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Medication should not be ‘first resort’ to challenging behaviour – NICE

There must be a move away from the over-reliance on antipsychotic medication given to people with a learning difficulty to manage challenging behaviour, NICE has said in new guidance.

Within the latest guideline, the health watchdog recommends that the use of antipsychotic medication to manage behaviour that challenges should only be considered if psychological or other interventions alone do not produce change within an agreed time and the risk to the person or others is very severe.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “A significant proportion of the antipsychotic medication given to people with a learning disability is for the management of behaviour that challenges.

“Too often medication is the first resort in attempting to manage what is often the result of a complex interaction between multiple individual and environmental factors. This guideline highlights the need for these factors to be considered systematically and comprehensively so that interventions to address behaviour that challenges in people with a learning disability can be tailored and appropriate to the individual.”

The areas covered by the guideline also include the support and interventions that should be available for family members and carers of people with a learning difficulty and behaviour that challenges which aim to improve the health and well-being of the family and carers.

The Royal College of Nursing’s chief executive Dr Peter Carter welcomed the latest guidance, saying: “This is an important issue for nurses, who often feel the effects of violent incidents at work long after any physical wounds have healed.

“It will be useful for many staff who may be at risk to have clear, specific guidance to help them manage in what can be a stressful and intense environment.”

Vivien Cooper, CEO of the Challenging Behaviour Foundation and a service user representative on the group that developed the NICE guideline, added that the guidance will help to drive up standards of support to deliver better outcomes for children, young people and adults and their families.

“There is a need to move away from a crisis management approach with a reliance on restrictive practices, to early intervention and prevention, providing accessible, timely and practical information and support to meet individual need,” she said. “We look forward to the recommendations being put into practice.”