New guidelines issued to prevent overmedication of people with learning disabilities

Families and carers of people with learning disabilities with behaviour that challenges, could benefit from a new quality standard to help them receive the personalised care and support they need, when they need it most.

The new standard, issued by The National Institute for Health and Care Excellence (NICE) is aimed at preventing overmedication with antipsychotics and ensuring people with learning disabilities receive care that is personalised to them.

Commenting on the new quality standard, deputy chief executive and director of health and social care for NICE, Professor Gillian Leng, said: “All too often people with a learning disability and behaviour that challenges are given antipsychotic medicines, rather than properly addressing the sometimes complex interplay of environmental and individual factors that can be at the root of such behaviour.

“The NICE quality standard focuses on ensuring that an assessment of both the overall health of people with a learning disability, and of the behaviour that challenges, is carried out which then leads to personalised care planning and access to meaningful activities. The quality standard aims to ensure that the approaches used by staff to support people with learning disabilities follow the least restrictive practice and promote privacy and dignity.”

Challenging behaviour can serve a purpose for someone with a learning disability, by attracting attention, producing sensory stimulation and communicating with others.

Behaviour can create interaction within empty or restrictive environments, resulting in aggression, self-injury, stereotypical behaviour (such as rocking or hand flapping), disruptive or destructive behaviour and withdrawal.

People with learning disabilities and communication difficulties, sensory impairment, autism, physical and mental health problems ¬– including dementia are recognised as being most likely to display behaviour that challenges.

The NICE quality standard contains eight statements aimed at helping staff to support people with learning disabilities, including:

• People with a learning disability have a comprehensive annual health assessment from their GP.

• People with a learning disability and behaviour that challenges have an initial assessment to identify possible triggers, environmental factors and the function of the behaviour and establish why the individual is behaving in a particular way.

• People with a learning disability and behaviour that challenges have a designated person responsible for coordinating the behaviour support plan and ensuring that it is reviewed.

• People with a learning disability and behaviour that challenges only receive antipsychotic medication as part of treatment that includes psychosocial interventions.

In Mencap’s 2013 ‘Out of Sight’ report, services aimed at people with learning disabilities were described as ‘fragmented, at times ineffective and unresponsive to family needs’. Professor of Clinical Psychology and Disability at the University of Kent and specialist member of the committee which developed the quality standard, Glynis Murphy, said: “Very often behaviour that challenges develops in childhood and results from a combination of personal characteristics (such as poor communications skills or autism, in addition to learning disabilities) and aspects of the environment (such as a barren or restrictive environment).

“People with such behaviour need early functional assessments and behaviour support plans, but they often receive too little service, too late, and families and care staff are not often offered the training they need in basic behavioural methods. This quality standard highlights what is needed to drive measurable improvements to the lives of people with learning disabilities and their families.”

Around five to fifteen per cent of behaviours found in educational, health and social care services for people with learning disabilities are difficult or upsetting to others.

These rates are significantly higher in young adults and people in their early 20s in specific settings with 30-40 per cent of behaviour that challenges being found in hospital environments.

The quality standard recognises the need to support those who provide care for people with learning disabilities and behaviour that challenges. It is hoped the new NICE quality standard will ensure those who need help, receive enough help, early enough in order to prevent overmedication with antipsychotics, disengagement from healthcare professionals and out-of-area placements.

To read the quality standard, visit: www.nice.org.uk/guidance/QS101