6 - Supporting Sleep, Exercise and Healthy Routines
1. Introduction
Sleep, physical activity and daily routines are closely connected with mental health. When these areas become disrupted, people may experience lower mood, increased anxiety, reduced concentration, irritability, fatigue and greater difficulty coping with everyday demands. Equally, mental health difficulties can make it much harder to sleep consistently, remain active or maintain a regular routine.
Case workers are well placed to help people understand these connections and make practical, manageable changes. This does not mean prescribing rigid routines, delivering specialist sleep treatment or expecting exercise to resolve a mental health condition. The case worker’s role is to explore what is happening, identify barriers, support realistic goals, monitor progress and escalate concerns when appropriate.
This lesson builds on earlier learning about behavioural activation, goal setting and collaborative problem solving. It considers how everyday routines can support recovery while recognising that people differ in their health, circumstances, culture, responsibilities, sensory preferences and available resources.
2. Learning Outcomes
By the end of this lesson, learners should be able to:
Explain how sleep, physical activity and daily routines can influence mental and physical wellbeing.
Explore a person’s current routine in a curious, respectful and non-judgemental way.
Help people identify small and achievable changes to their sleep, activity and daily structure.
Recognise common barriers to establishing healthy routines and use collaborative problem solving to address them.
Monitor the effect of changes without creating unrealistic expectations or encouraging perfectionism.
Recognise concerns that require discussion with or escalation to a senior clinician or healthcare professional.
3. The Lecture
Why Everyday Routines Matter
People do not experience mental health symptoms separately from the rest of their lives. Sleep, activity levels, meals, medication, social contact, responsibilities and exposure to daylight all interact with emotional wellbeing.
For example, a person who is feeling depressed may remain in bed for much of the day because they feel exhausted and unmotivated. This may reduce their exposure to daylight, physical movement, social contact and opportunities for achievement. They may then struggle to sleep at night, wake later the following day and feel even less able to begin activities.
Similarly, someone experiencing anxiety may stay awake worrying, use their phone as a distraction and then feel too tired to leave the house the next morning. Missing activities may provide short-term relief but can increase isolation and make future situations feel more difficult.
The aim is not to blame the person for these patterns. These are understandable responses to distress. The case worker’s task is to help the person notice the pattern and consider whether a small change at one point might gradually improve the overall cycle.
Avoiding the “Just Try Harder” Message
Advice about sleep, exercise and routines can easily sound simplistic. A person experiencing significant depression, trauma, chronic pain, neurodevelopmental differences or financial hardship may already know that sleep and exercise are important. Their difficulty is usually not a lack of information.
Statements such as “You just need to exercise more” or “You should go to bed earlier” may leave someone feeling criticised or misunderstood. They overlook the reasons why the person has been unable to make the change.
A more helpful approach would be:
“You have said that you would like to sleep more regularly, but your thoughts become much busier when you go to bed. Could we look at what happens during the evening and see whether there is one small change that might make things easier?”
This approach acknowledges the difficulty, seeks to understand the pattern and invites collaboration.
Understanding Sleep
Sleep is an active biological process that supports physical restoration, emotional regulation, memory, attention and learning. Sleep needs differ between individuals and across the lifespan. The quality, timing and regularity of sleep can be as important as the number of hours slept.
Sleep difficulties may include:
Taking a long time to fall asleep.
Waking repeatedly during the night.
Waking much earlier than intended.
Sleeping for long periods but not feeling refreshed.
Sleeping during the day and remaining awake at night.
Experiencing nightmares or distressing dreams.
Having an irregular sleep pattern.
Feeling excessively sleepy during the day.
Becoming anxious about sleep itself.
A poor night’s sleep does not necessarily indicate a sleep disorder. Temporary sleep disturbance is common during periods of stress, illness, bereavement or significant change. Concern increases when the problem is persistent, causes significant daytime impairment or may be associated with a physical or mental health condition.
The Sleep–Mental Health Relationship
The relationship between sleep and mental health usually works in both directions. Anxiety may make it difficult to settle because the mind remains focused on possible threats or unfinished problems. Depression may be associated with insomnia, early waking, sleeping excessively or an irregular sleep pattern.
