Receipt of psychotropic medication by people with intellectual disability in residential settings

AimsThe audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.MethodThe BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.Result4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.CAMHS services referred 1/16 patients.Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.ConclusionPatients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.

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COVID-19 and people with intellectual disability: impacts of a pandemic

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.45 ◽

2020 ◽

Vol 37 (3) ◽

pp. 231-236 ◽

Cited By ~ 20

Author(s):

K. Courtenay ◽

B. Perera

Keyword(s):

Intellectual Disability ◽

Infectious Diseases ◽

Psychotropic Medication ◽

Mental Stress ◽

Cognitive Impairments ◽

Social Effects ◽

Rigorous Approach ◽

Challenging Behaviours ◽

Community Supports ◽

Placement Breakdown

The impacts of the COVID-19 pandemic affect all groups in society. People with intellectual disability (ID) are especially vulnerable to the physical, mental and social effects of the pandemic. Cognitive impairments can limit understanding of information to protect them relying on carers to be vigilant on their behalf during quarantine. Restrictions on usual activities are likely to induce mental stress especially among those who are autistic leading to an escalation in challenging behaviours, risk of placement breakdown and increased the use of psychotropic medication. People with ID are vulnerable to exploitation by others where the usual community supports no longer function to protect them. In future pandemics, it is important that lessons are learned from the impacts COVID-19 have on people with ID. Collecting the evidence through a rigorous approach should help to empower people with ID and their carers to face future outbreaks of infectious diseases.

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Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour

Journal of Intellectual Disability Research ◽

10.1111/jir.12119 ◽

2014 ◽

Vol 59 (1) ◽

pp. 11-25 ◽

Cited By ~ 49

Author(s):

S. Deb ◽

G. Unwin ◽

T. Deb

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Aggressive Behaviour ◽

Medication Use

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Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK

BMJ Open ◽

10.1136/bmjopen-2019-032861 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032861 ◽

Cited By ~ 2

Author(s):

Rory Sheehan ◽

Angela Hassiotis ◽

André Strydom ◽

Nicola Morant

Keyword(s):

Decision Making ◽

Intellectual Disability ◽

Psychotropic Medication ◽

Stakeholder Involvement ◽

Medication Use ◽

Care Providers ◽

Family Carers ◽

Joint Decisions ◽

The Uk ◽

Medication Decisions

ObjectivesUnderstanding patient and carer perspectives is essential to improving the quality of medication prescribing. This study aimed to explore experiences of psychotropic medication use among people with intellectual disability (ID) and their carers, with a focus on how medication decisions are made.DesignThematic analysis of data collected in individual semistructured interviews.Participants and settingFourteen adults with ID, 12 family carers and 12 paid carers were recruited from specialist psychiatry services, community groups, care providers and training organisations in the UK.ResultsPeople with ID reported being highly compliant with psychotropic medication, based on a largely unquestioned view of medication as important and necessary, and belief in the authority of the psychiatrist. Though they sometimes experienced medication negatively, they were generally not aware of their right to be involved in medication decisions. Paid and family carers reported undertaking a number of medication-related activities. Their ‘front-line’ status and longevity of relationships meant that carers felt they possessed important forms of knowledge relevant to medication decisions. Both groups of carers valued decision-making in which they felt they had a voice and a genuine role. While some in each group described making joint decisions about medication with psychiatrists, lack of involvement was often described. This took three forms in participants’ accounts: being uninformed of important facts, insufficiently included in discussions and lacking influence to shape decisions. Participants described efforts to democratise the decision-making process by gathering information, acting to disrupt perceived power asymmetries and attempting to prove their credibility as valid decision-making partners.ConclusionsStakeholder involvement is a key element of medication optimisation that is not always experienced in decisions about psychotropic medication for people with ID. Forms of shared decision-making could be developed to promote collaboration and offer people with ID and their carers greater involvement in medication decisions.

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A multi-level ecological model of psychotropic prescribing to adults with intellectual disability

Advances in Mental Health and Intellectual Disabilities ◽

10.1108/amhid-01-2013-0001 ◽

2013 ◽

Vol 8 (1) ◽

pp. 24-31

Author(s):

Niki Edwards ◽

Chris Bain ◽

Allyson Mutch ◽

Julie Dean ◽

Nicholas Lennox

Keyword(s):

Intellectual Disability ◽

Psychotropic Medication ◽

Ecological Model ◽

Patient Characteristics ◽

Valuable Insight ◽

Community Based ◽

Content Type ◽

Multi Level ◽

Insight Into

Purpose – Simple linear accounts of prescribing do not adequately address reasons “why” doctors prescribe psychotropic medication to people with intellectual disability (ID). Greater understanding of the complex array of factors that influence decisions to prescribe is needed. Design/methodology/approach – After consideration of a number of conceptual frameworks that have potential to better understand prescribing of psychotropic medication to adults with ID, an ecological model of prescribing was developed. A case study is used to outline how the model can provide greater understanding of prescribing processes. Findings – The model presented aims to consider the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The utility of the model is illustrated through a consideration of the case study. Research limitations/implications – The model presented is conceptual and is as yet untested. Practical implications – The model presented aims to capture the complexity and multi-dimensional nature of community-based psychotropic prescribing to adults with ID. The model may provide utility for clinicians and researchers as they seek clarification of prescribing decisions. Originality/value – The paper adds valuable insight into factors influencing psychotropic prescribing to adults with ID. The ecological model of prescribing extends traditional analysis that focuses on patient characteristics and introduces multi-level perspectives that may provide utility for clinicians and researchers.

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Predictors of access to healthcare professionals for people with intellectual disability in Ireland

Journal of Intellectual Disabilities ◽

10.1177/1744629520937835 ◽

2020 ◽

pp. 174462952093783 ◽

Cited By ~ 1

Author(s):

Anne Doyle ◽

Michael O’Sullivan ◽

Sarah Craig ◽

Roy McConkey

Keyword(s):

Intellectual Disability ◽

Health Professionals ◽

Healthcare Professionals ◽

Access To Healthcare ◽

Family Carers ◽

Skill Mix ◽

Residential Settings ◽

The People ◽

Service Models ◽

Professional Resources

The Irish National Intellectual Disability Database is updated annually and in 2017 contained records for nearly 22,000 persons aged 15 years and over. Information was extracted on the contacts each person had with one of eight health professionals in the years 2007, 2012 and 2017. Over these years, there was an increase in the number of people in contact with any professional or with four and more professionals. Nevertheless, the people less likely to have contact were those with milder forms of intellectual disability, persons living with family carers or independently and those linked to smaller provider agencies. By contrast, the odds of people with more severe disability in residential settings were up to eight times greater for having contact with four or more different professionals. As demand for healthcare grows due to increased longevity and service models shift to the community, redeployment of existing professional resources will be needed along with a review of the skill mix.

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