Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard

The Royal Commission into Aged Care Quality and Safety (Aged Care Royal Commission) and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Disability Royal Commission) found that psychotropic medicines are being misused and overused, particularly in older people with cognitive disability or impairment. 

The Australian Commission on Safety and Quality in Health Care, the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission released a Joint Statement in March 2022 outlining the commitment by these three agencies to work together to reduce the inappropriate use of psychotropic medicines as a form of restrictive practice to control the behaviour of people who exhibit behaviours of concern.

Development of this clinical care standard aims to support the Joint Statement by providing guidance to enable appropriate management and improve outcomes for these vulnerable groups. The standard adds to the existing body of work by the Commission to reduce inappropriate use of psychotropic medicines.

This clinical care standard aims to ensure the safe and appropriate use of psychotropic medicines in people with cognitive disability or impairment and to uphold their rights, dignity, health and quality of life.

This clinical care standard relates to the health care that people of all ages including children and adolescents with cognitive disability or impairment should receive to optimise the prescribing and use of psychotropic medicines. It is relevant to people with cognitive disability or impairment who are:

• Living independently and may have visiting support workers 
• Living with family and may have visiting support workers
• Living in aged care homes 
• Living in specialist disability accommodation 
• Receiving care in acute healthcare facilities. 

The standard relates to the care provided to people with cognitive disability or impairment when psychotropic medicines are prescribed for one or more of the following reasons:

• In response to behaviours of concern 
• For treating diagnosed mental health or neurological conditions, or sleep disorders
• For treating diagnosed physical illnesses or conditions.

The standard recognises existing legislation that identifies use of psychotropic medicines for the primary purpose of influencing a person’s behaviour – rather than treating a mental health condition – as a restrictive practice, and the regulatory roles of the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission.5–8 It does not replace the regulations and requirements of these two Commissions. Similarly, in healthcare services where state or territory mental health legislation applies, the standard should be considered within the requirements of the relevant mental health Act. 

This clinical care standard provides guidance that can be applied across diverse settings and to people of different ages with different types of types of cognitive impairment and disability. When implementing this clinical care standard, clinicians and those governing the provision of healthcare, aged care and disability services should consider the context in which health care is delivered and the specific relevant jurisdictional and regulatory requirements that apply to the person and healthcare setting.

What is not covered 

This clinical care standard does not address the use of psychotropic medicines in:

• People who do not have cognitive disability or impairment
• The management of acute behavioural disturbance secondary to recreational drug or alcohol use 
• The management of terminal delirium during the last days of life.

This clinical care standard does not provide specific guidance on the selection and choice of psychotropic medicines for any indication.

The standard was developed in consultation with a topic working group of clinicians, researchers and consumers. Public consultation on the clinical care standard was carried out between April and May 2023. 

The standard has been endorsed by 25 key professional associations and consumer organisations.