Trauma-related difficulties may involve nightmares, fear of sleeping or remaining alert to possible danger. ADHD may affect the ability to wind down, stop stimulating activities or maintain consistent routines. Autistic people may experience differences in circadian rhythm, sensory sensitivities or a need for predictable bedtime routines.
Reduced need for sleep accompanied by increased energy, unusually elevated or irritable mood, rapid speech, racing thoughts, impulsivity or increased activity may indicate hypomania or mania. This is different from wanting to sleep but being unable to do so. It requires prompt clinical discussion.
Medication, caffeine, alcohol, nicotine, recreational substances, pain, breathing difficulties, hormonal changes and other physical health conditions can also affect sleep. Case workers should therefore avoid assuming that every sleep problem is caused by poor habits.
Exploring Sleep Collaboratively
A useful sleep conversation begins with understanding rather than advice. Questions might include:
What time do you usually go to bed and get up?
How long does it generally take you to fall asleep?
Do you wake during the night?
How do you feel when you wake in the morning?
Do you sleep or nap during the day?
What usually happens during the hour before bed?
Do worries, physical discomfort, nightmares or sensory difficulties affect your sleep?
How much caffeine, nicotine or alcohol do you use, and at what times?
Has anything recently changed?
What have you already tried?
What would feel like a realistic improvement?
It may be helpful to use a simple sleep diary for a limited period. This can record approximate bedtimes, waking times, naps and relevant factors such as caffeine or exercise. The purpose is to identify patterns, not to create an exact record or make the person feel monitored.
For some people, detailed sleep tracking increases anxiety or fixation. If this occurs, stop or simplify the monitoring and discuss the concern with the supervising clinician.
Supporting Healthier Sleep Patterns
General strategies that may help include maintaining a reasonably consistent waking time, developing a predictable wind-down routine and making the sleeping environment as comfortable as possible.
Morning light and daytime activity can support the body’s natural sleep–wake rhythm. Where appropriate, the person might open their curtains after waking, sit near a window or spend some time outdoors earlier in the day.
A wind-down routine could include:
Reducing demanding activities before bed.
Dimming lights.
Changing into comfortable clothing.
Having a warm non-caffeinated drink.
Reading or listening to something calming.
Using a relaxation or breathing exercise.
Preparing essential items for the following morning.
Writing down worries or tasks to revisit the next day.
Screen use may keep some people awake because of stimulation, time loss or exposure to distressing content. However, simply instructing everyone to remove all devices is not always realistic. A phone may provide safety, connection, calming audio or accessibility support. A collaborative plan might involve reducing stimulating content, using night settings, turning off notifications or placing the device slightly further from the bed.
The bedroom should ideally feel safe and reasonably quiet, dark and comfortable. Adaptations may be required for sensory differences. Some people may prefer complete silence, whereas others sleep better with consistent background noise. The aim is to identify what works for the individual.
Caffeine can remain active for several hours. If caffeine appears to affect sleep, the person could experiment with reducing it later in the day. Any reduction should be manageable, as sudden cessation may cause headaches or other withdrawal symptoms. Alcohol may help a person fall asleep initially but can disrupt sleep quality later in the night. Nicotine and some recreational substances may also interfere with sleep.
Case workers should not recommend starting, stopping or changing prescribed medication. Possible medication effects should be recorded and discussed with the prescribing clinician.
When Trying to Sleep Becomes the Problem
People sometimes become increasingly anxious about not sleeping. They may repeatedly check the time, calculate how few hours remain and try harder to force sleep. This can increase alertness and frustration.
It may help to explain that resting quietly is still valuable and that sleep cannot be forced. If someone remains awake and becomes increasingly frustrated, they may find it helpful to leave the bed temporarily, undertake a quiet activity in a safe environment and return when sleepy.
This is general supportive advice rather than a substitute for cognitive behavioural therapy for insomnia. Persistent insomnia may require assessment and a structured intervention from an appropriately trained professional.
Understanding Physical Activity and Exercise
Physical activity includes any bodily movement that uses energy. It is broader than formal exercise and may include:
Walking to a local shop.
