Yesterday, my research team published some worrying statistics about the use of antipsychotic medicines among people with learning disabilities in the UK. We discovered that most of these powerful and sometimes dangerous medicines are being prescribed to people with learning disabilities who have no signs of severe mental illness.
Not only is this potentially harmful to the patients themselves – many of the drugs, which are designed to treat illnesses such as schizophrenia, can have nasty side effects – but giving them out when they’re not necessary could also be costing the UK taxpayer large sums of money.
The reality is that no research to date provides evidence that antipsychotic drugs are helpful in situations beyond the severe mental illnesses they were created for, which means giving them out to people with challenging behaviour problems will ultimately not have the desired effect.
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On top of that, the unsolved problem can escalate. Once medication is started it is often continued for many years, and the cumulative cost slowly but surely mounts. If a patient starts suffering negative side effects, which in the case of antipsychotics are drowsiness, movement problems, obesity and diabetes, the need for monitoring and treatment takes the overall cost even higher.
So why are antipsychotics that are not intended to treat challenging behaviour being used in these situations at all? One possible reason is their short-term sedative side-effects, but the perception that other treatment options are extortionately expensive might also be a factor.
The recommended management of challenging behaviour and in people with learning disabilities is a multi-disciplinary approach that involves regularly assessing an individual's physical, psychological, and social health, and responding to this through specialised psychological therapies or environmental adaptations.
And herein lies the problem – the initial cost of this alternative approach might seem prohibitively high. Yet what isn't always fully appreciated is that this method would likely lead to improved outcomes, and lower overall treatment costs in the long-term.
As budgets continue to be squeezed, the need to achieve true value from health interventions is of immense importance. We can't justify continuing to use medicines that are not supported by robust research data and have little chance of success.
Medication is expensive, and while the exact cost of this concerning practice is difficult to estimate, doctors must be aware of the long-term risks, both in purely economic terms and on the health and wellbeing of the patients who are inappropriately treated. To deny the complexity of factors that contributes to the development and persistence of challenging behaviour by reactively reaching for the prescription pad does them a disservice.