Experts in intellectual disability support warn against excessive drug prescribing

Leading experts in Spain and from abroad outline best practices in the health and social care of people with intellectual and developmental disability

People with intellectual disability (ID), autism or both conditions are more likely to be treated with “low value” practices for which there is insufficient evidence of the benefits they offer or which have an unfavourable risk-benefit ratio. These practices include a higher likelihood of being prescribed psychotropic drugs, sometimes without a diagnostic that justifies such use, or a higher likelihood of using practices that limit consensual decision-making. Today, the Catalan Health Institute (IAS), the Catalan Society of Psychiatry and Mental Health (SCPiSM) and Granés Fundació are bringing together more than 300 professionals at the 2nd Seminar on Mental Health and Intellectual Disability, organised by the three organisations to discuss the best possible practices in the social and health care of people with intellectual and developmental disabilities (IDD).

Held as an all-day event at the Parc Hospitalari Martí i Julià in Salt, the Seminar will be attended by leading experts from Spain and abroad who will discuss the best practices in each of the subject areas highlighted this year. Among other issues, they will address drug-based treatments, consumption of intoxicants, the care of people with borderline intellectual impairment, or the improvement of competences and the development of innovative tools to support medical professionals’ practice in the care of people with intellectual disability.

In his presentation of the Seminar, Martí Masferrer, president of the IAS, provided a historical overview of the development of medical care in the region, from the former Hospital Santa Caterina in Girona to the present-day Parc Hospitalari Martí i Julià in Salt, from where the Intellectual Disability and Mental Health Service has been operating since 2003. For his part, Claudi Camps, director of the IAS’s Mental Health and Addictions Network, has stressed the “necessary” progress made in the care of people with intellectual disability: “A society is also defined by how it treats vulnerable people, and people with disability have been historically neglected. Seminars such as the one we are attending today are fundamental for moving forward in their health care and the protection of their rights.” When her turn came to speak, Granés Fundació’s general manager, Laura Masferrer, has focussed on the goal pursued by her organisation and these seminars: “We want to generate a positive impact in the health and social sectors, and also in education, and in all those areas that create wellbeing for people with disability.” Gemma Perramon, president of the SCPiSM, has talked about the value of the scientific community for knowledge generating and sharing and has highlighted the working group specifically created for the care of intellectual disability and mental health, whose members include a number of IAS professionals.

Over 70% of the people with intellectual disability receive drug treatments

In the morning’s first lecture, Ken Courtenay, the National Health Service in England’s psychiatrist specialised in intellectual disability, has sounded a warning note about the generalised overprescription of drugs in this population group. As he explained, over 70% of the people with intellectual and developmental disabilities receive drug treatments. The fact is that too many drugs are prescribed to people with intellectual disability. Various studies point out that 30-70% of the people living in residential environments, and 10-20% of the people living in the society are treated with psychotropics, basically antipsychotics and benzodiazepines. Usage of these drugs in people with intellectual disability is higher than that observed in the general population, while other drug classes, such as those prescribed for the treatment of high blood pressure or diabetes, which are just as prevalent or even more so in people with intellectual disability, are used to a much lesser degree as these conditions are not diagnosed and, therefore, not treated.

During the debate, attention has also been drawn to the risk of the medical community prescribing medicines to treat conducts that may be an expression of distress or a way of communicating, and not a disorder in themselves. On this subject, the experts remind that some people with intellectual disability have difficulties in conveying their needs and emotional preferences, and state that the evidence on the use of psychotropic drugs to treat behavioural disorders in people with intellectual disability “is insufficient”.

The results and conclusions of different studies carried out in Spain in recent years support this statement and, among other data provided, they indicate that the population with ID is more likely to receive drug therapy than the general population, and that drug consumption in this population is characterised by a “high degree of multi-drug consumption”. Psychiatric medication is prescribed to almost everyone with intellectual and developmental disability (94%) and, on average, they take 3.74 different medicines every day. 56% take antipsychotics and 46% take anticonvulsants. One third of the people with intellectual and developmental disability who take psychotropic drugs have not been given a formal diagnosis of mental illness.

In these studies, psychiatrists specialised in intellectual disability point out that the drugs may play a crucial role if they are integrated in a holistic multidisciplinary approach, in which psychotherapy must be considered to be the first option, particularly when the goal is to provide support to people who have difficulties in regulating their behaviour and emotions. They also argue that the medical community has the responsibility to make sure that a person’s potential for gaining benefit from medicines has been fully assessed before prescribing them. If they are prescribed with restraint, drugs –they say– may alleviate mental anguish and shorten a period of depression or psychosis, among other conditions, in people with intellectual disability. If a drug is being considered, prescribers must perform a detailed diagnostic assessment and take comorbidities into account before prescribing. In this respect, psychiatrists and clinicians must take the time to engage with and truly listen to people with intellectual disability, their family members and their support people regarding the short-term use of psychotropic drugs for mental diseases and/or worrying behaviours. They also highlight the need to offer easy-to-read information about the patient and the medicines prescribed and to make reasonable adjustments to meet a person’s needs as regards their comprehension capacity.

Ken Courtenay will be followed by the psychiatrists Joanneke van der Nagel, from the Dutch Health System; Ramon Novell, from the Catalan Health Institute and head of the Intellectual Disability Service at the IAS; and Maria del Mar Adrover, from the National Health Service of Wales. There will also be a lecture given by the social psychologist Jordi Solé, head of the Department of Social Rights’ People Services Area in Girona. At the end of each lecture, there will be a debate with input from people with intellectual disability and family members.

The Seminar will be closed at 5:30 pm by Martí Masferrer, president of the IAS; Lluís Torrents, secretary of Social Affairs and Families; and Miquel Carreras, manager of the Girona Health Region.

Today’s seminar is the second time that this hallmark event in the field of disability support is being held, targeting professionals working in social entities, basic and specialised social services, and primary, specialised and hospital healthcare, and in education. In one way or another, all these professionals provide support to improve the quality of life of people with intellectual disability and mental illness.