Gardening.
Cleaning.
Dancing.
Playing with children.
Cycling.
Swimming.
Using a wheelchair actively.
Stretching.
Taking part in a sport.
Completing a planned exercise session.
This distinction matters because some people associate “exercise” with gyms, competitive sport, weight loss or previous negative experiences. Asking about movement or activity may feel more inclusive.
Regular activity can support cardiovascular health, strength, sleep, energy, confidence and social connection. It may also support recovery from depression and anxiety. However, it should be presented as one component of care rather than a replacement for medication, psychological treatment, social support or clinical review when these are needed.
National guidance provides general activity targets for different age groups, but these are population-level recommendations rather than a starting requirement for every individual. Someone who is largely inactive may benefit from beginning with a few minutes of gentle movement and increasing gradually.
Finding the Right Activity
An activity is more likely to continue when it is:
Personally meaningful.
Enjoyable or at least tolerable.
Affordable.
Physically appropriate.
Accessible.
Compatible with the person’s routine.
Sensory-friendly.
Safe.
Realistic in the current circumstances.
Some people enjoy structured exercise, whereas others prefer walking, gardening, dancing at home or active household tasks. A person with social anxiety may prefer an activity completed alone initially. Another person may be more motivated when accompanied by a friend.
An autistic person may prefer predictable, repetitive activity in a quieter environment. Someone with ADHD may find variety, novelty, music or exercising with another person more motivating. A person with depression may require a very small first step because motivation and energy are reduced.
The best activity is not necessarily the theoretically perfect activity. It is the activity the person feels able and willing to try safely.
Starting Small and Building Gradually
A common mistake is to set a goal based on what the person believes they should be doing rather than what they can currently manage.
“Exercise for an hour every day” is unlikely to be sustainable for someone who is currently struggling to leave their bed. A more appropriate starting point might be:
“After lunch on Tuesday and Thursday, I will walk to the end of the road and back. If I am unable to complete the walk, I will stand outside for two minutes.”
This goal is specific and includes a reduced version for more difficult days. Completing a small goal builds confidence and provides useful information. An overly ambitious goal may reinforce a belief that change is impossible.
Progress might involve increasing the duration, frequency or intensity of activity, but only one of these usually needs to change at a time. Case workers should reinforce effort, learning and re-engagement rather than perfection.
Exercise Safety
Before encouraging increased activity, consider whether the person has:
A known cardiac or respiratory condition.
Unexplained chest pain, fainting or severe breathlessness.
A significant injury or mobility problem.
A condition affected by exercise.
An eating disorder or compulsive exercise pattern.
Recently given birth or undergone surgery.
Been advised by a healthcare professional to restrict activity.
Not exercised for a prolonged period and has significant health concerns.
The case worker should not conduct a medical fitness assessment. Where concerns exist, the person should seek advice from their GP or another relevant healthcare professional before substantially increasing activity.
Stop the activity and seek appropriate medical advice if concerning symptoms such as chest pain, fainting or severe unexpected breathlessness occur. Emergency symptoms require emergency services.
Supporting Healthy Daily Routines
A routine is a sequence of activities that provides some predictability and structure. It does not have to involve a strict timetable. For many people, a few reliable anchors are more helpful than planning every hour.
Routine anchors might include:
Getting up at approximately the same time.
Opening the curtains and getting dressed.
Taking medication as prescribed.
Eating regular meals.
Leaving the home or spending time outdoors.
Completing one necessary task.
Having one period of enjoyable or meaningful activity.
Making contact with another person.
Beginning a wind-down routine at a similar time.
These anchors can help the day feel more manageable. They can also reduce the number of decisions a person needs to make when energy, motivation or concentration is limited.
Balance Within a Routine
A healthy routine should not consist entirely of obligations. It should ideally contain a balance of:
Necessary activities, such as appointments, housework and administration.
Self-care activities, such as eating, washing and resting.
Meaningful activities connected with values or responsibilities.
Enjoyable activities.
Social connection.
Physical movement.
Genuine rest and recovery.
