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Why are we still over-prescribing as a means of treating behaviour that challenges?

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Over-prescribing: yes it still happens. 

Despite numerous campaigns and interventions, over-prescribing still happens to individuals with a learning disability.

A document published by the NHS this year outlines that in England, between 30,000 and 35,000 adults with a learning disability are being prescribed behaviour-modifying medication without diagnosis of a behavioural disorder or mental health condition.

A significant proportion of these individuals are more than likely to have been prescribed this medication to modify behaviours that challenge. A person centred approach is needed to prevent over prescribing where alternative methods could be as affective, if not better.

What are the alternatives?

Dog therapy, or any kind of animal therapy is something I feel very strongly about as an alternative to drug treatments. Animals are used in many situations and their calming effects have been proven effective.

I support a number of individuals with learning disabilities who can present behaviours that challenge. Many of these individuals have been prescribed medication without a specific diagnosis of what the medication is treating, other than undesirable behaviours.

Myself and other staff members have taken our dogs and small furries to work and the impact being with an animal has had is remarkable.

”Spending time with my little puppy appeared to mellow the mood and bring real happiness”

For an individual whose mood is often heightened (despite medication), spending time with my little puppy appeared to mellow the mood and bring real happiness.

If regular contact with an animal makes an individual feel calm, happier and reduces undesirable behaviours then isn’t this a better and much more person centred approach to care? Yes, animals aren’t for everyone and as a therapy this won’t work for some individuals, but for those that it does work for, it should be considered an option before giving medication.

What are behaviours that challenge?

Many behaviours that challenge do not stem from a behavioural or psychological condition.

Causes tend to be individualised circumstances such as communication difficulties, physical health issues and/or environmental factors such as a restrictive social environment.

”Us learning disability nurses need to be pushing for change”

Uncontrolled diabetes is a physical health condition that can influence an individual’s behaviour. Experiencing hypoglycaemia or hyperglycaemia on a frequent basis will play havoc with an individual’s mood, hence the possibility of displaying behaviours that challenge.

This is a situation where prescribing behaviour modifying medication would be inappropriate and ineffective. An alternative therapy such as changes to diet and increased exercise accompanied with the correct medical interventions would be better suited.

Alternative therapy for behaviours that challenge do not have to be extravagant, but they do need to suit the individual. Anything can be a therapy if it is used to make beneficial changes to life, health and wellbeing.

”Anything can be a therapy if it is used to make beneficial changes to life, health and wellbeing”

Us learning disability nurses need to be pushing for change to the types of treatment received by those we support. Not only is medication inappropriate to use for treatment in people without a specific diagnosis, it is expensive and when it doesn’t work the dose is increased as are the associated risks.

I am a real believer that we don’t need as much medication as we use. I will always recommend alternative therapies where it is appropriate, and once my little puppy is a year old she will be going for assessment to be a volunteer therapy dog, helping to change the approach to learning disabilities with me.


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