News

GPs told to end “chemical restraint” of people with learning disabilities

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3137 (Published 03 June 2016) Cite this as: BMJ 2016;353:i3137
  1. Anne Gulland
  1. London

GPs have been urged to cut the number of inappropriate prescriptions of psychotropic drugs for people with learning disabilities.

New guidance from NHS England and the Royal College of General Practitioners encouraged GPs to review prescriptions for patients with learning disabilities or autism, and make sure that psychotropic drugs were only continued where the person posed a severe risk to themselves or others, and all other alternatives had been exhausted.1

According to a review of the prescribing of drugs to people with learning disabilities published last year, between 30 000 and 35 000 people were taking either an antidepressant or an antipsychotic without having the conditions for which they are indicated.2

Patients were prescribed the drugs when they were seen as being difficult to manage. Long term use of the drugs could lead to weight gain, organ failure, and even death.

Guidance from the National Institute for Health and Care Excellence said that specialists should only prescribe psychotropic medication to manage challenging behaviour if psychological or other interventions did not produce change in an agreed time; treatment for any coexisting problem had not led to an improvement in behaviour; or the risk to the person or others was severe.3

The new guidance urged GPs to undertake a number of steps, including appointing a GP lead, obtaining details of all people with a learning disability on psychotropic medication, and checking if attempts at drug reduction or withdrawal had already been made.

Alistair Burt, minister for community and social care, NHS England, and the Royal Colleges of GPs, Psychiatrists, and Nursing joined forces to sign a pledge to stop overmedication of people with a learning disability.

Patients were usually seen by specialists, who initiated the prescription of psychotropic drugs, and were then passed to primary care. However, Public Health England found that there was inadequate review of patients.

Matt Hoghton, medical director for the Royal College of General Practitioners’ Clinical Innovation and Research Centre, said, “While GPs rarely initiate these medications, they have a key role to play in reviewing and ensuring our patients with learning disabilities are only taking drugs if they need to, and that their records indicate why they are taking them, so this guidance is welcome.”

Dan Scorer, head of policy at Mencap, said that it was time that the “culture of chemical restraint” was ended. He added, “Families tell us time after time that their loved one has been given high levels of antidepressant or antipsychotic medication to make their behaviour easier to manage rather than spending time to understand their needs. They report the serious side effects from these drugs and the lack of evidence that the medication is helping.”

References

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