20 March 2012
How 'understanding the person' is reducing reliance on medication
Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) is
proving that a healthy dose of respect is sometimes the best
Over the last few years there has been increasing concern about
the use of antipsychotics (major tranquillisers) to control
behavioural symptoms in people with dementia, with the perception
that they may have been used as a "chemical cosh" to sedate
patients as a quick fix to their problems.
These drugs also raised concerns with the Department of Health
that they may have been in some way responsible for nearly 2000
excess deaths nationally and 1600 strokes. While this led to a
drive to reduce the prescribing of such medication, the issue was
what to replace it with. The answer seems to be quite simple:
understanding the patient.
AWP's Consultant in Old Age Psychiatry, Dr Simon Manchip says
that antipsychotics can, in some circumstances, be replaced with
very simple methods of 'understanding the person': "We discovered
that bathing times were a trigger for physical aggression in some
patients, and this was down to our well-meaning effort to ensure
patients bathed or showered at least once a day," he explains.
"Some of our patients chose to bath just two or three times a
week so every day was difficult for them. The sense of difficulty
came out as aggression. This is what we mean by understanding the
person; what are they used to? What prevents them from feeling
The staff found that adopting different approaches for different
people helped, although there were some rules which applied to all.
"If a patient is sitting, we sit to talk to them so they feel less
intimidated. It seems very simple but the figures are showing that
it's very effective."
An audit of current antipsychotic usage was completed in
February this year and showed the current rate of prescriptions in
Swindon for people with dementia is just 8%. This is probably one
of the lowest rates in the whole of the United Kingdom. All
prescriptions which are now given are time limited and in most
cases the stop date for the medication is written on the start date
to avoid prolonged unnecessary prescriptions.
Dr Manchip is keen to point out that working in partnership has
been key to the success of the project.
"It is a real joint approach. General Practitioners are
prescribing less and liaising with AWP in most cases before
prescribing. Very importantly, all the care homes we work alongside
are looking at non drug ways of helping their residents more and
more. We believe that this medication still has a role to play for
certain patients with dementia but knowing where it will not be
effective is increasingly important."