In this guest blog, Sue Hullin, quality and service director at Tracscare, explains the importance of addressing environmental and psychosocial factors affecting people with learning disabilities who have behaviour that challenges.

In October, the National Institute for Health and Care Excellence (NICE) issued a new quality standard on learning disabilities and challenging behaviour, which included recommending that antipsychotics should only be given to people with learning disabilities if provided alongside psychosocial support. At Tracscare, a care and support provider for individuals with autism and learning disabilities, we welcomed the recommendations and hope they will be implemented throughout the sector. As care providers, however, we must also take responsibility for the culture within our services that unquestionably impacts the behaviour of the people being supported.

It is clinically limiting to claim that behaviours that challenge in people with learning disabilities or autism can be “treated” by medication. This shows a lack of understanding. Antipsychotic medications are largely used to chemically restrain and sedate people when their behaviours are deemed to be challenging. However, challenging behaviours almost always have a functional value for the person with the learning disability. It is the service provider’s role to assess and understand that behaviour. Only then will they be in a position to set out a positive behaviour support plan that will ensure a safe and nurturing environment where needs are anticipated and challenges de-escalated. Assessments should also give consideration to the potential effects on behaviour that may be posed by general health issues. 

Medicines should never be used instead of addressing the environmental and psychological factors that often cause challenging behaviour. In line with the NICE recommendation, service providers should aspire to minimise the use of medication, making it a last resort option. While medication may sometimes be necessary to manage a crisis situation or related mental health issue, for the most part carers must work alongside the people supported to understand and address their psychological needs.

For the past 15 years at Tracscare we have employed our own behaviour advisors and created positive behaviour support plans for every person we support. We make a commitment to assess and understand the function of the behaviour to the individual as well as identifying potential triggers to the challenges they may present. This means that we can anticipate the person’s needs before their frustration makes their behaviour difficult to manage. This is not an assessment we conduct once but a continual process that is reviewed and improved on a regular basis, constantly fine-tuning each person’s positive support plan. This is key to understanding the behaviour of the people we support. 

Other key factors include person-centred processes that focus on what is important to each individual, alongside Active Support providing each person with meaningful activities, skill development and progression. These principles are also recognised in the new NICE quality standard. 

As care providers we must take responsibility for this issue. If the person is behaving in a challenging manner, then in most cases we have failed to adequately assess and understand the behaviour. The key is staff knowledge and understanding and a positive and respectful service culture. Tracscare’s induction is focused on every individual staff member taking responsibility as a ‘Custodian of the Culture’. Cultural audits and involving the people we support as paid quality checkers helps ensure sustainability of these principles. 

Acknowledging the necessity for a greater emphasis on the use of psychosocial support and making medication a last resort is crucial to understanding the behaviour and needs of individuals we care for. However, we must also look inwardly and place great importance on creating a positive culture among staff members to ensure we achieve the best outcomes for the people we support. 

To read the full NICE quality standard on learning disabilities and challenging behaviour, go to:

For more information on Tracscare, go to: