People with challenging behaviour should only be hospitalised as 'last resort', says NICE

People with challenging behaviour should be only be treated in a mental health hospital or a residential setting as a last resort, according to new draft NICE guidelines.

According to the guideline committee, this significant group of the population often face unnecessarily long hospital stays or are admitted to hospitals tens of miles away from friends and family. The new draft guidelines are an attempt to stem these admissions by providing better home care for those who often require more community support due to the side effects of their challenging behaviours.

Jonathan Senker, chief executive of VoiceAbility and chair of the guideline committee, said: “Our draft guidelines recognise that some people with learning disabilities and behaviour that challenges are not receiving the care they deserve. Good, specialist support in the community is often lacking and this can make life for people and their families extremely difficult.

“They can find themselves in a crisis and admitted to hospital as an inpatient. We want services to provide better support in the community to break this disruptive pattern of care.”

An estimated 1.2m people in England have a learning disability, and 10-17 per cent of these behave in a way that challenges, according to the report by NICE.

A description of ‘challenging behaviour’ in the NICE draft guidelines is: ‘Behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit or delay access to and use of ordinary community facilities’.

It is this 'challenging behaviour' which causes individuals to face difficulties living within the wider community. Kicking, biting and other such aggressive acts mean that individuals are often referred to residential care or hospitals.

One of the key components of the new guidelines is the assignment to each individual of a ‘named worker’ from the community learning disability team, whose role it is to make sure people can choose how and where they want to live.

It is hoped that this move towards more coordinated care for those displaying challenging behaviour will result in a reduction of mental health hospitals admissions or stays in residential homes for this population group.

Where someone is eventually admitted, the guidelines stress that local authorities and NHS bodies should make sure that the hospital or residential home is as close as possible to where they live.

NICE also wants local authorities to appoint a lead commissioner to ensure that the right support is made available.

Professor Gillian Leng, director of health and social care and deputy chief executive at NICE, said: “We know that services for people with learning disabilities, and their families, can be hugely difficult to navigate.”

“Providing better and local support will ensure that someone who needs treatment doesn’t have to be away from home. Our advice, once final, will set out how services can deliver good care to meet their needs.”

The draft guidance can be found at https://www.nice.org.uk/guidance/gid-scwave0770/documents/draft-guideline. It is out for consultation until 20 November. Stakeholders and members of the public are invited to comment on the proposed recommendations