People with learning disabilities 'over-medicated' with anti-psychotic drugs

People with learning disabilities are regularly ‘over-medicated’ with anti-psychotic drugs, according to a study by Public Health England.

The report ‘Prescribing of psychotropic drugs to people with learning disabilities and/or autism by general practitioners in England’ found one in six adults with a learning disability are being prescribed anti-psychotic drugs, which are normally used to treat major mental illnesses.

Over half of these adults do not have a recorded diagnosis of major mental illness and so are wrongly being prescribed the drugs.

Gyles Glover, consultant in public health and co-director of the learning disabilities team in Public Health England (PHE) said: “Psychiatric drugs are often given to people with learning disabilities to try and manage challenging behaviour. These drugs have important side effects, but the evidence that they are effective is limited.

'Used more widely than is appropriate'

“Services are overstretched and care is demanding, so we understand how the use of these drugs can be considered normal or necessary. However, the report, which is the first of its kind, suggests that psychiatric drugs are used more widely than is appropriate and this comes with risk. It is crucial that we build our evidence of what drugs are being used to manage behaviour and how often to support and guide a change in practice.”

The report revealed that over half of the people being given anti-psychotic drugs did not have a diagnosis in their GP record of a condition which they are designed to treat, including psychosis, bipolar disorder, depression and anxiety.

The PHE report is one of three exploring the use of anti-psychotic drugs by people with learning disabilities.

The other two reports which also highlighted the need for change, were by the Care Quality Commission and NHS Improving Quality. These found that medicines are often used for long periods without adequate review and there is poor communication with parents and care workers, and between different healthcare providers.

NHS spearheads 'call to action'

NHS England has sent out letters to patients and doctors urging prescriptions be reviewed, and promised to spearhead a ‘call to action’ to tackle these problems, similar to that which has been so effective in reducing the inappropriate use of antipsychotics with dementia patients.

Dominic Slowie, NHS England’s national clinical director for Learning Disabilities, said: “This is a historic problem, but one that nobody knew the true scale of; that’s why we worked with patients, carers and professionals to get to the bottom of the issues once and for all.

“These medicines can be helpful when used appropriately and kept under review, but the prevalence and the lack of review or challenge that these reports have highlighted is completely unacceptable, and we are determined to take action to protect this group of patients from over-medication.

“While no specific research has been undertaken on the physical health implications of long-term use of such drugs on people with learning disabilities, past studies looking at patients with schizophrenia and dementia highlighted significantly increased risk of movement disorders, anticholinergic effects, stroke and death.”

However he warned: “Individuals and their loved ones who are concerned with a current prescription are encouraged not to stop taking medication immediately, but to consult their doctor or supervising clinician as soon as possible.”

Drugs should not be prescribed as 'matter of course'

Dr Maureen Baker, chair of the Royal College of General Practitioners (RCGP) welcomed that “NHS England have recognised that the majority of anti-psychotic and anti-convulsant drugs are prescribed by specialist doctors and that on occasions when GPs do prescribe these drugs, patients are still in specialist care”.

She added: “Psychotropic drugs can have benefits for some patients with learning disabilities, it is important that every patient is taken on a case by case basis and not simply prescribed drugs as a matter of course.

“It is also important that the principle of prescribing the lowest possible dose for the shortest possible time, which doctors generally follow in their everyday practice, is applied to all patients – including those with learning disabilities - when dealing with drugs associated with mental health – and that these prescriptions are regularly reviewed.

“Prescribing drugs appropriately is something that GPs take incredibly seriously – and supporting family doctors and their teams to do this is a priority for the RCGP.”