Royal Commission highlights concerns about over-medicating people with cognitive disability

The Royal Commission has today released its report into the sixth public hearing ‘Psychotropic medication, behaviour support and behaviours of concern’.

The report provides an analysis and summary of the evidence presented during this hearing and it finds that, despite the absence of reliable statistical data, there is ample evidence to suggest that psychotropic medication is being over-prescribed to people with cognitive disability to deal with so-called ‘behaviours of concern’, and in too many cases, as a form of chemical restraint. The report accepts that while widely used and commonly understood, the use of the phrase ‘behaviours of concern’ is controversial, acknowledging that such behaviours, particularly for people with cognitive disability are a form of communication.

A large body of medical evidence along with anecdotal observations from family and carers identified to the Royal Commission that people with cognitive disability often experience serious negative consequences as a result of using such medication.

These consequences range from varying degrees of side effects such as reduced cognitive functioning, nausea, headaches and weight gain. These side effects can be further exacerbated over the longer term, as well as if the psychotropic medication interacts adversely with other drugs.

In the worst cases the results of these side effects can be fatal.

The report outlines that the Royal Commission heard there is limited evidence to support the efficacy of psychotropic medication as a way to address behaviour escalation. In some instances it may act as a sedative but for many people with cognitive disability it has the opposite effect and this type of medication can lead them to express increasing and varied behaviours of concern.

As an alternative to psychotropic medication, the Royal Commission has been told that the practice of ‘positive behaviour support’ (PBS) can significantly reduce the incidence of behaviours of concern and therefore reduce the need for the use of psychotropic medications as chemical restraints.

These programs, however, require careful design and should be individually tailored. People with cognitive disabilities and their carers have told the Royal Commission there can be a lengthy wait to access a PBS program and in many cases the plans are poorly developed and unsatisfactory.

To fully understand the impact this kind of medication has on the lives of people with disability, the report notes that gathering data and conducting quality research into the use of psychotropic drugs is critical, yet the overall funding for such research has been reduced.

Despite the absence of data and the reductions in funding of research, the Royal Commission heard consistent evidence confirming the over prescribing and misuse of psychotropic medication for people with cognitive disability, reinforcing evidence heard by the Royal Commission in Public hearing 4, observing the disproportionate and inappropriate use of such medication for people with cognitive disability. This enabled the Royal Commission to find that despite that data and the underfunding of research:

• psychotropic medication is over-prescribed to people with cognitive disability in response to behaviours of concern and
• the distinction drawn in legislation between medication used as a chemical restraint and medication prescribed as a treatment for people with cognitive disability is problematic.

The report acknowledges requests that in the future there should be regular medication reviews and comprehensive health check-ups to avoid the over use of psychotropic medication and that it is critical to the safety and wellbeing of people with cognitive disability that they are assigned a multidisciplinary support team who are aware of best practise alternatives to psychotropic medication.

There are calls for much better training for medical professionals regarding the use and prescribing of psychotropic medications. There is also a need for better education about the underlying causes of escalating behaviours, and improvements in PBS planning, rather than a focus on the behaviours themselves and blaming the person being treated.

Better communication is also vital to ensure that, whenever possible, informed consent to use psychotropic medication is sought and given, and alternative methods of behaviour management are suggested and discussed.

The report describes the emergence of a common theme running through the evidence of family members and advocates for people with disability detailing devastating self-perpetuating cycles. They explained how escalating crises led to increasing and more severe behaviours of concern and in turn this would lead to a greater likelihood of psychotropic medication being administered. Over time they watched as the overall health and wellbeing of the person with disability, the person they loved, deteriorated markedly.