The use of psychotropic medication for the management of problem behaviours in adults with intellectual disabilities living in Canada

The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis-reactive than those in the UK.