NHS promises urgent action after report reveals extent of 'inappropriate use of psychotropic drugs' in people with learning disabilities

Up to 35,000 adults are being prescribed medication without justification

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NHS England has said it will take urgent action after finding a "high level of inappropriate use of psychotropic drugs in people with learning disabilities".

A report estimated that up to 35,000 adults with a learning disability are being prescribed an anti-psychotic, an anti-depressant or both without appropriate clinical justification.

In a letter to professionals and patients, NHS England officials have urged the review of prescriptions, and promised to spearhead a "call to action" to tackle the issue.

They have also called an "urgent action summit" to bring together carers and family representatives, professionals, and other key interested parties "to agree the steps that need to be taken to reduce the inappropriate use of these medicines and improve this aspect of care in people with learning disabilities who are some of the most vulnerable people in our society".

A review found that 58% of adults receiving anti-psychotics and 32% of those receiving anti-depressants had no relevant diagnosis recorded.

 

It also discovered that 22.5% of prescriptions for anti-psychotics included more than one drug in this class - and 5.5% were for doses exceeding the recommended maximum.

Dan Scorer, head of policy at Mencap, said: "The research findings issued today by the NHS shine a light on the shocking scale of the inappropriate use of medication.

"It is simply outrageous that up to 35,000 adults with a learning disability are being prescribed an anti-psychotic, an anti-depressant or both without appropriate clinical justification."

In a joint statement with Viv Cooper, chief executive at the Challenging Behaviour Foundation, he added: "This confirms what we have heard from families time and time again about their loved ones being given high levels of anti-depressant or anti-psychotic medication, often for years.

"In many cases families report serious side effects and no evidence that the medication is helping the individual.

"Fundamental changes must now be delivered, addressing a widespread culture of 'chemical restraint', and replacing it with individualised behaviour support."

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."

NHS England said the review was prompted by three reports from the Care Quality Commission (CQC), Public Health England (PHE) and NHS Improving Quality, which found a much higher rate of prescribing of medicines associated with mental illness amongst people with learning disabilities than the general population.

They found that in the "majority of cases" there was no clear justification for these medicines.

Other key findings were that medicines are often used for long periods without adequate review and poor communication between parents and carers and different healthcare providers.

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A bottle of antidepressant pills named Effexor is shown March 23, 2004 photographed in Miami, Florida. The Food and Drug Administration asked makers of popular antidepressants to add or strengthen suicide-related warnings on their labels as well as the possibility of worsening depression especially at the beginning of treatment or when the doses are increased or decreased.

NHS England said it was also considering issuing a patient safety alert to ensure that frontline clinicians and other health professionals are aware of the concerns, and has published information on its website for concerned patients and family members.

They said that while no specific research has been undertaken on the impact 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.

Gyles Glover, consultant in public health and co-director of the learning disabilities team at PHE, said that with services overstretched, he could see how these drugs have become "considered normal or necessary" to try to manage challenging behaviour.

"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," he said.

"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."

Press Association

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