RAtionalising Psychotropic medications for adults with Intellectual Disabilities: sCOPing (RAPID-COP).

Research questions Are there an adequate number of prescribers in the UK who see the need for a “StruCtured prOgramme of Psychotropic rationalisation in pEople with intellectual disabilities (ID) (SCOPE)” and agree to participate in its implementation, including participating in a future definitive RCT to assess the clinical and cost-effectiveness of SCOPE?

This will allow us to assess whether SCOPE if developed, could be implemented at a scale.

What is the current rate of psychotropics withdrawal/rationalisation, and what could be reasonably expected and feasible to achieve with the support of SCOPE?

Background Overmedication of people with ID, particularly the off-licence use of psychotropic medications for behaviours that challenge (BtC) in the absence of a psychiatric illness, is a major public health concern.

Withdrawal/deprescribing/rationalisation of inappropriately prescribed psychotropics will reduce overmedication and improve the quality of life of adults with ID. Currently, no national programme/training for psychotropic medication withdrawal/rationalisation is available.

The project was developed with people with ID, their family carers and psychiatrists in the UK who will remain involved all throughout the project. Aims and objectives. We will achieve our objectives through six work packages (WPs) described here. WP1 (0-4 months): Stakeholder workshop.

A workshop involving 30-35 consultant psychiatrists from all parts of the UK and specialist nurses and pharmacists who prescribe psychotropic medicines for adults with ID for BtC to explore current practice and the prescriber s views on the scope and contents of SCOPE and its implementation. WP2 (5-8 months): Wider stakeholder consultation-online survey.

Wider stakeholder consultation with the UK-wide prescribers of psychotropics for adults with ID using an online questionnaire survey to assess the current state of clinical practice in this area and collect examples of good practice to conduct case studies. WP3 (5-10 months): Longitudinal clinic-based data collection.

Prospective record keeping of psychotropic withdrawal and new prescriptions by several consultant psychiatrists over six months from various parts of the UK to assess the current withdrawal rate, what could be reasonably achieved with the help of SCOPE and what resources may be needed to implement SCOPE locally.

WP4 (10-15 months): Qualitative research involving interviews and focus groups.

Interviews and focus groups of a purposive sample of prescribers, health and social services managers, and multidisciplinary team (MDT) members to explore some issues related to the implementation of SCOPE and the experiences of psychotropic withdrawal. WP5 (16-18 months): Dissemination workshop with wider stakeholders.

Dissemination workshop with wider stakeholders to disseminate study findings and determine whether and how to establish a multiagency forum to adapt and implement SCOPE locally.

Impact and dissemination This project will help raise awareness among UK prescribers of issues like overmedication and its possible solutions.

The dissemination will primarily be through the Royal College of Psychiatrists, the dissemination workshop, study web page (including accessible information), publications in peer-reviewed international journals and conference presentations, but also through various organisations such as social service providers, family carers (Challenging Behaviour Foundation) and the Learning Disability Senate, a multi-agency national forum that addresses service issues in the UK.