Medication Pathway

Section C Medication has been suggested

Alternatives to medication

Medication should not be the only option considered in response to challenging behaviour and should only be used if alternative strategies have not reduced the behaviour. There should be a clear rationale for prescribing the medication.

NICE guidance states that medication prescribed for challenging behaviour should only be given alongside other interventions and there is further guidance under the Mental Capacity Act (2005) for anyone who lacks capacity to make decisions about medication.

Under the Mental Capacity Act (2005), if someone lacks capacity then any decision made in their best interests should consider the least restrictive option for that person. This means that if two interventions are likely to be similarly effective, the intervention that allows the person the most freedom should be used.

Psychotropic medication, like physical intervention and seclusion, can be a restrictive practice. This is because it can limit someone’s freedom, for example if someone experiences sedation as a side effect, this impacts on their ability to go out and do the things they enjoy. Therefore, when medication is suggested, less restrictive options should also be considered.

There are many alternative interventions to medication, such as Positive Behaviour Support, Intensive Interaction or Active Support. There is more information about alternatives to medication and getting support right in Section G.

Examples of support in situations where medication is often suggested are given below. You may want to think about whether any of these could be useful for your relative and suggest trying alternative interventions before medication is prescribed or alongside medication.

SituationHave you tried…
Initial diagnosis (of learning disability, autism, or other genetic conditions)
  • Use information about the diagnosed condition to understand the child’s or adult’s needs
  • Getting support from other family carers, voluntary groups or charities
  • Parenting programmes, such as Stepping Stones, Early Bird, E-Pats.
Personal/family crisis
  • Planning support for your family member that will make the situation less unpredictable and unsettling for them
  • Helping your relative understand a situation by using resources such as Easy Health and Books Beyond Words
  • Asking social services for extra support during difficult periods, such as short breaks or a personal assistant
  • Accessing the Community Learning Disability Team, crisis team or mental health services if appropriate
Placement breakdown
  • Looking for ways to reassure your relative and help them feel secure
  • Planning a time of reduced demands and preferred activities, to help them cope
  • Accessing the Community Learning Disability Team, crisis team or mental health services, if appropriate
Starting school
  • Preparing your child in advance, with the help of alternative and augmentative communication (e.g. a picture story)
  • Planning with the school your child’s support on the way to school, during the day and coming home
  • Using any taster days offered to familiarise your child with the school
  • Discussing with the school the behaviour support they will use and whether they should contact you in the event of behaviour incidents
Puberty/adolescence
  • Helping your relative understand changes to their body using resources such as Easy Health and Books Beyond Words
  • Checking they are getting enough sleep and enough exercise
  • Supporting your relative to make more choices and have more control over their daily life, with the help of alternative and augmentative communication, ideally following the advice of a Speech and Language Therapist
  • Seeking sexual health and relationships support
Poor or no planned transition from child to adult services
  • Asking social services to action the transition and escalate if planning is not done: this is a legal duty under the Care Act 2014
  • Preparing your relative for the changes to their support, with the help of alternative and augmentative communication (e.g. Makaton)
  • Planning a time of reduced demands and preferred activities, to help your relative cope
Change in placement, such as leaving the family home
  • Ensuring the transition plan includes meeting new staff and housemates, making appropriate adaptations to their new home and putting familiar belongings in the new home
  • Preparing your relative for the move, with the help of alternative and augmentative communication (e.g. photos or symbols)
  • Planning a time of reduced demands and preferred activities, to help your relative cope
  • Ensuring a clear and usable Positive Behaviour Support plan and communication passport are in place and support staff are given personalised inductions