Rest is not laziness. It is an important part of wellbeing. However, there is a difference between restorative rest and becoming stuck in prolonged inactivity that leaves the person feeling worse. This distinction should be explored sensitively rather than assumed.
For example, watching a familiar programme for an hour may help someone recover after a demanding appointment. Remaining in bed watching videos throughout the day may provide immediate escape but could also increase isolation and make sleep more difficult. The meaning and effect of the activity are more important than labelling it as good or bad.
Working With Barriers
Before proposing a solution, ask what makes the desired behaviour difficult. Barriers may include:
Low mood or lack of motivation.
Anxiety about leaving home.
Fatigue or physical illness.
Pain.
Executive functioning difficulties.
Sensory sensitivities.
Caring responsibilities.
Shift work.
Unsafe housing or neighbourhood conditions.
Limited finances.
Lack of transport.
Previous negative experiences of exercise.
Fear of judgement.
Cultural or religious considerations.
Medication side effects.
Alcohol or substance use.
An unsettled family environment.
Once the barrier is understood, the plan can be adapted.
If remembering is difficult, prompts or linking the activity to an existing habit may help. If initiation is the problem, the first step can be made very small, such as putting on walking shoes. If anxiety is the barrier, the person may begin with a familiar route at a quiet time or walk with someone they trust.
If finances are limited, free activities should be considered. If fatigue is significant, the person may need a clinical review rather than simply being encouraged to push through it.
Using Existing Habits
A new behaviour may be easier to remember when attached to something that already happens. Examples include:
Opening the curtains after switching off the morning alarm.
Taking a short walk after lunch.
Preparing breakfast after taking prescribed morning medication.
Beginning the wind-down routine after a regular evening programme finishes.
Completing gentle stretches while waiting for the kettle to boil.
The link should be straightforward and relevant to the person’s life. Too many changes introduced simultaneously can become overwhelming.
Supporting Motivation
Motivation often follows action rather than preceding it. Waiting until a person feels fully motivated may keep them stuck. At the same time, pressuring someone into an activity they have not chosen is unlikely to produce lasting change.
Helpful questions include:
What would be different if your sleep or routine improved slightly?
Which change feels most important to you?
What is the smallest step you could imagine taking?
On a scale from 0 to 10, how confident are you that you could do this?
What would raise your confidence by one point?
Who or what could support you?
What might get in the way?
What could the backup plan be?
If confidence is low, make the goal smaller or change the plan. A small goal completed consistently is often more useful than an impressive goal that cannot be started.
Reviewing Progress Without Judgement
At review, avoid asking only whether the person succeeded. Instead, explore what happened:
What were you able to try?
What effect did you notice?
What helped?
What made it harder?
Was the goal realistic?
What did you learn?
Would you like to continue, adapt or replace the plan?
A missed goal is information, not failure. Perhaps the activity was scheduled at the wrong time, depended on another person or required more energy than expected. The plan should be revised using what has been learned.
Changes should be reviewed over time rather than judged on a single day. Sleep, mood and energy naturally fluctuate. The aim is gradual improvement and increased understanding, not perfect adherence.
Maintaining Choice and Respecting Difference
There is no single ideal routine that suits everyone. Shift workers, parents of young children, people with disabilities and those from different cultural or religious backgrounds may organise their days in different ways. Some people are naturally more alert later in the day.
Healthy routines should therefore be based on function and wellbeing rather than conformity. The key questions are whether the routine meets the person’s needs, supports their responsibilities and contributes to their health.
Case workers should also avoid moral language. Terms such as “lazy”, “bad habits” or “lacking discipline” are unhelpful. Difficulties with routines may reflect illness, disability, environmental barriers or limited resources.
The Limits of the Case Worker Role
Case workers can:
Explore current patterns.
Provide agreed general health information.
Help identify barriers.
Support collaborative goal setting.
Encourage safe, gradual change.
Monitor progress.
Record relevant observations.
Share concerns with the clinical team.
Signpost to approved services and resources.
Case workers should not:
Diagnose a sleep disorder or physical health condition.
Recommend starting, stopping or changing medication.
prescribe sleeping medication or supplements.
Provide specialist treatment outside their competence.
Advise a person to exercise despite medical warning signs.
