12 Intellectual disability12.4 Clinical
12.4.5 Coordinating multidisciplinary mental health care
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
One shared formulation
Multidisciplinary care means more than several professionals seeing the same person. Each discipline's assessment feeds into one agreed explanation of the person's difficulties. That explanation links to clear actions, and someone is responsible for reviewing progress.
The person says what they prefer and what their goals are. Give them the communication support they need to do this. Involve family, carers or an advocate in line with the person's wishes and any lawful decision-making arrangements.
Baseline functioning comes first. Find out how the person usually sleeps, behaves, communicates, keeps active and looks after themselves in each setting. Only then can you judge whether any of these has changed.
The shared formulation pulls together psychiatric symptoms, physical illness, communication, medication effects, relationships and the environment. It should also name competing explanations that still need testing.
Linking findings to actions
Each finding should lead to a coordinated response that draws on the right people.
Finding | Who contributes and how |
|---|---|
New withdrawal with suspected pain | Medical assessment, nursing observations and accessible communication support |
Distress during difficult tasks | Psychology looks at what the behaviour achieves for the person (its function); occupational therapy adjusts the demands; supporters record how the person responds |
Depressive symptoms and lost activity | Psychiatry and psychology plan treatment; occupational therapy and carers support activities the person has chosen |
Housing instability or exploitation | Social work leads the relevant support and safeguarding work, alongside clinical assessment |
Decline in functioning linked to medication | The prescriber and pharmacist review treatment; nursing staff and supporters monitor the agreed outcomes |
Who does what depends on the person's needs and on the expertise available locally. One professional should not stand in for another discipline's assessment when that expertise is needed.
A named coordinator keeps in touch across services. They check that agreed actions actually happened and help the person know who to go to.
The care plan
Keep one integrated plan. It records agreed goals, treatment decisions, adjustments, who is responsible for each task and the review date. This stops different services giving contradictory instructions.
Outcomes: measure meaningful daily functioning and quality of life as well as symptoms. Do not judge success only by fewer incidents or by sedation.
Practical delivery: check that carers and staff have the time, skills and support to carry out the plan consistently.
Crisis arrangements: set out early warning signs, responses that help, urgent contacts and how to escalate. Use the least restrictive approach that is feasible.
Review and transitions
Joint review compares progress with baseline, checks for adverse effects and asks whether the formulation or the intervention needs to change.
Disagreement should be written down and settled through further evidence and discussion. Do not leave parallel plans running side by side.
Transitions need a named clinician or team to receive the person, an accessible handover, and confirmation that medication, monitoring and support will continue.