A paradigm shift in dementia care: From ‘Behaviours that Challenge’ to be managed to ‘Behavioural Expressions of Need’ to be met

Following the publication of BPS Division of Clinical Psychology guidelines on psychosocial alternatives to psychotropic medication for Behaviours that Challenge in Dementia (James et al., 2024), momentum has been growing towards a paradigm shift (Kuhn, 1962). This paper outlines the developments in this work so far, which have included a panel discussion and vote at UK Dementia Congress, a presentation at North East and Cumbria Regional FPOP meeting, a publication in the Journal of Dementia Care, a position statement by the Association of Clinical Psychologists (ACP-UK) Psychology of Ageing Network (POAN) and the review of a clinical pathway within Tees Esk and Wear Valleys NHS Foundation Trust. The article summarises the evidence and rationale for ACP-UK’s and Dementia Community’s endorsement of the term ‘Behavioural Expressions of Need’. This is not just a change in language. It marks a transformation in the way that behaviours often viewed as problematic or disruptive are understood. If behaviours are viewed as expressions of needs to be met, rather than symptoms to be treated or managed, this directly influences the support offered to people living with dementia and their care partners. This approach fits with the NHS shift from sickness to prevention, acting earlier to reduce escalation and the long-term harm caused by antipsychotic prescribing.