Prevention has a key role to play in the management of behaviour that challenges and this can include overcoming manageable trigger factors such as providing stimulating activities and managing environmental factors like limiting noise or the time spent in a noisy environment. Ensuring the correct diagnosis of any underlying mental health disorder will also help to facilitate treatment to remove the trigger.

For example, someone showing aggressive tendencies, hyperactivity and poor sleep may point to a mood disorder requiring treatment. Without such treatment the symptoms may lead to limited daytime activity and ultimately impact on quality of life.

In 2015, NICE published guidance on Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges, which recommends the following measures are taken to address behaviour that challenges:

• There should be an assessment of the individual, their environment and any biological triggers
• There should be a focus on improving quality of life of the person
• If non-pharmacological methods do not produce the desired change in behaviour then consider medicine in combination with psychological intervention
• Medicine must never be used in isolation to manage behaviour that challenges.

The assessment process is fundamental to understanding the needs of an individual showing behaviour that challenges. It usually involves specialist input and will take time to collate the relevant information. Assessment often involves the recording of behaviours in a diary that helps to identify trends and potential triggers. Pharmacy professionals may be able to support people who display behaviour that challenges, and their families and carers, by giving them diaries and encouraging them to make use of these.

The major role of pharmacy professionals in supporting those with behaviour that challenges will be around the use of medicine to help manage this behaviour. NICE guidance clearly states that medicine should only be considered when:

• Psychological intervention does not produce the desired change
• Treatment for co-existing mental health illness has not reduced the behaviour
• There is severe risk to the individual, such as violence, aggression or self-injury.

The Winterbourne View final report commented on the overuse of antipsychotic and antidepressant medicines in people with a learning disability. This has led to the development of a review of all such prescribing with the intention to reduce, and potentially stop, the reliance on psychotropic medicines to manage behaviour that challenges.