Challenging Behaviour: A Unified Approach

A new Council report, Challenging behaviour: a unified approach, is the result of a joint working group of learning disability faculties of the Royal College of Psychiatrists and the British Psychological Society, in consultation with the Royal College of Speech and Language Therapists.

It provides clinical and service guidelines for supporting people with learning disabilities who are at risk of receiving abusive or restrictive practices.

Challenging behaviour requires a multidisciplinary and multi-agency approach, and this report has been produced with the intention that it will be relevant to a wide range of health and social care professionals, family and paid carers, service providers and commissioners.

The fundamental unifying principle is to improve the quality of life for people whose behaviour challenges others, and who are often marginalized, stigmatised and excluded from mainstream society. The report focuses primarily on adults with moderate to severe learning difficulties, although the broad principles outlined are applicable to children and adults of all degrees of intellectual disability.

The term ‘challenging behaviour’ was originally developed to describe the interaction between the behaviour of a person with a learning disability and the complex environment in which they live, but over time has come to be misused as a diagnostic label. The report redefines challenging behaviour, building on past definitions and focusing on the responses that the behaviour evokes in others, including those that are punitive or restrictive.

There is a diversity of learning disability policy throughout the UK. Despite shared commitments to support ordinary lives in the community, there has been a growth in the provision of long-stay residential provision. Challenging behaviour reviews current legislation, which varies between the different legislatures and is continually changing. The development and enactment of mental capacity legislation is clarifying the principle of best interests, and the process of decision-making, for adults who lack capacity.

The report addresses the importance of focusing on the individual. A comprehensive assessment should address a range of issues, including underlying medical and organic, as well as social and environmental, factors. Interventions, which should be routinely evaluated for their effectiveness, include psychotherapy, positive programming, physical and/or medical treatments, and medication where appropriate. Communication and feedback between professionals, carers and service users is essential at all stages of care.

Improving services and enabling people with challenging behaviour to remain in their own homes requires the creation and support of ‘capable environments’.

Training and professional support for all carers is needed, as well as creative solutions to the challenges faced. A set of good practice standards is provided against which local services and stakeholders can audit and evaluate their current service provision.

Future work must address the issues of challenging behaviour and early intervention in children. The service user perspective needs to be emphasised, and it is hoped to achieve this through the development of a charter outlining what standards of service provision people should expect.