Burstow bid to use Dols to curb antipsychotics use ‘draconian’

Concerns have been raised over “draconian” proposals from Paul Burstow to use the deprivation of liberty safeguards to crack down on inappropriate prescriptions of antipsychotic drugs to sedate people with dementia.

The care services minister has indicated that he is prepared to require doctors to seek authorisation from councils or primary care trusts under the Dols to prescribe antipsychotic drugs to patients with dementia who lack the capacity to consent to their treatment.

This would mean prescriptions could only take place after six assessments, including a test of whether the treatment was in the patient’s best interests, and would be regularly reviewed. Introducing the change would require an amendment to the Mental Capacity Act 2005.

Burstow’s comments reflect a frustration with a lack of action to reduce antipsychotics use since a 2009 report for the last government found two-thirds of prescriptions for people with dementia were inappropriate, resulting in 1,800 deaths a year.

A target he set last year to reduce prescriptions by two-thirds by the end of this month is set to be missed, and last week the minister said he was prepared to take “whatever steps are necessary” to cut their use.

“Call it the chemical cosh, call it chemical restraint, call it what you will. It is a prison sentence, locking a person in their own body,” Burstow told last week’s annual Dementia Congress. “Antipsychotic drugs, prescribed against the evidence, without clear justification, amount to a deprivation of liberty.”

However, the plan drew a sharp response from Royal College of General Practitioners chair Dr Clare Gerada.

Though she said the college supported a reduction in antipsychotic use for people with dementia, she added: “The minister’s comments are surprising, and suggest a draconian measure that the college fears would cause more problems that it would solve.”

Community care law researcher Lucy Series, who blogs as the Small Places, said the Dols were a “peculiar vehicle” for tackling inappropriate prescription of antipsychotics. “The case law is moving rapidly away from associating the meaning of ‘deprivation of liberty’ with factors like restraint and sedating medication,” she said.

Dr Andy Barker, vice-chair of the Royal College of Psychiatrists faculty of old age psychiatry, said he did see how amending the Dols in the way suggested would work.

He said the problem was not so much the initial prescription of antipsychotics but that their use was not reviewed rigorously enough.

Under the MCA, doctors prescribing drugs for people who lack capacity to consent must ensure that the treatment is in their best interests and the least restrictive option available, but Burstow has indicated these provisions are not being followed.

Given the sedative effects of the drug, they can also be a contributory factor, alongside others, to someone being deprived of their liberty in care homes or hospitals, which would require a Dols authorisation.

However, Burstow’s proposal would go much further in requiring a Dols authorisation simply for the prescription of antipsychotics.

Though it did not back the proposal explicitly, Alzheimer’s Society said “something more needs to be done” to reduce use, and called for mandatory reviews of antipsychotic prescriptions after 12 weeks.

Barker said there was a need to establish dementia registers – which log patients in an area with the condition – to monitor and review prescriptions to ensure the drugs are used appropriately.

Burstow indicated he would wait until March to make a decision on the policy. By then, clinical reviews of all 180,000 dementia patients on antipsychotics should have been completed, as part of an agreement with sector coalition the Dementia Action Alliance.

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