Do the NHS abide by Article 25 of the UNCRPD? Using the STOMP-STAMP Guidelines to check, a UK study, Dr Amani Hassan, Dr Sarah Karrar

Dr Amani Hassan
Cwm Taf Morgannwg University Health Board
Wales
Dr Sarah Karrar
Sandwell and West Birmingham NHS Trust
UK

Abstract

Introduction: Article (25) of the UN Convention on the Rights of Persons with Disabilities (UNCRPD), states that persons with disabilities have the right to the enjoyment of the highest attainable standard of health. Psychotropic medications are used sometimes when persons with intellectual disabilities presents with a behaviour that challenges. Such behaviour could lead to the child being expelled from school or being sent away from family to reside in residential settings. The first line interventions should be psychological and that a behavior support plan should be commenced, and parent-training programs should be considered to try tackle the behavior according to Nice Guidelines. STOMP-STAMP Guidelines were launched in December 2018 by NHS England and The Royal College of Paediatrics and Child Health, the British Association of Childhood Disability and the Council for Disabled Children pledged to ensure that children and young people with intellectual disability, autism or both, have access to appropriate medication [in line with National Institute for Health and Care Excellence (NICE) guidance] but are not prescribed inappropriate medication.

Aim: The aim of this study is to identify the compliance of the Child and adolescent intellectual disability Psychiatric service (CAID) in South Wales with the STOMP-Stamp guidelines in the monitoring of child and adolescents with LD who are prescribed psychotropic medications.
Methodology: A retrospective study of clinical notes of children and adolescents with moderate to severe intellectual disability, i.e. IQ of less than 50, who are currently under CAID tertiary mental health service.
Results: 59 children and adolescents (78% males and 22% females, age range 8 to 17 years with mean age of 13.18 years). Autism Spectrum disorder was the most common comorbid diagnosis followed by anxiety disorders. 3.3% of the children have additional diagnosis of Down’s syndrome. Epilepsy was associated with polypharmacy, poor response to medications and severe challenging behaviour. Consents to medications were well documented and obtained from those with parental responsibilities. More than half of the participants were on monotherapy. The Antipsychotics were the most common medication prescribed followed by antidepressants. Diagnoses of the comorbid conditions were well documented in each file. Insomnia was the most common symptoms with majority on sleeping medicines. Obesity was the commonest physical health problem in the sample followed by constipation, and both are known side effects of antipsychotic medication. Most of the children couldn’t have the appropriate investigations recommended by NICE guidelines before initiating the medicine such as bloods and ECG.
Conclusion and recommendations: Medication (polypharmacy) is still the main method of controlling severe challenging behaviour in the absence of evidence based psychological therapy like Applied behaviour analysis (ABA). Judicious use of antipsychotics is required in the LD population given the increased risk of the side effects to the child and young person’s short term and long-term physical health. Stress the importance of multiagency working to minimize use of antipsychotics.