Thread by @chrishattoncedr, Thanks @ainehillbilly for sharing the live tweets from the @DRC

Thanks @ainehillbilly for sharing the live tweets from the @DRC_AU sessions on restrictive interventions and medication. This tweet thread goes through some of the evidence from the UK that might be relevant
@CIDvoice @3DN_UNSW
1/18

First, a LOT of adults with learning disabilities get prescribed psychoactive medication. This @PHE_uk analysis of adults on GP registers in England found the following proportions of adults with learning disabilities were prescribed the following:

https://www.gov.uk/government/publications/psychotropic-drugs-and-people-with-learning-disabilities-or-autism/psychotropic-drugs-and-people-with-learning-disabilities-or-autism-results
2/18

Psychotropic drugs and people with learning disabilities or autism: results

https://www.gov.uk/government/publications/psychotropic-drugs-and-people-with-learning-disabilities-or-autism/psychotropic-drugs-and-people-with-learning-disabilities-or-autism-results

Antipsychotics 9.3% age 18-24; 14.6% age 25-44; 23.7% 45+
Antidepressants 11.4% age 18-24; 19.8% age 25-44; 21.6% 45+
Anti-anxiety drugs 4.5% age 18-24; 9.1% age 25-44; 11.6% 45+
Big initiatives like STOMP might be having some impact
https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/
3/18

People aren't prescribed these drugs in isolation. This study with adults with learning disabilities in Jersey by @mcmahonm44 shows 23% were prescribed at least two different psychoactive drugs, and 38% of people were prescribed 5+ different drugs
4/18 https://onlinelibrary.wiley.com/doi/full/10.1111/jir.12775

Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross‐sectio...

Background Adults with intellectual disability (ID) are prescribed high levels of medication, with polypharmacy and psychotropic polypharmacy common. However, reported rates vary between studies,...

https://onlinelibrary.wiley.com/doi/full/10.1111/jir.12775

The more drugs prescribed, the more likely there are to be serious drug-drug interactions. The @leder_team review of deaths of people with learning disabilities found 12% of people had been prescribed drugs with potentially severe interactions
5/18
http://www.bristol.ac.uk/media-library/sites/sps/leder/LeDeR_2019_annual_report_FINAL2.pdf

Clearly way more people with learning disabilities are being prescribed antipsychotics than show signs of psychosis. There are some signs that medics may be retrofitting their diagnoses to fit the medication prescribed...
6/18

So, @NHSDigital data from half of GP practices in England report that 7.9% of people with learning disabilities have a diagnosis of 'severe mental illness' compared to 0.9% of people without learning disabilities. Really???
7/18 https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2018-to-2019

Health and Care of People with Learning Disabilities, Experimental Statistics: 2018 to 2019 [PAS] -...

This publication includes aggregated data on key health issues for people with learning disabilities in England compared to those without learning disabilities

https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2018-to-2019

So far, this info has been from people with learning disabilities going about their lives largely in the community. For people in inpatient units, in 2015 @NHSDigital reported that 72% had been prescribed antipsychotic medication in the last 28 days
8/18
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/508909/ld-census-further-sep15-rep.pdf

On top of this, 'chemical restraints' are part of the range of 'restrictive interventions' people can be subject to. Recent @NHSDigital data (summarised here https://chrishatton.blogspot.com/2020/09/restraints-used-on-people-with-learning.html ) shows high & increasing use of these chemical restraints alongside other forms of restraint
9/18

[As an aside, these figures are likely to massively underestimate the true picture as data from many private sector inpatient units don't appear in these statistics, although reporting is supposed to be mandatory]
10/18

So, there is massive use of these medications, without the corresponding mental health diagnoses that would be required for anyone else, with serious consequences for people's health, wellbeing, and chances of living an active, fulfilling life.
11/18

In England, @NICEComms in 2016 produced a detailed set of clinical guidelines relating to mental health and people with learning disabilities
https://www.nice.org.uk/guidance/ng54
Annual review of antipsychotic medication is one of the 5 'quality standards'. Is this happening? Monitored?
12/18

The last point I want to make is that the @DRC_AU sessions seem to be focusing on behaviour support as a potential alternative to medication. Both of these seem very narrow and reactive to me...
13/18

The best thing you can do to reduce the kind of distress that leads people to be 'treated' in these ways is for people to grow up free of poverty and discrimination, and supported to lead lives which people find fulfilling (the same holds true for anyone and everyone).
14/18

Last graph to follow, from a study led by Eric Emerson in 2007 with children and adolescents with learning disabilities...
15/18
https://www.researchgate.net/profile/Eric_Emerson/publication/5792139_Mental_health_of_children_and_adolescents_with_intellectual_disabilities_in_Britain/links/0912f5087bd126a384000000/Mental-health-of-children-and-adolescents-with-intellectual-disabilities-in-Britain.pdf

It shows what percentages of children with and without learning disabilities experience emotional disorder (eg. anxiety) as they experience more social and economic adversity. In benign circumstances anxiety is similarly rare for kids with and without learning disabilities.
16/18

As you load on the adversity, things get worse for kids without learning disabilities but much worse for kids with learning disabilities. THIS is where to focus our attention if we really want to make a difference.
17/18

A note on words. In the UK 'learning disabilities' is the term most commonly used to describe the broad population of people that come under the label 'intellectual disabilities' internationally.
18/18

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