Quality statement 6: Use of medication

Quality statement

People with a learning disability and behaviour that challenges only receive antipsychotic medication as part of treatment that includes psychosocial interventions.

Rationale

Antipsychotics are the most frequently used drugs for people with a learning disability and behaviour that challenges, often in the absence of a diagnosis of a mental health problem. They should be used only if no or limited benefit has been derived from a psychosocial intervention, and treatment for any coexisting mental or physical health problem has not led to a reduction in behaviour that challenges. Psychosocial interventions are the most commonly reported forms of intervention used for people with a learning disability and behaviour that challenges and should be the first‑line intervention to address any identified triggers for the behaviour.

Quality measures

Structure

a) Evidence of local arrangements to ensure that people with a learning disability and behaviour that challenges only receive antipsychotic medication as part of treatment that includes psychosocial interventions.

Data source: Local data collection.

Process

a) Proportion of people with a learning disability and behaviour that challenges prescribed antipsychotic medication as part of treatment that includes psychosocial interventions.

Numerator – the number in the denominator who are receiving psychosocial interventions.

Denominator – the number of people with a learning disability and behaviour that challenges prescribed antipsychotic medication within the past 12 months.

Data source: Local data collection.

b) Proportion of people with a learning disability and behaviour that challenges prescribed antipsychotic medication with a recorded rationale for the prescribing decision.

Numerator – the number in the denominator with a recorded rationale for the prescribing decision.

Denominator – the number of people with a learning disability and behaviour that challenges prescribed antipsychotic medication within the past 12 months.

Data source: Local data collection.

Outcome

Prescribing rates of antipsychotics in people with a learning disability and behaviour that challenges.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care services) ensure that systems are in place for people with a learning disability and behaviour that challenges to only be prescribed antipsychotic medication as part of treatment that includes psychosocial interventions.

Healthcare professionals only prescribe antipsychotic medication for people with a learning disability and behaviour that challenges as part of treatment that includes psychosocial interventions.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services that only prescribe antipsychotic medication for people with a learning disability and behaviour that challenges as part of treatment that includes psychosocial interventions.

What the quality statement means for service users and carers

People with a learning disability and behaviour that challenges only have antipsychotic medication if they are also having psychological therapy or other therapies as part of their care. This should help to ensure that medication is only used if other therapies, or treatments for any physical health problems, have not changed or reduced the behaviour that challenges, or if there is a serious risk of the person harming themselves or others (for example, because of violence, aggression or self‑harm).

Source guidance

Definitions of terms used in this quality statement

Psychosocial interventions

Psychosocial interventions include a broad range of therapeutic approaches designed to support the person. They are generally non‑pharmacological and aim to identify underlying factors for behaviour, reduce the person's distress and increase their skills. Approaches include communication interventions, applied behaviour analysis, positive behaviour support and cognitive behavioural therapy.

[Adapted from challenging behaviour and learning disabilities (NICE guideline NG11), section 11 of the full guideline]

Equality and diversity considerations

The communication needs of people with a learning disability, particularly the needs of people who are unable to communicate through speech, should be taken into account in a health assessment. Practitioners may need to provide support for those who have limited speech and for those who have difficulty with English.