Learning Disabilities: Turning improvement ideas into local action (Ben Briggs)
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This document summarizes a presentation given on stopping the overmedication of people with learning disabilities. It discusses that up to 35,000 adults with learning disabilities in the UK are wrongly prescribed antipsychotics and antidepressants, putting their health at risk. The presentation introduces the STOMPLD (Stop Over Medicating People with Learning Disabilities) initiative, which aims to improve lives and health outcomes by reducing unnecessary psychotropic medication use. Attendees are asked to consider what their organizations can do to support this effort to stop overmedication of people with learning disabilities.
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Learning Disabilities: Turning improvement ideas into local action (Ben Briggs)
- 1. www.england.nhs.uk Building the Right Support for Learning Disabilities Turning improvement ideas into local action Kia Oval, Surrey County Cricket Club, London SE11 5SS 19 July 2016
- 2. www.england.nhs.uk/learningdisabilities pping over dication of ople with rning abilities d autism 2016
- 3. www.england.nhs.uk/learningdisabilities Thankyou for inviting us David Branford Carl Shaw Ben Briggs Learning Disability Programme NHS England
- 4. www.england.nhs.uk/learningdisabilities • Background to this work • Why is this work important? • The aims of STOMPLD • YOUR role in this What we’re going to talk about
- 5. www.england.nhs.uk/learningdisabilities This work is part of Transforming Care There are 6 partner organisations, and 48 local Transforming Care Partnerships. We all work with people with learning disabilities, families and services. We want to: 1. Reduce the number of people in learning disability and mental health hospitals 2. Reduce how long people stay in these hospitals 3. Improve the quality of care and support for people in hospital and community settings
- 6. www.england.nhs.uk/learningdisabilities Medicines Programme Structure Medicines Oversight Group (Chaired by Hazel Watson) Provides oversight, scrutiny and advice on the work of the delivery group Medicines Delivery Group (Chaired by Anne Webster) Responsible for delivering on the work set out in the STOMPLD Project Plan, including communications, TCP delivery of STOMP and engagement with a wide range of stakeholders Learning Disability Programme Board and Transforming Care Assurance Board Hazel Watson- Quality Assurance and Health Inequalities Work stream Lead
- 7. www.england.nhs.uk/learningdisabilities So what’s it all about?
- 8. www.england.nhs.uk/learningdisabilities Psychotropic medication? • Medication for psychosis – antipsychotics • Medication for depression – antidepressants • If people have psychosis or depression these medicines can be really helpful When is it a problem? • Too much • Too many • Too long • Giving prescriptions without finding out what is wrong • Using it to manage people’s behaviour Problems of over-medication
- 9. www.england.nhs.uk/learningdisabilities Ann and her son who was at Winterbourne View Hospital It was 3 years before he went home This is why we’re here
- 10. www.england.nhs.uk/learningdisabilities • If you are drugged up, you can’t communicate with people properly • The world passes you by • It can make your behaviour more challenging in the long run • It doesn’t help you learn or change • It doesn’t help you get out of hospital, the opposite in fact • People shouldn’t be living like that A human rights issue
- 11. www.england.nhs.uk/learningdisabilities Why? There’s usually a reason: • Not listened to or understood? • Abuse or trauma? • Unable to deal with feelings? • Too much physical restraint? • Too little contact with others? • Poor relationships with staff or patients? • Pain or illness? • Is medication always the answer?
- 12. www.england.nhs.uk/learningdisabilities Figures from Public Health England Think of 100 adults with learning disabilities • Doctors are prescribing antipsychotics for 17of those people • Doctors are prescribing antidepressants for 17 of those people.
- 13. www.england.nhs.uk/learningdisabilities • 7 people are being prescribed both • Only 4 of those 100 adults with learning disabilities have psychosis • Fewer than 7 people have depression • 16 are taking one or other drug and don’t have either a psychosis or depression Figures from Public Health England
- 14. www.england.nhs.uk/learningdisabilities Medicines Project Core Message Public Health England estimates that every day 30,000 to 35,000 adults with a learning disability are being wrongly prescribed an antipsychotic, antidepressant or both. Unnecessary use of these drugs, puts people at risk of significant weight gain, organ failure and even premature death.
