5.3 Antipsychotic medicines dispensing, 17 years and under

Since 2015, initiatives to improve use of antipsychotic medicines in people aged 17 years and under have been undertaken as part of a wider strategy to improve the management of mental health conditions in Australia. The National Mental Health Commission, which was established in 2012, continues to provide advice on ways to improve Australia’s mental health and acts as a catalyst for change. In 2016, the Australian Bureau of Statistics published Patterns of Use of Mental Health Services and Prescription Medications, 2011.

Updated guidelines from the Royal Australian and New Zealand College of Psychiatrists – Professional Practice Guideline 7: Guidance for psychotropic medication use in children and adolescents (2015) – were also published. Mental health organisations such as Beyond Blue and the Black Dog Institute provide support to all people across Australia, including children and adolescents, who are living with a mental health condition. Other programs such as Headspace have been developed to specifically focus on supporting youth mental health.

Concerns have been raised about prescribing of antipsychotic medicines outside guideline recommendations – such as for behavioural disturbances related to dementia or delirium – before secondary causes have been excluded and non-pharmacological measures have been tried.

The Atlas found that, between 2013-14 and 2016-17, there was no decline in the use of antipsychotic medicines in people aged 17 years and under or in people aged 18-64 years, nationally. The rate of antipsychotic medicines dispensed per 100,000 people in both of these age groups increased by 8-9% during the four year period. The magnitude of variation in dispensing has decreased, but is still considerably high. For people aged 65 years and over, prescription rates of antipsychotic medicines decreased during the four years, however, the volume of antipsychotics supplied on any given day in the Australian community remained stable, indicating that there has been little change in the overall amount of use during the four years. 

The current use of antipsychotic medicines outside current guideline recommendations as a form of restrictive practice to manage behavioural and psychological symptoms of dementia (BPSD) in aged care homes is a matter of grave concern. Efforts to reduce inappropriate use of antipsychotic medicines in Australia have included guidelines, safety warnings, education and policy. The Commission proposes a series of regulatory responses.

Dispensing rates and the volume of antipsychotic medicines in the community on any given day in people aged 17 years and under continued to increase during the four years from 2013–14. It is unclear whether this reflects increased incidence of mental health conditions and diagnosis, improved access to medicines, or increased inappropriate use. Although the magnitude of variation in dispensing rates fell from 2013–14, it was still high in 2016–17. Further investigation is required to identify whether these patterns are unwarranted, and what ongoing vigilance is needed to promote safe and appropriate use of these medicines. The Commission will publish a further analysis of these data in 2019, including analyses by state and territory, and local area; and an analysis by practitioner type. This information will help to identify what further targeted interventions are needed to improve the management of mental illness, and that of behavioural disturbances in autism spectrum disorder.

Download the antipsychotic medicines dispensing (17 years and under) section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Content list:

• Context
• Why is it important to monitor antipsychotic medicines use nationally?
• What initiatives have taken place since 2015?
• About the data
• What do the data show?
  • Magnitude of variation
  • Rate of prescriptions dispensed
  • People dispensed at least one prescription
  • Volume of antipsychotic medicines use in people aged 17 years and under
• Interpretation
• Is there more to be done?