Can medication be an effective part of a PBS Plan? Jonathan Beebee

DIsclaimer! I am not saying medications are bad!

What medications are we talking about? Antipsychotics Beta-blockers Opiate based medications Any other medication used to reduce or manage challenging behaviour in people with learning disabilities Collectively referred to as psychotropics

How do they get prescribed? There is a crisis situation Family/support have tried everything and are at wits end Go to a doctor and need a quick solution Start medication and behaviour stops Medication perceived as the solution and no further intervention is explored.

Some of the impacts of behaviour Repeated injury to family/support Repeated self injury Repeated damage to property Reduction in coping strategies Reluctance to do positive things with the person, fear Anger and frustration Life becomes about the challenging behaviour. No light at the end of the tunnel.

Secluded, medicated, broken What must it be like for the person who is having the medication? Challenging behaviour is happening for a reason. Silenced instead of being listened to. Being restricted, sedated, having things important to you removed.

There is no medication to “treat” challenging behaviour.

Side effects Sedation Changes in appetite Extra pyramidal side effects dependency/addiction Neuroleptic Malignant Syndrome (life threatening)

Stop Over Medicating People with learning disabilities (STOMP) Based on the findings of 3 studies: Prescribing of psychotropic drugs to people with learning disabilities and/or autism by general practitioners in England. Public Health England (2015) Winterbourne Medicines Programme. NHS Quality Improvement (2015) Survey of Medications for Detained Patients with a Learning Disability. CQC (2016)

What did the studies say? Around 35,000 people with learning disabilities are prescribed psychotropic medication for which they do not have a diagnosed mental illness for. This was true for more than half of people in hospital 24% of people in hospital had more than one psychotropic medication, rising to 57% if PRN is included. Of the 57% - 40% of these are prescribed 5 or more medications

Response from Dominic Slowie “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.”

There is no hierarchy of badness/ restrictiveness - Needs to be person centred Medication Physical restraint Locked doors Restrictive clothing Seclusion For some people medication is the least restrictive and most person centered.

What to do if a person is prescribed psychotropic medications Firstly, it’s ok! Check that medication isn’t the only answer. Is the medication in the person’s best interest or their support’s? Is there a PBS plan from a competent practitioner with a functional assessment? Is it being reviewed? Are there plans to stop/reduce it or is it forever? Consider the family/teams wider coping strategies Monitor for side effects

Can medication be part of a PBS plan Put simply, yes! Medication can be used as a setting event to support the person to be in a position to learn functional alternatives. It can be a setting event to help the family/support to have space and time to build coping skills and resources. PRN can be used as a active or reactive solution to support the person to avoid or end that incident.

But... Medication is not the answer on its own PBS is a multi-elemental approach which medication may be one part of. Just because the behaviour has stopped that doesn’t mean “job done”.

Over-generalisation and mob rule

Thank you jonathan.beebee@pbs4.org.uk