Better systems needed to stop overmedication of people with intellectual disability

Coordinated specialist health services are needed to deal with the complex needs of people who have an intellectual disability so that they are not unnecessarily given psychotropic drugs to manage challenging behaviours, QUT researcher Dr Niki Edwards has told the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.

Dr Edwards, from the Faculty of Health School of Public Health and Social Work, has worked in health, disability and human services and, over the past 15 years, researched intellectual disability and use of psychotropic medication.

Dr Niki Edwards

Psychotropics drugs are mood-altering agents prescribed to treat a range of mental illnesses. Dr Edwards said they are also used as a ‘chemical restraint’ for people with an intellectual or developmental disability whose behaviour is considered aggressive or potentially harmful to others or themselves. In Queensland, court-appointed ‘guardians’ have oversight over use of these medications as a restraint.

In her statement to the Royal Commission and in her evidence via video link, Dr Edwards said the rates that psychotropic medication was being given to people with intellectual disability in Queensland were “much too high”.

“This medication can have serious adverse health effects, particularly when used in high doses and for extended periods, and there is evidence that its actual effectiveness in minimising or preventing behaviours of concern is questionable,” she said.

She presented to the Royal Commission her published findings from a 2006-07 survey of Queensland psychiatrists, preliminary observations from a similar survey of psychiatrists she has conducted over the past year, and her 2018 published research exploring the attitudes of guardian decision-makers.

These studies have shown:

  • A majority of psychiatrists consider antipsychotics were overused to control aggression in people with an intellectual disability.
  • Many psychiatrists believe inadequacy of community services for people with intellectual disability influences overprescribing.
  • Prescribers sometimes diagnose a person with disability as having a mental illness, such as schizophrenia, “in order to avoid and circumvent the legislative requirements concerning authorisation of chemical restraint”.
  • Many psychiatrists do not feel equipped to treat patients with intellectual disability and mental illness.

Dr Edwards said people with intellectual and developmental disability have complex support needs, particularly with respect to their mental health, and they have “fallen through the gaps in Australia as health and disability departments historically have played and continue to play a game of ‘ping pong’ with this vulnerable group – health stating disability is not their responsibility and disability asking for mental health to take responsibility”.

She said what was needed was a multi-faceted policy and strategy approach across Australia, with government investment in leadership to ensure more collaboration and in training so health professionals and disability service providers better understand the mental health and wellbeing needs of adults with intellectual and developmental disability, as well as changes to current regulatory restrictive practices frameworks.

She suggested the establishment of a national network of multidisciplinary centres that cross the health/disability sector divide, with sustained resourcing and support from state and federal governments.

“Adults with intellectual and developmental disability form the most disadvantaged of all people with a disability,” Dr Edwards said. “They are typically voiceless and without agency.

“… there is relatively nothing provided to address [their] mental health needs. It is not surprising then that they may be medicated in response to inadequate service responses.

“Psychotropic medication can do great good for many people living with mental illness; however, it can also do great harm where evidence-based and best practice prescribing is not adhered to.”

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