Quality standard
Quality statement 11: Use of medication
Quality statement 11: 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. [2015]
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
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.
What the quality statement means for different audiences
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.
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
Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NICE guideline NG11 (2015), recommendation 1.8.2
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 NICE's full guideline on challenging behaviour and learning disabilities, section 11]
Behaviour that challenges
Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or physical safety of the person, or others around them. It also includes behaviour that is likely to severely limit, or result in the person being denied, access to and use of ordinary community facilities.
[Adapted from NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this 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.