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Drug overuse for learning disability patients 'must be tackled'


NHS England has committed to “rapid and sustained” action against the over-prescribing of psychotropic drugs for people with learning disabilities, after research found a high level of their inappropriate use, particularly in primary care settings.

Medication is often being given both in the absence of the patient having any symptoms indicating the relevant condition and also as a way to manage challenging behaviour, according to the research.

“In a significant number of cases medication appeared to be prescribed primarily to manage behaviour that was perceived as challenging”

NHS England

In a letter to professionals and patients, NHS England officials have promised to tackle these problems through an action plan similar to that which was used for reducing inappropriate antipsychotics use among dementia patients.

But a learning disability care expert has claimed NHS England’s plans will be hampered unless the specialist nurse workforce is significantly boosted to help provide alternative therapy to medication and questioned how quickly change could be delivered.

A Public Health England study of 29,000 patients estimated on a national basis that local GPs are prescribing antipsychotic and antidepressant drugs for up to 35,000 patients without any record of them having a condition that justifies its use.

Meanwhile, preliminary findings from Care Quality Commission research looking at 796 patients in private and NHS hospitals that required a second opinion for medication have shown similar results.

“Over half of the prescriptions did not overtly match the accepted indications by reference to the diagnosis,” said NHS England officials in their letter laying out the findings.

“In a significant number of cases medication appeared to be prescribed primarily to manage behaviour that was perceived as challenging rather than for symptoms of mental illness,” they added.

“If you have a reduced specialist healthcare workforce…it’s hardly surprising that busy GPs choose [to prescribe this medication]”

Bob Gates

Bob Gates, professor of learning disabilities at University of West London, described the results in both settings as “worrying” and commended NHS England for commissioning the research and revealing the extent of problems.

Inappropriate prescribing within inpatient services was the “most distressing” to see, due to the presence of specialist healthcare professionals who should be “acutely” aware of the importance of correct prescribing, he said.

Meanwhile, he warned that the problem would not be solved in community settings solely by a clampdown on the use of psychotropic drugs.

Specialist learning disability nurses have been “tumbling” for years and more would be urgently required to reduce incorrect prescribing and offer alternative therapeutic care, said Professor Gates.

“If you have a reduced specialist healthcare workforce able to provide the correct advice then it’s hardly surprising that busy GPs choose an option – however inappropriate it might seem – that helps patients manage things and get on with their day to day lives,” he said.

“It is crucial we build our evidence of what drugs are being used to manage behaviour and how often to support a change in practice”

Gyles Glover

Professor Gates said that inappropriate use of drugs for learning disability patients had been know n for more than 40 years and questioned whether NHS England would be able to deliver rapid action.

“There is nothing new here so to imagine it is going to be addressed in a short period of time is overly optimistic,” he added.

Gyles Glover, consultant in public health and co-director of the learning disabilities team in Public Health England, said: “Psychiatric drugs are often given to people with learning disabilities to try and manage challenging behaviour.

“These drugs have important side effects, but the evidence that they are effective is limited,” he said. “Services are overstretched and care is demanding, so we understand how the use of these drugs can be considered normal or necessary.”

He added: “It is crucial that we build our evidence of what drugs are being used to manage behaviour and how often to support and guide a change in practice.”


Readers' comments (4)

  • Nothing new then

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  • This is a problem that has existed for many years and for many people. It's never appropriate to treat one person for the benefit or convenience of another - whether that's a dementia patient, someone with a learning disability or a schoolchild. Any treatment must be for the benefit of the individual concerned.

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  • Is it crucial that we build evidence of what drugs are being used to manage behaviour?

    This is just reinventing the wheel. Both people with learning disability and this suffering dementia are unnecessarily subjected to this ineffective but damaging "treatment." We already know how to use person centred care and behaviour modification techniques alongside educational and leisure activities to get the best out of people and the best for them. We just do not put it into practise. Research has already been done regarding how to meet challenging behaviour sensibly and as far as possible, kindly.

    Always we must first think best interest OUTCOMES for our service users, not messing about for more years while they suffer the side effects you mention.

    It's not just more training for nursing and care staff that's needed in these residential settings. It's the will and education of ignorant managers who can be the ones ensuring the foolish withholding of funding in these settings because whilst these people (often doctors) may gain extra accounting qualifications, they remain utterly uncomprehending of how to deliver full time, permanent care in a residential setting and they lead providers astray with the blessing of the equally ignorant Whitehall mandarins. Then they stupidly wonder why there's a problem finding and keeping nurses!

    The delivery of person centred care, using adequate care plans and documention with sound communication amongst all, especially the user, is what works. These service users are not the most skilled at verbal communication which is where the observational and reporting skills of those looking after them come into it.

    Using these drugs in all but the most physically dangerous situations is very simply bad nursing and bad management. (Yes, I have worked with those who have very challenging behaviour and it's very rewarding work when you get it right.)

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  • I think another problem here is the significant huge number of people with LD who are not known to services. We still don't know many people actually have LD so in some cases primary care will be treating them in the absence of this knowledge. Many people with mild and borderline LD are passing under the radar...we need to be better at screening. we should be using the HASI as standard in my view

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