Stopping over-medication of People with Learning Disabilities (STOMPLD) 2016. Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.

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Learning Disabilities:
Share and Learn Webinar
David Branford
Learning Disability Programme, NHS England
Ben Briggs
Learning Disability Programme, NHS England
Carl Shaw
Learning Disability Advisor, NHS England
26 May 2016
Stopping over-medication of
People with Learning Disabilities
(STOMPLD) 2016
Reducing Inappropriate Psychotropic Drugs
in People with a Learning Disability in
General Practice and Hospitals in 2016

2. www.england.nhs.uk
• Winterbourne View review - deep concerns about the use of
antipsychotic and antidepressant drugs
• Expert reference group established by Chief Pharmaceutical Officer
• LD Census, GP prescribing audits, CQC audit showed:
• Extensive use of all categories of psychotropic drugs (antipsychotics,
antidepressants, mood stabilisers, benzodiazepine sedatives)
• NICE guidance
• Challenging behaviours, autism, mental illnesses
• Development of STOMPLD programme
• Launch of GP leaflet by Alistair Burt on 1June at RCGP
Background to STOMPLD

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To improve the quality of life of people with a learning
disability, by reducing the harm of inappropriate
psychotropic drugs which are used as a “chemical
restraint” in place of other more appropriate care and
treatments.
Everyone needs to make this a priority to reduce and
stop the use of drugs inappropriately, to reduce adverse
effects and potential harm. This is a matter of our
patients’ safety and their quality of care.
The Goal of the STOMPLD 2016

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It is estimated that on an average day in England, between
30,000 and 35,000 adults with a learning disability are being
prescribed an antipsychotic, an antidepressant or both
without an appropriate clinical reason.
Unnecessary use of these drugs, puts people at risk of
significant weight gain, organ failure and premature death.
Is one of these 35,000 people your patient? Stop this
happening and take action today. Check and review your
patients immediately to ensure another day of potential
harm doesn’t go by.
Key Message

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A Fundamental Rethink
It is not: It is:
This is not just about improving record
keeping
This is about improving peoples lives
This is not just about improving the
transfer of information about
medicines between GPs and
specialists (and everyone else
involved)
This is about helping people live longer
lives and giving families more time with
their loved ones
This is not just about ensuring that
there is a diagnosis
This is about fundamentally rethinking the
role of psychotropic drugs for the
management of behaviours that challenge
in learning disabilities
This is not just about tidying up the
prescriptions to remove any errors and
anomalies

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• Consider psychotropic drugs to manage behaviour that
challenges only if:
• psychological or other interventions alone do not produce change
within an agreed time or
• treatment for any coexisting mental or physical health problem has
not led to a reduction in the behaviour or
• the risk to the person or others is very severe (for example,
because of violence, aggression or self-injury)
• Only offer psychotropic drugs in combination with
psychological or other interventions.
Adapted from the NICE guideline [NG11] Published date: May 2015 ‘Challenging behaviour and learning
disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’
Make psychotropic drugs the last
resort

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• The psychotropic drugs should be prescribed at the
lowest possible dose and for the minimum duration
• Non-drug based management strategies and the
withdrawal of the psychotropic drugs should be
considered at regular intervals
• If the improvement of the behaviours that challenge
is unsatisfactory, an attempt should be made to revisit
and re-evaluate the formulation and the management
plan, not just add more drugs.
Adapted from the International guide to prescribing psychotropic medication for the management of problem behaviours in
adults with intellectual disabilities
Deb S et al ,World Psychiatry. 2009 Oct; 8(3): 181–186
Minimising the use of psychotropic
medicines

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How often do you hear these
excuses?
• He has just been admitted
• We have just got her stable
• We are just getting him
ready to move on
• We need to give her time to
adapt to the community
• Everything is currently going
well - don’t rock the boat!
The time to start reduction of
psychotropic drugs is now
You can do it
• A 2014 Dutch study investigated
the effects of controlled
discontinuation of antipsychotics
prescribed for challenging
behaviour.
• Of 98 participants, 43 achieved
complete discontinuation; at follow-
up 7 had resumed use of
antipsychotics.
• Higher baseline problem behaviour
rating predicted higher odds of
incomplete discontinuation
Effects of controlled discontinuation of long-term used antipsychotics for behavioural symptoms in individuals with intellectual disability
de Kuijper G1, Evenhuis H, Minderaa RB, Hoekstra PJ. (2012). Intellect Disabil Res. 2014 Jan; 58(1):71-83

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Questions

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Contact details
David Branford, Learning Disability Programme, NHS England
davebranford@gmail.com
Ben Briggs, Learning Disability Programme, NHS England
b.briggs@nhs.net
Carl Shaw, Learning Disability Advisor, NHS England
carl.shaw@nhs.net

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Next webinar
The next Share and Learn Webinar will take place on:
Thursday 30 June at 12:30 to 1:30pm
We will be discussing the work we are doing on 10 High Impact
Actions for Learning Disabilities which is in early development
and we hope to have a contribution from service user
We are currently building the programme of Share and Learn
Webinars up to the end of March 2017.
Please let us know if you would like to contribute to these and tell
us what topics you would like us to include on future ‘Share and
Learn’ Webinars by emailing Debbie Barnhurst at
deborah.barnhurst@nhs.net