- 15. www.england.nhs.uk/learningdisabilities Time to change - STOMPLD • This is about improving people’s lives • This is about helping people live longer and giving families more time with their loved ones • This is about stopping the use of these drugs to manage people’s behaviour • Stop Over Medicating People with Learning Disabilities - STOMPLD
- 16. www.england.nhs.uk/learningdisabilities The STOMPLD Pledge The STOMPLD pledge was signed at a summit in London on 1 June by • Royal Colleges of Nursing, Psychiatrists and GPs • Royal Pharmaceutical Society • Challenging Behaviour Foundation • British Psychological Society • NHS England • The Minister Alistair Burt They have pledged to work together and with people with a learning disability and their families, to take real and measurable steps to stop over medication
- 17. www.england.nhs.uk/learningdisabilities First steps – GP campaign • As part of this, a new booklet for GPs has been launched. • It was written by NHS England and the Royal College of GPs • It encourages family doctors to only consider psychotropic drugs to manage behaviour when the person is at severe risk of harming themselves or others • And only when all other options have been explored
- 18. www.england.nhs.uk/learningdisabilities STOMPLD is about more than…. • Better record keeping • Better transfer of information about medicines between GPs and specialists (and everyone else involved) • Ensuring people get a diagnosis • Stopping prescription errors • Although these are all important too • It is about quality of life
- 19. www.england.nhs.uk/learningdisabilities Over to you What can you or your organisation do to stop the over medication of people with learning disabilities or autism?
- 20. www.england.nhs.uk/learningdisabilities • Visit the NHS England website • www.england.nhs.uk/learningdisabilities For more information
- 22. www.england.nhs.uk/learningdisabilities Health and Social Care Information Centre Learning Disabilities Census Report – Further analysis England, 30 September 2013 • Survey responses were received from 104 provider organisations on behalf of 3,250 service users • Over two thirds of service users (68.3% or 2,220) had been given anti-psychotic medication leading up to Census day. Of these, 93.0% (2,064) had been given them on a regular basis. .
- 24. www.england.nhs.uk/learningdisabilities Data from CPRD General Practice prescribing study
- 25. www.england.nhs.uk/learningdisabilities Data from CPRD General Practice prescribing study
- 27. www.england.nhs.uk/learningdisabilities Make psychotropic medication the last resort The NICE guideline [NG11] Published date: May 2015 ‘Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’ • Consider antipsychotic medication 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 antipsychotic medication in combination with psychological or other interventions.
- 28. www.england.nhs.uk/learningdisabilities 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 • The medication should be prescribed at the lowest possible dose and for the minimum duration. • Non-medication based management strategies and the withdrawal of medication should always 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.
Editor's Notes
- Ben, Carl and David introduce themselves
- We’re really interested in hearing what people think about our core message.
- Ask the audience what they think the medication work is all about…
- Reference: Department of Health (2012) Transforming Care: A national response to Winterbourne View Hospital Final Report, (p.45).
- ‘My son has had many indignities foisted upon him. He was deprived of his liberty, abused, removed from his home and medicated all without his consent. In his position would you stand for it?’
- Carl/Ben- In the run up to Care and Treatment Reviews which are now carried out by local teams around the country, our Improving Lives team at NHS England carried out well over 100 in depth reviews of people’s care. Of the people we reviewed who were still in hospital (whose situations were particularly complex), at least 3 out of 5 people were receiving regular anti-psychotic medication. There is robust evidence that certain categories of drugs prescribed for certain mental health problems such as psychosis and medication for seizures can adversely influence physical health outcomes, especially without regular monitoring.
- Ben (Quote from a parent) “In the past my son was prescribed 3 different drugs to manage his behavioural difficulties. The behavioural problems were often a result of environmental issues such as bullying, excessive use of restraint, the use of punitive/aversive approaches or rapid staff turnover which resulted in a failure to deliver the person centred care plan. Pain from physical problems such as an undiagnosed, untreated, bleeding stomach ulcer, an untreated urinary tract infection and other commonly occurring illnesses would often result in Challenging Behaviour. Once the health issues were addressed and proper person centred care was in place the medication was not needed. Regrettably the issues around sustaining the right model of care and support proved impossible to resolve and the decision to use Sertraline and Carbamazepine in an effort to compensate for environmental issues which could not be solved was reluctantly accepted by us”
- Reference: Public Health England (2015) Prescribing of psychotropic medication to people with learning disabilities and/or autism by general practitioners in England, London: Public Health England. In 2015 Public Health England 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. -Prescribing Observatory for Mental Health: Nationally, over 60% of people with a learning disability who are seeing a psychiatrist, are being prescribed an antipsychotic drug but only half of these have the diagnosis of a psychotic mental illness that these drugs were developed to treat Ask people what they think of this message. Is it strong enough? Should it be stronger?
- Fellow Nurses! Ask them “What do you think of this message?”
- David