Oireachtas committee hears of over-prescription of antipsychotic medication

Oireachtas committee hears of over-prescription of antipsychotic medication

'There’s a history of over-medication' when it comes to people with learning disabilities, claimed Malcolm McLachlan of Maynooth University. File Picture: Pexels

More than half of people on antipsychotic medication who have learning disabilities have no psychotic symptoms, the Oireachtas health committee has heard.

This is a symptom of the over-prescribing and thrust towards institutionalisation within disability services in Ireland based on a medical model of delivering care, Malcolm McLachlan of Maynooth University said.

Impassioned calls were made at the Oireachtas health committee for new laws to compel the State to provide adequate therapies and supports to people — particularly children — with disabilities.

Chronically understaffed disability services

Yvonne Lynch of the Irish Association of Speech and Language Therapists said that children were missing vital interventions in their youth, which were limiting their life chances and academic development.

A crisis in human resources, with chronically understaffed disability services throughout the country, is an issue that needs to be urgently addressed, she said.

She said that if children had therapeutic help sooner, they would need less intervention in the long term, but instead they are sitting on waiting lists as their problems become more complex and intractable.

“Waiting lists are a very serious issue,” she said. 

Speech and language therapists are doing a lot of firefighting.” 

Independent senator Tom Clonan spoke of his 20-year-old son who has complex additional needs.

“I know how hard you work on the frontline,” he said. "But the needs are so much greater than the resources.

Senator Tom Clonan during a national day of action at Leinster House by Families Unite for Services and Support over a lack of services for children with special needs and disabilities. Picture: Gareth Chaney/ Collins Photos
Senator Tom Clonan during a national day of action at Leinster House by Families Unite for Services and Support over a lack of services for children with special needs and disabilities. Picture: Gareth Chaney/ Collins Photos

“My son is 20. When he’s not in college, he has no personal assistant hours. He has a very large iPad to assist him, as his eyesight is restricted.

But he doesn’t have a personal assistant to plug it in and charge it and hand it to him during the day. So he has it until it runs out of power.

“He has watched, this summer, all of the seasons of Friends [TV show], which is great. But it would be wonderful if he actually had friends. But he can’t have friends in Ireland because he doesn’t have those PA [personal assistant] hours.” 

Ireland is exceptionally poor in the area of disability services and is an outlier in this sphere within Europe, he said.

Assistive technology

While assistive technology can be a means to an end, it is not an end in itself and it requires adequate input from therapists to allow users to use it properly, he said.

His son has been unable to avail of properly of eye-gaze technology, speech-recognition technology, and a promising exoskeleton at Dublin City University because he lacked adequate therapies such as speech-and-language therapy and physiotherapy, which would have allowed him to avail himself of these technologies.

He said his son was “shivering with excitement” going to try the exoskeleton, only to be told on arrival that he was not a candidate due to untreated scoliosis and lack of physiotherapy.

Assistive technology will not make a meaningful difference unless we get the building blocks in place,” said Mr Clonan.

“We can oblige the services legally to provide an assessment of need, but Ireland, unlike the UK, Northern Ireland, Wales, Scotland, Germany, and other EU countries, we cannot legally oblige the State or its agents to provide therapies. So in the absence of those therapies and PA supports, the assistive technology becomes more or less meaningless.

“It’s in absolute extremes that we find ourselves in. 

We’re in excess of 10 years with no intervention. The only interventions we get are to measure deterioration. We must be the only country in Europe where this happens.” 

 Malcolm McLachlan of Maynooth University said that Ireland is now in the “terrible situation” where people with disabilities who need assistive technology are not getting it.

He called for legislation to ensure that people with additional needs who would benefit from assistive technology would get it and would have that technology maintained on an ongoing basis.

“Unless there is legislation, those requirements will not be met,” he said, describing the situation as “unacceptable”.

The area of disability has struggled because of the history of the medical model in Ireland, he said.

History of over-medication

“There are great things about the medical model, medical interventions can be health-promoting, lifesaving, and really crucial to help people not be in pain," he said. 

"But the bad element is the institutionalisation of people with disabilities. There’s a history of over-medication.

“Over half of people with intellectual disability who are on antipsychotic medication have no psychotic symptoms at all,” he said. 

"So there are continuing problems with our model."

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