5.4 Antipsychotic medicines dispensing, 18-64 years

Since 2015, initiatives to improve use of antipsychotic medicines in people aged 18–64 years 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. Regulatory changes have also been made to the number of repeat supplies that can be ordered on prescriptions for low-dose quetiapine.

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 18–64 years 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 variation in the magnitude of dispensing of antipsychotic medicines has fallen since 2013–14, it is still high. 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.

Download the antipsychotic medicines dispensing (18-64 years) 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
  • Estimated proportion of population treated daily with antipsychotic medicines
• Interpretation
• Is there more to be done?