In 2015, NHS England published reports highlighting the widespread inappropriate use of antipsychotics and other medicines used to treat mental illness in people with learning disabilities. And, following these reports, NHS England led a ‘call to action’ which brought together representatives of professional and patient groups to make sure changes were made to these bad practices.
‘It is estimated that every day about 35,000 people with learning disabilities are prescribed psychotropic medicines when they do not have a diagnosed mental health condition, often to manage behaviour which is seen as challenging.’– NHS England
Thereafter, a three year strategy was founded which runs until 2019, centred upon finding other ways to ensure people receive the help that they need without the inappropriate use of medication.
Of course, medication is not bad per say.
Where medication is the right pathway for an individual, STOMP is about getting the right medicine, that medication reviews are regular and that individuals are involved and supported in decisions affecting them. It highlights the importance of inclusion of families and social care providers in supporting people.
STOMP is gaining momentum!
Here at Apple House care homes the principles of STOMP are carved deeply into our work and always have been. However, we welcome this formalised approach which is raising awareness to a long history of inappropriate medication of people with learning disabilities.
Increasingly, health professionals and groups such as the British Association of Social Workers, Voluntary Organisations Disability Group, Royal College of Speech and Language Therapies, and Care Management Group, are joining the Royal Colleges of GPs, Nursing, Psychiatrists and the NHS, in pledging to uphold the ethos of STOMP.
Does this mean there is zero medication in Apple House care homes?
Of course medicine is still the appropriate choice for some people. What we believe, though, is that medication might be appropriate right now but that does not mean it needs to necessarily be a long term pathway. Here, Jayne Jackson tells us just a few ways in which Apple House care home is embracing the STOMP project:
“If we give ‘as required’ medication, we immediately liaise with the mental health team so that we are all participating in the monitoring of the medication’s effectiveness and exploring why it was needed, what could and would work better to prevent the need for ‘as required’ medicine.
We use ‘flat mood’ charts as part of investigative work we are undertaking with Y and we noticed an increase in Y’s anxiety and darkening mood. [This should help his psychiatric doctor understand if his low mood is linked to behaviour or mental health; this will also reflect on what medication he will be taking]
We know that sleeping well has been proven to keep Y’s mental health well and so we focus, with Y, on relaxation techniques, on ensuring Y’s environment is conducive to peace, calm and rest, and that Y is encouraged to talk about stresses or thoughts or emotions that might prevent a good night’s sleep. Although guidelines are in place for the use of an as required medication, we have not needed to administer this for five years because we achieve results by more organic means.
We request referrals and screening tests – this ensures that underlying physical health is good and it also alerts us to any possible effects of reductions in medication.” — Jayne, Registered Manager, Apple House care home.
Communication is key!
Communication with the individual, with their mental health team, GP and community nurse. With family and outside agencies. Together we ensure medication is regularly reviewed, side effects minimised and alternatives explored and used alongside or instead of medicine.
“We have a fantastic relationship with the people we support, their family and professionals. We work as a team.” — Jayne, Registered Manager, Apple House care home.
What about alternatives to medicine?
We have previously reported, right here on our blog, about the extensive benefits of sensory stimulation via sensory rooms, sensory gardens and other creative means to defuse challenging behaviour.
As a ‘family friendly’ organisation, we encourage loved ones to be intrinsically involved unless an individual does not want this. We draw on their knowledge, the likes and dislikes and the past of the individual we support. Triggers to mood change and behaviour escalation are identified and form the cement that underpins care plans and positive behaviour management.
“We as a provider carefully cherry-pick the best staff, the most compassionate and insightful team members who will look past the presenting behaviours and really see the individual.
Just today, at a senior team meeting, I introduced the team to an exciting new handbook called ‘Please Tell Me,’ by John’s Campaign of which we are members. This is a book by and for the people we support. It is their history, their present, and their future, as perceived by them and for them. Not only might it be cathartic to work on their book (with or without support as needed), but it provides a precious tool to record memories, to log events that have shaped them and thoughts that make up the person they are.
If we can see each person holistically, then together we can be more creative in finding alternative ways to medication to ensure life is full and pleasurable and safe.” –Jane Montrose, Managing Director, Apple House care homes.
Here are some useful links for further reading:
Care Management Group, on STOMP: CLICK HERE
NHS England, on the STOMP pledge: CLICK HERE