There are better alternatives to medication

In the third of four blogs to mark the launch of today’s drive by NHS England urging doctors and other healthcare professionals to sign up to a national pledge to Stop the Over Medication of People with a learning disability, autism or both (STOMP), a community nurse explains how it is making a difference:

I work mostly with people who present with behaviours that others find challenging, and have a special interest in positive behaviour support (PBS).

PBS focuses on finding out why a person behaves in the way that they do and helps me work with people and their circle of support to see if there are any other ways their needs can be met. The main purpose of PBS is to make sure the person is able to live a life that is meaningful to them.

Although PBS is becoming more widely recognised as a good way of supporting people with a learning disability, autism or both and behaviours that challenge, this has not always been the case. In the past lots of people have been prescribed strong medications usually used to treat mental health problems which are more likely to make them sleepy and disinterested rather than helping them with their behaviour.

I regularly meet people who are in this position and often they have been on these powerful psychotropic medications for many years without a diagnosed mental health problem. There is sometimes no clear reason why the medication has been continued other than hope that it will control challenging behaviour.

We know that a lot of the time these medications are not effective at managing challenging behaviour because even after taking them for a long time many people are still being referred to my team for more help. This makes us question whether some people need these medications at all!

When I speak with people with a learning disability, autism or both, their carers and families have become used to medications being a part of managing challenging behaviour, and they often tell me how worried they are about taking this away. Lots of people have come to rely on medications and don’t know what other options are available.

This is where STOMP has become a big part of my role. Instead of looking at what other medication could be used, my team works with people to try to find out what the person is trying to tell us with their behaviour. We can then put together a person-centred behaviour support plan, monitor how this improves their life and look to take away inappropriate medication.

As a community learning disability nurse I believe it is important that I am able to support people to understand that there are alternatives to medication such as PBS and how they might help people to have a better quality of life. Then I can support them to consider reducing any medication that might not be helpful to them.

I have been lucky enough to see first-hand the positive impact PBS and STOMP have made to people’s lives. Whether it has been a person becoming more awake and doing the activities they love or being able to let others know how they feel more easily, this all spurs me on to promote STOMP and PBS for people with a learning disability, autism or both who present with challenging behaviour.

Ruth Lee

Ruth Lee is a community learning disability nurse for Northumberland Tyne and Wear NHS Foundation Trust.

She has worked with adults with a learning disability, autism or both who present with behaviours that are considered challenging for six years.

Ruth works with people and their circle of support to use positive behaviour support (PBS). PBS helps us to understand the reasons behind a person’s behaviour.

Her overall aim is to help improve the quality of life of people with a learning disability, autism or both.


  1. Dennis says:

    Lisa (learning disabilities) has used Citalopram for a number of years now which keeps her moods fairly even. Ferrous Sulphate has been prescribed recently and her moods seem to be worse,
    do you know of any contradiction between these tablets.

    • NHS England says:

      Hello Dennis and thank you for your question.

      While there is no reported interaction with these two medications it will be hard to say that the addition of the ferrous sulphate has affected how well the citalopram is working for Lisa.

      If you are at all concerned please discuss with your Doctor or pharmacist for further advice as they should know Lisa well.

      A change in mood can be caused by several factors and exploring these with someone who knows Lisa’s care may well be beneficial.

      It will also be worth checking with your doctor that they monitor how well the ferrous sulphate is working and how long that Lisa will need to take it.

      Kind regards
      NHS England

  2. Kassander says:

    The people who are the subjects of this Plea to Pledge are Professionals who everyday deal with matters of Life and Death.
    To run this campaign is an INSULT to their integrity.
    I am a professional entrusted with certain critical aspects of people’s lives. If I was preented with such a Pledge to sign I would be greatly tempted to reply with words rarely used by professionals in their formal role.