Stop the over medication of people with learning disabilities

david-banford(1)By David Branford, Chief Pharmacist, Derby Hospital

The nation was shocked by the Panorama expose of cruel behaviour to people with a learning disability living at Winterbourne View in Bristol. The subsequent enquiry not only raised many concerns about the care of people with a learning disability but also about the use of antipsychotics and antidepressants.

Subsequent investigations and actions took two paths. The first, a series of studies demonstrated widespread use of many categories of psychotropic drugs often in combinations. In addition there was widespread use of PRN psychotropic drugs. The second was NICE guidelines relating to aspects of treatment of people with a learning disability.
Stopping Over-medication of People with Learning Disabilities (STOMPLD) 2016 is a campaign launched by Alistair Burt today. It aims to improve the quality of life of people with a learning disability, by reducing the harm of inappropriate psychotropic drugs which are used as a “chemical restraint” in place of other more appropriate care and treatments.

The RPS has played a key role in the development of the campaign. Today Sandra Gidley, Chair of the English Pharmacy Board, along with officers of NHS England, Royal College of General Practitioners, Royal College of Psychiatry, British Psychological Society, Royal College of Nursing and other key organisations launched a key guidance for GPs from NHS England and signed a pledge on behalf of the professions and organisations to work together, and with people with a learning disability and their loved ones, to take real and measurable steps to stop over-medication.

The campaign is a ‘Call to Action’. The key message is ‘Everyone needs to make this a priority to reduce and stop the use of psychotropic drugs inappropriately, to reduce adverse effects and potential harm. This is a matter of our patients’ safety and their quality of care.

It is estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without an appropriate clinical reason. Unnecessary use of these drugs, puts people at risk of significant weight gain, organ failure and premature death.

The campaign asks ‘Is one of these 35,000 people your patient? Stop this happening and take action today. Check and review your patients immediately to ensure another day of potential harm doesn’t go by’.  It also asks for a fundamental rethink about the role of psychotropic drugs for the management of behaviours that challenge in learning disabilities.

Other key messages are adapted from the NICE guideline ‘Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’ published in May 2015.  These are:
• make psychotropic drugs the last resort
• minimise their use
• prescribe them at the lowest possible dose and for the minimum duration
• consider non-drug based management strategies
• withdrawal of the psychotropic drugs should be considered at regular intervals

People with learning disabilities are among the most vulnerable using the health service and deserve better health care.  Let’s make it happen.

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