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10th August 2015

Medication for people with learning disabilities in care

Medication in care for people with learning disabilities

The NHS in England has released a circular, expressing concern about the over-medication of people with learning disability .

In the wake of the Winterbourne View abuse investigation in 2012, staff were convicted and some imprisoned for abuse of the patients at a private hospital. A Department of Health follow up to this scandal noted that there was significant 'over-use of anti-psychotic and antidepressant medicines', with potential long term harmful effects for people with learning disability.

The NHS has noted that possibly 20% of people receiving these medicines long-term may develop adverse conditions as a result, including movement disorder, neurological difficulties and weight gain. Stroke and heart attack risks may also increase.

NHS England has overseen three studies of this issue. Public Health England (PHE) looked at the use of medicines in primary care: NHS Improving Quality (NHS IQ) looked at six sites where alternative approaches were tested, and the Care Quality Commission (CQC) audited information on 2nd doctor opinion on medicines used by people detained under the Mental Health Act.

Results of the studies on over-medication

The results were concerning and, in some cases, I believe shocking. The PHE study found that '58% of adults receiving antipsychotics and 32% of those receiving antidepressants had no relevant diagnosis recorded' and '...between 30,000 and 35,000 adults' had no clinical indications of the need for these medicines. 'This is 16.2% of the adult population known to their GP as having a learning disability.'

The scale of prescribing exceeded the known prevalence of illnesses the medicines were designed to treat.

The NHS IQ study found many positives, but also concerns about communication: families, carers and patients did not always know why medicines had been prescribed.

The CQC study found that more than half of the prescriptions appeared inappropriate, and in many cases were to control behaviour rather than to treat illness. Inappropriate use of medicines in treating autism was also identified.

The future

NHS England has concluded that there is significant inappropriate use of powerful medicines in treating people with learning disabilities. They are organising an 'urgent action summit' to look at the problem. Given the slow progress on some of the other problems seen in the Winterbourne investigation, we hope that the urgency of this problem will be recognised.

There is a role too for individual care services: training for staff and carers in positive behaviour support, in alternative approaches, and advocating that medication is regularly and thoroughly reviewed for appropriateness are important courses of action that can easily be taken.

Tony Clarke – QCS Expert Scottish Care Contributor

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