.
The toolkit comes as NHS England and Alistair Burt MP, Minister of State for Community and Social Care, joined forces with 5 professional bodies and the Challenging Behaviour Foundation to pledge sustained action to tackle the over-prescribing of psychotropic drugs to people with learning disabilities and/or autism whose behaviour is seen as challenging.
Multiple psychotropic drug use often starts at a specialist level, which is then passed onto primary care for long-term management. An estimated 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification. Long-term use of these drugs can lead to significant weight gain, organ failure and, in some cases, death.
The Learning Disability Census 2015, which surveyed some 3,000 people with learning disabilities receiving inpatient care, found that 72% had received antipsychotic medication, yet only 28.5% were recorded as having a psychotic disorder.
In addition, research commissioned by NHS England and delivered in three reports from the Care Quality Commission, Public Health England and NHS Improving Quality last year found that there is a much higher rate of prescribing of medicines associated with mental illness among people with a learning disability than the general population. Often more than one medicine prescribed is in the same class – in the majority of cases with no clear justification – and are often used for long periods without adequate review. Finally, there is poor communication with parents and carers, and between different healthcare providers over prescriptions.
The Stopping Over-Medication of People with a Learning Disability (STOMPLD) pledge has been signed by the Royal Colleges of Nursing, Psychiatrists and GPs, as well as the Royal Pharmaceutical Society, the British Psychological Society and NHS England at a summit in London. It commits each to “work together, and with people with a learning disability and their loved ones, to take real and measurable steps to stop over-medication”, and is intended to mark the beginning of a series of actions by the signatories over the coming months.
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The new pamphlet, co-designed by NHS England and the Royal College of GPs, will support and encourage family doctors and their teams to review prescriptions of people on their patient list, and ensure that psychotropic drugs are only continued where the person poses a severe risk to the safety of themselves and others, and all other alternatives have been exhausted.
Professor Sir Bruce Keogh, NHS England’s national medical director, said: “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 Royal College of GP’s Clinical Innovation and Research Centre, added: “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.”
Dr Ashok Roy, chair of the Intellectual Disability Faculty at the Royal College of Psychiatrists, said: “Overmedication has been found to be 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.”
Annie Norman, Royal College of Nursing professional lead for learning disabilities and criminal justice said: “The RCN has repeatedly highlighted that people with learning disabilities are still being failed by the health care system. It is simply not acceptable that people with a learning disability are being prescribed anti-psychotic drugs without appropriate clinical justification.
“Learning disability nurses are highly skilled nurses who care and treat people with complex mental and physical needs and can support people without automatically relying on medication by using a whole host of interventions.
“This pledge should be an opportunity for health and medical professionals to work more closely together to provide a more person centred approach to the care of people with learning disabilities, to give them a better quality of life. People with learning disabilities deserve and expect so much better from their health service.”
Individuals and their loved ones who are concerned with a current prescription are encouraged not to stop taking medication immediately, but to consult their doctor or supervising clinician.