South east London STOMP clinic: case study
Find out how STOMP provides specialist services tailored to individual needs and reviews patients’ medication, ensuring treatment is appropriate, safe and effective.
What is STOMP?
STOMP stands for stopping over‑medication of people with a learning disability, autism or both.
The STOMP service helps ensure people take only the medicines they need. In south east London (SEL), around one in four people with a learning disability are prescribed mental health medication without a recorded diagnosis. To help address this, the SEL STOMP Clinic was established. The clinic provides specialist services tailored to individual needs and reviews their medication, ensuring treatment is appropriate, safe and effective.
The following case study tracks Janine’s* patient journey with the STOMP service.
Background
Janine lives in a small residential home for people with learning disabilities in south east London. She moved there two years ago and really likes where she is living.
“It’s amazing, I’m happy. [I like] everything[…]. The house is ok, but the staff are amazing.”
Janine was prescribed the psychotropic medication, mirtazapine, for over ten years even though she did not have a recent mental health diagnosis. Janine was stable, but the circumstances of why she started on the medication were not clear, as she stated they were “for [her] mental health”. However, Janine remained on the medication so she “could fit in”, reporting she “felt odd without taking it” and believing it helped her to fit in. The medication affected Janine in several ways, including how openly she communicated with others and a decrease in energy levels, as she reported that she “mainly […] kept on sleeping”.
“I like to go out, get myself pampered, have my nails done, but then I just kind of stay in and help out in the house.”
About a year after moving into the residential home, Janine was discharged from the local mental health team. Janine’s GP practice was working with the SEL STOMP clinic team and felt she could benefit from their support services.
Janine’s profile
Name: Janine (*pseudonym)
Age: Mid-thirties
Location: Small residential home for people with learning disabilities, in south east London
Prescription: Mirtazapine (psychotropic medication) despite having no recent mental health diagnosis
Symptoms: Socialising and communication affected, decreased energy levels
Work with the STOMP team
Harriet from the SEL STOMP team worked with Janine for nine months. While the focus of STOMP is to reduce prescribing of psychotropic medications, the support she provided was holistic. With help from the team at the residential home – including Sandy (pseudonym), the manager of the residential home – Harriet worked to help improve Janine’s overall health.
Harriet looked at all aspects of Janine’s health and day-to-day life, regularly visiting her at home. Janine was “excited” about Harriet’s visits to the house as they would have “a good old conversation” before checking her medication and care plan folder. Together, Harriet, Janine, and Sandy worked to slowly reduce Janine’s medication, with each change to the medication taking at least six weeks.
Harriet focused on improving Janine’s diet and hydration to help ensure she didn’t lose any more weight when she started reducing her medication. They also focused on holistically tackling Janine’s sleep problems, as Janine reports she “put the phone away, and […] did listen about turning the TV off” to allow some time for herself before bed.
When asked what helped the most, Janine replied:
“I think it was just the support, and her not giving up on me. […] She didn’t give up on me”.
In addition to the regular home visits with Janine, there was also ongoing communication between the residential home staff and Harriet. Janine’s mood was also logged by the residential home team via an app that could be seen by the SEL STOMP team. By the end of the nine months, Janine had gone from taking 45mg of mirtazapine per day to being fully off it.
Key changes
Sandy has noticed a real difference in Janine, finding she carries herself with more confidence and communicates more openly. When Janine goes to work and comes home now, Sandy notices that Janine will “vocalise everything about her day – what’s happened, what’s not happening… she doesn’t keep anything in, she doesn’t hold back”. This is a marked change, as Janine reflects that she “used to bottle it all in” before.
Janine’s energy levels also markedly increased. She was already volunteering three days a week at a day centre for older people, but has now increased her responsibilities as she became the go-to person for “everything that needs happening”. Sandy notes how Janine also gets involved in more activities and helps in the kitchen at home. On days when Janine is not volunteering, she likes to “go out, get pampered” or “just kind of stay in and help out in the house”.
As Janine continues to go from strength to strength, the SEL STOMP team also supports her to ensure she has a continued healthy, happy, and safe life within her community. For instance, Harriet organised for Janine to partake in activities at a day centre once a week to ensure that she wasn’t bored once she was feeling better. Recently, Janine also received a certificate for some dementia training she undertook. Harriet, Sandy, and Janine have also discussed the possibility of Janine looking for paid work in the near future.
Janine’s feedback since coming off medication
- ” [feels] happy, glad, and [that she has ] more energy”
- “[feels more empowered] to stand up for [herself] a bit more now”
- “More social at home”
- “I’m coming out of my shell a bit more”
- Believes it is a combination of settling into her home and coming off medication that has caused such a marked difference
- “[mental health services] need more people like Harriet!”
Get in touch
For more information about the project “helping people with a learning disability, who have behaviours that challenge, to avoid harm from psychotropic medicines”, get in touch via email.
Stay up to date
Our newsletter keeps you in the loop with the latest developments in health and care innovation.