Leading-practice recommendations for psychotropic medications

Page posted: 3/6/24

Knowledge and use of psychotropic medications is always evolving with increased understanding of the effects of medication on the body.

As part of current leading-practice recommendations, the expanded support team (defined in Minn. Stat. §245D.02, subd. 8b) should:

· Follow the principles of person-centered practices and shared decision-making in all approaches and processes (refer to DHS – Person-centered practices and National Library of Medicine – Shared decision-making).

· Establish and monitor specific person-centered outcomes and objectives.

· Consider and use non-medication supplemental therapies (e.g., cognitive behavior therapy, dialectical behavior therapy, positive behavior supports) before and combined with psychotropic medication.

· Select treatment approaches grounded in evidence-based practices.

· Ensure treatment is appropriate for the person’s condition and not aimed at physical restriction or excessive sedation.

· Consider and use a range of person-centered assessment processes and treatments when developing treatment regimens and care plans (refer to the interdisciplinary assessments to determine support needs section).

· Try lower doses and fewer medications first before moving to more complex treatment medication regimens.
Note: There are exceptions to this recommendation when supported by empirical evidence.

· Have a goal to achieve optimal health outcomes with the lowest dose of the medication necessary.

· Collect data to track effectiveness and side effects and to determine appropriate dosages and combinations with other medications.

· Reevaluate the person’s need to continue medications regularly and systematically.

Additionally, expanded support teams should keep in mind that a variety of factors can contribute to a person’s symptoms, including:

· Biological factors (e.g., physical health, genetics, nutrition).

· Psychological factors (e.g., feelings, emotions, thoughts, behaviors).

· Social factors (e.g., relationships with others, trauma, natural supports).

· Environmental factors (e.g., time of day, noise level, temperature).

Some of these factors, such as noise levels in a home or poor relationships with roommates, can be addressed by the 245D-licensed provider, people who coordinate care or family members. The expanded support team should work together and take a holistic approach to support the person instead of relying solely on the licensed practitioner and psychotropic medication.

Interdisciplinary assessments to determine support needs

As explained in the previous section, one of the best ways to support a person who needs psychotropic medications is to use a person-centered, interdisciplinary process to assess their supports. Assessments should inform positive support care plans that outline how to help the person live their best life.

The most useful types of assessments vary from person to person. Medical or mental health professionals must conduct some assessments while other members of the expanded support team can conduct other assessments. The level of detail and complexity of the assessment process also varies from person to person. Typically, the process is determined by the person’s target symptoms, diagnoses, preferences and the relationship between biological, psychological and social (i.e., bio-psycho-social) variables in their life.

DHS recommends requesting or conducting a combination of the following assessments/tools to support a person who is prescribed psychotropic medications:

· Psychotropic Medication Manual – Diagnostic assessments and medical evaluations.

· Psychotropic Medication Manual – Functional behavior assessment (FBA).

· Psychotropic Medication Manual – Person-centered tools to support medication management.

· Psychotropic Medication Manual – Quality-of-life assessments.

Support teams should consider using assessments in the following situations:

· Before the person visits a doctor.

· Before the person starts a new medication.

· To assess the effectiveness of a medication already in use.

· When the person starts displaying new symptoms.

· When the person gets a new service provider.

· When the person engages in an interfering behavior for more than six months without any decrease in occurrence.

Example of when to use an assessment

Anne has lost interest in activities she used to enjoy. She has very little appetite, and it is difficult to get her to eat. Anne wakes up often at night and is tired and irritable during the day. She wants to spend all her time alone in her room. She gets very angry when asked to participate in activities with others. In this situation, Anne and other people who are important in her life may decide to conduct some assessments and gather data about how she feels, and then visit a licensed practitioner so they can evaluate her for a mental health diagnosis and treatment plan.

Additional resources

Psychotropic Medication Manual
Psychotropic Medication Manual – Appointments
Psychotropic Medication Manual – Medications