The prevalence of mental illness in individuals with learning disabilities is more than double that of the general population. 1 in 6 adults with a learning disability are prescribed antipsychotic drugs to treat mental illnesses. However, over half are prescribed antipsychotics without any appropriate clinical judgement, explains Student NT editor for learning disabilites, Rebecca Hammond.
Unfortunately, the over-medicating experienced by individuals with learning disabilities is all too common.
In response to the Winterbourne View Scandal, there has been a drive to ensure that when antipsychotics are prescribed it should be appropriate, proportional, safe and in collaboration with other interventions.
Antipsychotic drugs are often prescribed to individuals with learning disabilities to manage “challenging behaviour” and are often used for their side effects to restrain individuals when their behaviours are perceived as challenging.
This has resulted in a crucial call to gather evidence of what antipsychotic drugs are being prescribed and how often, to influence a change in practice.
Many individuals with learning disabilities have difficulty in expressing themselves and their needs due to communication difficulties. Communication is a way in which we control our environment and influence others. When an individual struggles to communicate, this control is limited and as a result, an individual may display challenging behaviour and become frustrated.
If this behaviour provides the individual with what they want, the likelihood is that the behaviour will occur in the future.
“There is currently strong evidence which suggests that PBS is both a positive and proactive method for challenging behaviour”
Through professionals having a good understanding of an individual’s most effective means of communication and through consistently responding to what they believe the individual is trying to communicate, reducing the number of challenging behaviour incidences is more probable.
Positive Behaviour Support (PBS) involves the process of understanding and finding resolutions for perceived challenging behaviour, which is all based on empirical research. PBS uses a set strategies, based on research, to increase meaningful activities and decrease problem behaviours through making changes to the individual’s environment and teaching new skills.
Through participating in PBS, professionals can develop an understanding of why the individual displays challenging behaviours and what interventions are effective in preventing the occurrences.
Through PBS professionals can take a holistic approach which takes in to account all contributing factors of an individual’s behaviours and can be used to address a range of behaviours from aggression to social isolation.
There is currently strong evidence which suggests that PBS is both a positive and proactive method for challenging behaviour. PBS is positive because through ‘reinforcement’ it increases and strengthens helpful behaviours (punishment or negative consequences are not used to reduce challenging behaviours).
“Yes, medication can manage crisis situations short term, however, use long-term is detrimental and inattentive”
PBS’s proactivity is demonstrated through anticipating challenging behaviour incidences and preventing them from happening, rather than only reacting when incidences occur.
PBS involves professionals going through a process and this is typically written in a support plan. Collaboration and consultation with the individuals involved are of priority. This is because everyone has the distinctive knowledge to contribute to the understanding of the situation and develop and implement strategies of consistency, once they have been agreed.
As a team, professionals assess the individual’s strengths, abilities, quality of life and support needs and assess how well these are being met. Through the assessment, process professionals can identify what support services/ interventions could be put in place to improve the individual’s quality of life.
Professionals will also participate in an investigation into challenging behaviour which is often completed through data collection and observation. The information gathered is reviewed to aid an understanding of why a challenging behaviour is repeatedly occurring. This is an essential process to enable agreeable strategies.
After the assessment is complete, PBS formulates a support plan with varied components. These components include: creating an environment which promotes positive behaviours and minimises challenging behaviour triggers; reinforcing an appropriate behaviour that substitutes the challenging one; a planned response to challenging behaviour.
It is important that the PBS support plan is implemented consistently across a variety of settings and the plan’s effectiveness is reviewed and evaluated often.
So why should PBS be used? PBS uses a person-centered approach. This is done through listening to the individual, through recognition of an individual’s strengths, skills, and goals and ensuring that all treatments are best for that individual. PBS also results in positive changes via the teaching of coping mechanisms, e.g. mindfulness, and reduces the need for punishment or restrictiveness, e.g. restraint.
Yes, medication can manage crisis situations short term, however, use long-term is detrimental and inattentive. When individuals with learning disabilities are prescribed with antipsychotics, it should be collaborative with PBS, to ensure that they are only used short-term and not abused.