Patients with a learning disability and/or autism are prescribed antipsychotics, benzodiazepines and antidepressants at a significantly higher rate than in patients without a learning disability, new NHS data shows.

In addition, only 57.8% of patients with a learning disability had a Learning Disability Health Check in 2019-20. Reductions in the numbers having a health check could be seen in all age groups apart from those patients who were aged 14-17 years.

Annual health checks are designed to encourage GP practices to identify undetected health conditions early, and ensure the appropriateness of ongoing treatments such as psychotropic medications.

The new data is from the Health and Care of People with Learning Disabilities Experimental Statistics 2019 to 2020 report, which aims to highlight health inequalities between those individuals with a learning disability and those without.

This is because research has shown that people with learning disabilities have poorer physical and mental health than other people and die younger even though many of these deaths are avoidable and not inevitable. 

Data was collected from 56.6% of patients registered in England in 2019-20 and 0.5% of the patients included in this publication were recorded by their GP as having a learning disability in 2019-20. It looked at key health issues such as cancer screening, prescribing, ADHD and epilepsy.

Inappropriate prescribing of psychotropic medication

Some patients with severe learning difficulties can have high rates of ‘challenging behaviour’ such as acts of aggression towards people or property, self-neglect, self-harm and risk exploitation. This is usually managed using behavioural strategies, but in more severe cases antipsychotics may be considered.

Antipsychotics are used to reduce and control many psychotic symptoms, but they are not suitable or effective for everyone as side effects can affect people differently. A Public Health England report suggested that about 30,000–35,000 people with learning disability and/or autism are on antipsychotics or antidepressants, or both, without appropriate indications.

It also found that antipsychotic and antidepressant drugs are being prescribed for people with learning disabilities in England in the absence of recording of the conditions for which they are known to be effective.

Latest NHS data on prescribing in patients with a learning disability

The NHS data report found that 15.2% of patients with a learning disability were prescribed antipsychotics compared to 0.9% of patients without a learning disability.

In addition, benzodiazepines, a sedative to treat sleeping problems and anxiety, were prescribed to 7.2% of patients with a learning disability compared to 2.1% without.

The percentage of patients with a learning disability treated with antidepressants without an active diagnosis of depression was also significantly higher (11.6%) than in patients without a learning disability (4.4%).

Use of anti-epileptic drugs were also analysed in the report. It found that each year between 2015-16 and 2019-20, a significantly larger percentage of patients with a learning disability without an active epilepsy diagnosis were also treated with epilepsy drugs compared to patients without a learning disability.

STOMP-STAMP initiative

STOMP-STAMP is a national project to stop the over-use of psychotropic medicines in people with a learning disability, autism or both. STOMP (stopping over medication of people with a learning disability, autism or both with psychotropic medicines) was launched by NHS England in 2016 with the aim of improving people’s health and their quality of life. This is by encouraging regular medicines check-ups, ensuring that health professionals involve people, families and support workers in decisions about medicines, and by raising awareness of other non-medicine interventions and support to reduce the need for medicines.

STAMP (Supporting Treatment and Appropriate Medication in Paediatrics) was launched in 2018 and looked at how children and young people with a learning disability, autism or both who need medication can get it for the right reason, in the right amount for as short a time as possible.

Latest figures suggest more needs to be done to raise awareness of the initiative to ensure that people with a a learning disability and/or autism are not prescribed medications that they don’t need. This will also ensure that medication is reviewed regularly, monitored thoroughly and challenged as soon as it is thought not to  be beneficial.

A Government spokesperson told Learning Disability Today: “We are committed to reducing health inequalities and ensuring people with a learning disability and people with autism receive safe and high-quality care, and that they are treated with dignity and respect.

“We are working to put in place the right community-based support to reduce the need for specialist inpatient care while making sure people can get the help they need to live fulfilling lives. NHS England are also doing more and through the STOMP-STAMP initiative, they are taking steps to raise awareness about the over-medication of autistic people and people with learning disabilities.”