‘Lots of Black people are on meds because they're seen as aggressive’: STOMP, COVID-19 and anti-racism in community learning disability services

Background
The STOMP agenda (Stopping Over-Medication of People with learning disabilities, autism, or both) drew focus to individuals with a diagnosis of a learning disability being prescribed psychotropic medication to manage ‘behaviours that challenge’. The following study is an audit of two community learning disability services in the London boroughs of Westminster and Kensington and Chelsea for compliance with national guidance on the use of medication in this population, the impact of the COVID-19 pandemic, and equality, diversity and anti-racism.

Method
Routinely collected data were audited relating to clients identified in each service, totalling 54 participants. Data were audited against five standards: minimum effective dose, medication reviews, alternative multidisciplinary input, the impact of the COVID-19 pandemic and equality, diversity and anti–racism. Comparisons were made to the overall caseload (N = 365) where appropriate.

Results
Evidence demonstrated a greater risk of receiving psychotropic medication to manage behaviours that challenge for service users from racialised backgrounds, further evidencing institutional and/or individualised racism within practice for this population. Prescriptions also increased in dosage during the COVID-19 pandemic exacerbated by insufficient provision of alternative input and regular multi-disciplinary review as required by national guidance.

Conclusions
Community learning disability teams require dedicated, co-produced STOMP pathways to review those at risk of over-medication. Additional research is required to explore individual and systemic factors contributing to ethnic disparities in medication prescription for behaviours that challenge among people with learning disabilities. Further recommendations are considered around developing data collection, service user involvement, and future directions.

Accessible summary:

- Abuse at care home (Winterbourne View) led the NHS to start a campaign known as STOMP to make sure people with learning disabilities and/or autism got the right medication.

- We looked at the medications people with learning disabilities in our area were given. We looked at how often these medications were checked by a doctor. We looked at what other support people were given.

- We also looked at how people with learning disabilities were affected by COVID-19. We also looked at differences between people from different racial backgrounds.

- We found that some people were given more medications to manage their behaviour. We found that the medications were not checked as often as they should be. This happened most for Black, Brown, and Asian people.

- We spoke to a local service user project about our findings. They said they think racism is one of the reasons for more medications. They also said it is bad that people are on too much medication and that people should get more support.