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Nearly 70% of LD patients in specialist units on anti-psychotics

Anti-psychotic medication is given to more than two thirds of inpatients with learning disabilities in specialist units, a census has shown.

It also found that over half (56.6%) of the patients had experienced an “incident” during the three months preceding the census date such as self-harm, an accident, physical assault on the patient, hands-on restraint or seclusion.

The findings are the result of further analysis of the 2013 Learning Disability Census commissioned in response to events at Winterbourne View Hospital and have been published by the Health and Social Care Information Centre (HSCIC).

“This is an important contribution to understanding how episodes, such as those at Winterbourne View, can be avoided in future”

Kingsley Manning

They are based on survey responses received from 104 – 58 NHS and 46 private – provider organisations in England on behalf of 3,250 service users in September last year. The patient group included people with learning disabilities, autistic spectrum disorder and/or behaviour that challenges.

The census shows that 68.3% (2,220) of the inpatients had been given anti-psychotic medication in the 28 days leading up to census day. Of these, 93% (2,064) had been given the medication on a regular basis.

Proportionally more people belonging to black and minority ethnic groups had been given these drugs on a regular basis than in white ethnic groups − 72.6% (284 out of 391) compared with 61.8% (1,682 out of 2,720).

Of the 56.6% (1,841) of patients who had experienced an “incident”, more women experienced every type of incident than men.

The HSCIC also said there appears to be an association between hands-on restraint and the administration of anti-psychotic medication − 40% (889) of the 2,220 given these drugs had experienced at least one instance of hands-on restraint compared to 21.5% (221) of the 1,030 who were not given any of this medication.

Some 78% (2,536) of service users were subject to the Mental Health Act 1983 on census day, compared with 22% (714) who were classified as informal patients.

Of those subject to the Act, 99.5% (2,524) were subject to “longer term hospital orders” − a duration greater than 72 hours.

The census found 46.4% (1,508) of service users were in receipt of an active care plan without a discharge plan in place. Around 4.7% (152) were experiencing a delayed transfer of care.

Care of 86% (2,795) cost between an estimated £1,500 and £4,499 per week, with 37.9% (1,231) being in the £2,500-£3,499 range. For 11.4% (369), care provision was indicated to cost over £4,500 per week per person.

Some 20% (112) of service users staying in wards more than 100km from home were in high cost placements (over £4,500 per week), while 34% (208) staying within 10km from home were in placements costing under £2,500 per week.

Data was collected via the HSCIC on behalf of the Department of Health, the Care Quality Commission, Public Health England and NHS England.

The background to the census includes the BBC Panorama programme in May 2011 which reported the mistreatment and assault of adults with learning disabilities and autistic spectrum disorder at Winterbourne View Hospital, the HSCIC said.

HSCIC chair Kingsley Manning said: “The Learning Disabilities Census, and this further analysis, is an important contribution to understanding how episodes, such as those seen at Winterbourne View Hospital can be avoided in the future.

HSCIC

Kingsley Manning

“This further analysis of the census data will aid understanding of the experience of inpatients with learning disabilities nationally, and is an important benchmark.

“It is crucial that service providers have accurate data about complex issues such as these, to help them to develop their understanding and improve their services for patients. Providing this sort of data is a key role for the HSCIC.”

The HSCIC said the census will be re-run in September 2014 in order to identify change and particularly, where appropriate, reductions in inpatient care in favour of more suitable community care and support options.

 

Readers' comments (3)

  • Nowhere does this article state the percentage of these people with both learning disabilities and co morbid mental health problems. Where such dual diagnosis exist, then it is quite legitimate to prescribe antipsychotic medication. Co morbidity with both LD and Mental health is generally high.

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  • I agree Steve. I'm a student nurse with a daughter who has LD. The article is somewhat sensationlist, leaning towards inference about inappropriate prescribing of anti-psychotics. Rhyming off numbers of people on types of medication doesn't mean anything in real terms. I would have liked to see this balanced with co-morbidities taken into account. You wouldn't draw attention to how many people on a surgical ward are on opiates, as it would be expected. Having said that, if this is long term and there is inappropriate prescribing going on, there are a number of people in the chain who can be made to rationalise their clinical judgement. Headlines just dont do it.

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  • seems a high percentage of the elderly in care homes and perhaps in the community too are on anti-psychotics with a cocktail of medis.
    could be a factor associated with all sorts of problems such as poor memory, falls, lack of motivation, depressed mood, etc. and not to mention interactions with other drugs.
    should be reviewed for all patients and then those who really need them, far more regularly.

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