STOMP and Antipsychotic Medication Review in Dementia Care

For years, antipsychotic medication was prescribed to people with dementia and to people with a learning disability or autism far more often than the clinical evidence supported — frequently to manage behaviour that was actually a form of communication, rather than to treat a genuine psychiatric condition. STOMP, which stands for Stopping Over-Medication of People with a learning disability, autism or both, is the national initiative that grew out of recognising this problem, and understanding it helps care staff play their part in getting medication reviews right rather than defaulting to the status quo.

How Over-Medication Became So Common

Antipsychotic and other psychotropic medications work quickly to sedate and reduce visible distress, which made them an appealing short-term response to behaviours that challenge — particularly in settings under time and staffing pressure, where a fast, medication-based response was often easier to access than the time-intensive work of understanding and addressing the underlying cause. The problem is that these medications carry significant side effects, including increased falls risk, sedation that reduces quality of life, and, in people with dementia specifically, an increased risk of stroke and mortality with prolonged antipsychotic use — risks that are often disproportionate to any modest benefit gained.

What STOMP Actually Calls For

STOMP isn't a blanket ban on psychotropic medication — there are genuine clinical situations where it's appropriate and necessary. What it calls for is a shift away from medication as a first-line, default response to distress or behaviour that challenges, toward proper assessment of the underlying cause first, and toward regular, genuine review of any psychotropic medication already prescribed, rather than it continuing indefinitely simply because no one revisited the original decision. This connects directly to the wider approach already covered in our guide to positive behaviour support — understanding what a behaviour is communicating, rather than only suppressing it.

The Care Home's Role in Medication Review

Care staff aren't responsible for prescribing decisions, but they hold information that's essential to a good review — detailed, specific observations of how a resident's behaviour actually presents day to day, what seems to trigger distress, whether non-medication approaches have been tried and how they worked, and how the resident seems to be affected by the medication itself, including side effects like increased drowsiness or falls. Staff should feel able to raise a question with a GP or psychiatrist about whether a long-standing prescription has been reviewed recently, rather than assuming medication decisions are outside their scope to even ask about.

What a Good Review Actually Looks Like

A meaningful medication review considers whether the original reason for prescribing still applies, whether the dose could be reduced or the medication stopped entirely, what non-medication strategies are in place to manage the underlying need, and what would be monitored and by whom if a reduction is trialled. Reviews shouldn't be treated as a box-ticking exercise carried out in isolation from the resident's day-to-day reality — the people who see the resident daily, including care staff and family, should be genuinely consulted as part of the process, not just informed of the outcome afterwards.

Recognising When Reduction Has Gone Too Far, Too Fast

Reducing or stopping psychotropic medication needs to be done carefully and gradually, under proper clinical oversight, with close monitoring for any return of the symptoms the medication was managing. STOMP is about appropriate, evidence-based use — not about withdrawing medication regardless of clinical need, which can cause its own serious harm. Care staff have an important role in flagging early signs that a reduction may be causing genuine distress to return, so the plan can be adjusted rather than pushed through regardless.

Building STOMP Awareness Into Everyday Practice

STOMP works best when it's a shared, everyday awareness across the whole team, not a one-off training module or a project that fades once the initial focus moves on. Simple habits help sustain it: routinely asking "when was this medication last reviewed?" during care plan reviews, recording specific behavioural observations rather than vague summaries so a reviewing clinician has something concrete to work with, and treating a long-standing psychotropic prescription with the same scrutiny as any other aspect of a resident's care, rather than assuming it was correctly decided once and needs no further attention.

Frequently Asked Questions

Does STOMP mean antipsychotic medication should never be used? No — it means medication should be used appropriately, based on genuine clinical need and proper assessment, not as an automatic first response to behaviour that challenges.

How often should psychotropic medication be reviewed? Regularly, and this should be built into routine medication reviews rather than left to happen only if someone specifically raises a concern — many homes build this into scheduled GP or pharmacist medication reviews.

What should staff do if they think a resident's medication hasn't been reviewed in a long time? Raise it directly with the resident's GP, pharmacist or the home's clinical lead — staff observations are a valuable and legitimate part of prompting a review, not an overstep of their role.

Getting psychotropic medication use right protects residents from unnecessary harm while still meeting genuine clinical need. Learnsignal's CPD courses for care staff cover medicines management and behaviour support as part of a wider clinical curriculum.