5 Organisation and delivery of psychiatric services5.1 Providing care in mental health services
5.1.2 The psychiatrist in coordinated care
2 min read
Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
What the psychiatrist brings
The psychiatrist adds a medical view to the shared plan: making a medical diagnosis, looking for physical causes, prescribing and managing severe mental illness.
Clinical leadership means explaining what is still uncertain, asking other professions for their findings and resolving conflicting recommendations with the patient.
Who is accountable
Each professional stays accountable for their own work. Chairing a meeting does not pass every team member's duties to the psychiatrist.
When the responsible consultant or clinician delegates, they keep accountability for managing the patient's care. Colleagues stay accountable for their own actions.
Task | Psychiatrist's contribution | Shared work |
|---|---|---|
Assessment | Differential diagnosis, physical causes and drug effects | Combine nursing observations, the psychological formulation and the functional assessment |
Treatment | Explain the medical options, their harms and monitoring | Agree psychological, social and rehabilitation interventions |
Risk | Assess how the illness links to behaviour and foreseeable harm | Agree immediate actions, escalation and review |
Transitions | Pass on the diagnosis, medication changes and tests still outstanding | Confirm the receiving team, follow-up and crisis contacts |
Turning discussion into a plan
Start with the patient's priorities. They set the aim, such as sleeping, returning to work or living independently, alongside improvement in symptoms.
A named coordinator keeps in contact with the patient and joins up services. This need not be the psychiatrist.
Each action needs a responsible person and a timescale. Sending a referral without checking it was accepted leaves a gap in care.
Disagreement should be written down, with the competing explanations and the agreed review. Do not hide it behind a plan that looks unanimous.
For example, a patient who stays withdrawn after psychosis could be depressed, sedated, still troubled by delusions or have lost confidence. A medical review, observations at home and an occupational assessment each answer a different part of that question.
Statutory roles and communication
Responsible clinician is a defined role under mental health legislation in England and Wales. It need not be a doctor: an approved clinician from an eligible non-medical profession can hold it.
Delegation needs a suitable colleague, clear instructions and access to supervision. Both people stay accountable for their part in making it safe.
Handover says what has changed, what is still uncertain, who will monitor it and when urgent help is needed.