In 2005, Andrew’s doctors started prescribing him a variety of medication to attempt to manage his behaviour on a long term basis. As Andrew had no mental health diagnosis he was taking these medications off-label, as there are no psychotropic medicines licensed for use in managing behaviour in adults.
He was taking olanzapine, as an antipsychotic to control behaviour that challenges; carbamazepine, to control his mood and propranolol, as a beta blocker to treat the physical symptoms of anxiety. Andrew gained weight and felt sedated – which are common side effects of these drugs.
Andrew’s clinicians at Hertfordshire Partnership University NHS Foundation Trust worked with him to reduce the medication in a planned and controlled way – a process that took place in the community and was led by his learning disability psychiatrist. This was part of NHS Improving Quality’s Winterbourne Medicines Programme, commissioned by NHS England.
Andrew has now successfully stopped taking both the olanzapine and the carbamazepine and has reduced the propranolol by half. He is less tired, more alert and better able to express himself. He does more activities has more contact with the community. He is able to cope better with changes to his routine and is in control of his behaviour by using behavioural strategies. He has been discharged by his psychiatrist to his GP – who is working with him to further reduce the propranolol.
Over two years his weight decreased from 82 kg to 56 kg, which is within the recommended BMI. His weight and behaviour is being monitored by the community mental health team and the GP.
Pledging to stop over-medication of people with a learning disability
Andrew’s story reflects the work of the Stopping Over-Medication of People with a Learning Disability (STOMP) campaign.
STOMP pledges to reduce the inappropriate prescribing of psychotropic medication to people with a learning disability, autism or both where they have been prescribed to contain and manage behaviour. (There are cases where psychotropic medication may need to be prescribed if there is a clear indication and an underlying mental illness).
The STOMP pledge was signed by the Royal Colleges of Nursing, Psychiatrists and General Practitioners, as well as the Royal Pharmaceutical Society, the British Psychological Society and NHS England in June 2016.
Public Health England’s report on prescribing psychotropic drugs to people with learning disability, autism or both by GPs in England discovered that nearly one-third of all adults known to have a learning disability were receiving one or more psychotropic drugs, and over half of these people do not have a mental health diagnosis documented in their clinical notes.1 In addition, studies commissioned by NHS England found that these medicines are commonly prescribed without adequate monitoring or review.2
Withdrawing one medication at a time can make it easier to monitor the person’s response to the changes.
Danielle Adams, Hertfordshire Partnership University Foundation Trust, Danielle.Adams@hpft.nhs.uk
Dr Indermeet Sawhney, Hertfordshire Partnership University Foundation Trust, Indermeet.Sawhney@hpft.nhs.uk