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Antipsychotic use in patients with a learning disability but no mental health diagnosis

You may be aware of an impending national ‘Call to Action’ relating to minimising the use of psychotropic medication for people with a learning disability, but no mental health diagnosis, who live in the community.  This will require a detailed review of people who are known to have a learning disability but do not have a diagnosis of a mental health condition.  The use of psychotropic medication in these patients is off-licence.

The scale of action required is significant.  Initial searches from other CCGs indicate that approximately 40% of people on the learning disability register will not have a mental health diagnosis but will be on one of more psychotropic medicines.  The majority of these patients will have been discharged to primary care.

All stakeholders will need to prepare a plan to provide a safe and measured process to review patient’s medications.  Patients, their carers, and GPs in particular, need to know urgently that although the call to action is imminent, they do not need to make immediate or en bloc referrals to Learning Disability Services. This is because local plans are being develop to manage what could be potentially a significant increase in referrals and activity.

The aims of the review will include:  improved patient and carer understanding of their medication and involvement in any discussions about change;  identification of benefits and harms arising from the medication; consideration of reduction of dose, and/or number of medication types, as well as consideration of alternative approaches (e.g. positive behavioural support).

To be safe, any medication alterations will need to be planned, with careful monitoring with specific and well documented agreement for each person on what is monitored and by whom, and what happens if the person’s quality of life seems to be deteriorating.  GPs will need support to assess the appropriateness of complex medication regimes, in making and monitoring any changes and documenting the rationale for continued medication use.

A Regional Learning Disabilities Fast Track Transformation Board is in place, and the medication sub-group of this board plans to provide written guidance over the next few months to assist local action.  Practices will be updated as and when more information and guidance becomes available.