5 Organisation and delivery of psychiatric services5.1 Providing care in mental health services
5.1.3 Combining medical, psychological and social treatment
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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.
Matching treatment to the formulation
A good management plan comes from the formulation, not just the diagnosis. Each intervention should have a clear purpose. It treats a current problem, tackles a maintaining factor (something that keeps the problem going), or helps prevent recurrence.
Medical, psychological and social treatments can work together. A diagnosis alone does not tell you every intervention a person needs.
Decisions should be shared. Weigh the likely benefit against the burden and possible harms, and set this against the person's own goals. Declining an intervention is one of the options.
Domain | Examples | What to review |
|---|---|---|
Medical | Treat physical illness, start or reduce medicines, manage substance withdrawal | Symptoms, side effects, drug interactions and monitoring |
Psychological | Cognitive behavioural therapy, family work, relapse prevention | Agreed targets, engagement and changes in how the person copes |
Social | Housing, income advice, safeguarding, supported employment | Access, safety, relationships and day-to-day functioning |
Combining interventions: an example
A person recovering from psychosis may still hear voices, feel sedated by their medication and be facing eviction. Each problem needs its own response. Raising the medication dose will not fix all three.
Review the illness and treatment. Assess the voices, adherence, substance use and side effects before you change medication.
Offer psychological work. Help with distress, beliefs about the voices and coping. Fit this to how ready the person is and what they prefer.
Address housing. Involve the right worker early and agree practical steps with the person.
Review together. Check symptoms and sleep, and also whether housing and daily activity have improved.
Sequencing and review
Urgent threats may need action straight away while longer-term treatment is arranged. Examples are withdrawal, severe self-neglect and unsafe accommodation.
Reasonable adjustments help people use services. They include interpreters, accessible information, help with transport and appointment times that fit around caring responsibilities.
Treatment burden is the load that treatment puts on the person: travel, monitoring, side effects and the effort of attending several services. Plans that conflict with each other can also make people less likely to engage.
Outcome review checks three things: whether the intended change happened, whether any harms have appeared, and whether the person still wants the intervention.
Recovery means more than symptom control. It includes agency (a sense of control over one's own life), relationships and meaningful activity, even when some symptoms continue.