Present lifestyle changes as a cure for a mental health condition.
ignore a significant change in sleep, energy or behaviour.
Encourage weight-loss interventions unless these form part of an agreed clinical plan.
Recognising When to Escalate
Concerns should be reported to the supervising clinician when there is:
A marked or sudden change in sleep.
Very little sleep accompanied by increased energy, elevated or markedly irritable mood, rapid speech, impulsivity or unusual behaviour.
Persistent insomnia causing significant daytime impairment.
Excessive sleepiness that creates a safety risk, including when driving or operating equipment.
Loud snoring, observed pauses in breathing, choking during sleep or morning headaches.
Recurrent nightmares or fear of sleep linked to trauma.
Severe fatigue that is unexplained or worsening.
Suspected medication side effects.
Increasing use of alcohol, sedatives or other substances to sleep.
Compulsive or excessive exercise.
Exercise associated with an eating disorder.
Chest pain, fainting or severe unexpected breathlessness during activity.
Deterioration in self-care, eating, medication adherence or daily functioning.
A significant decline in mood or an increase in risk.
Any concern that falls outside the case worker’s competence.
If there is an immediate threat to life or serious physical safety, follow the organisation’s emergency procedure and contact emergency services when indicated.
Clinical Example
Amir has depression and reports that he is sleeping until midday, missing breakfast and spending most afternoons in his bedroom. He wants to return to work but feels overwhelmed when asked to plan his whole week.
An unhelpful approach would be to advise Amir to wake at 7 am, exercise daily and create a detailed timetable. This is a large change and may confirm his fear that recovery is beyond him.
The case worker first explores his current pattern. Amir usually wakes briefly at 9.30 am but goes back to sleep because he cannot see a reason to get up. He previously enjoyed sitting in the garden with a cup of tea.
Together, they agree that on Monday, Wednesday and Friday he will get out of bed at 9.30 am, make a drink and sit near the open back door for five minutes. If he feels able, he will walk to the end of the garden. His wake-up time on other days will remain unchanged initially.
At review, Amir reports completing the plan twice. On the third day, it was raining and he remained in bed. Rather than describing this as non-compliance, the case worker helps him develop an indoor alternative: sitting beside the living-room window while listening to one song.
This intervention is small, but it introduces a reason to get up, daylight, movement and a familiar pleasurable activity. It also provides a foundation that can be built on gradually.
4. Clinical Perspective
Clinical Pearls
Sleep, exercise and routine should be explored as connected systems rather than separate lifestyle topics. A small change in one area may influence several others. For example, a short morning walk may provide movement, daylight, a sense of achievement and support an earlier sleep pattern.
Begin with the person’s priorities. If they are most concerned about morning exhaustion, they may be more willing to explore sleep and evening routines than exercise targets.
A consistent waking time is often a more practical anchor than demanding an exact bedtime. People cannot always control when they fall asleep, but they may have more influence over when they get up.
Do not confuse reduced motivation with unwillingness. Depression, anxiety, ADHD, autism, trauma and physical illness can all interfere with starting or sustaining activities.
The more difficult the person’s current situation, the smaller the first goal may need to be.
Practical Tips
Ask permission before offering advice:
“Would it be helpful if we looked at a few strategies that other people sometimes find useful?”
Offer choices rather than a long list of instructions. Too many suggestions can overwhelm someone who already has reduced concentration or motivation.
Encourage the person to select one change at a time. Establishing one reliable routine anchor may be more helpful than creating a complicated schedule.
Develop a reduced version of the goal for difficult days. A planned five-minute walk might become standing outside for one minute. This protects continuity without expecting the same performance every day.
Record the agreed plan clearly, including when it will happen, what support is required and when it will be reviewed.
Common Pitfalls and Misconceptions
One common pitfall is delivering generic “sleep hygiene” advice without exploring the cause of the sleep problem. General advice may not address pain, trauma, sleep apnoea, medication effects, substance use or emerging mania.
Another is presenting national physical activity targets as an immediate requirement. These targets can inform longer-term goals, but the starting point should reflect the person’s present ability.
Avoid assuming that a person has failed because a strategy did not work. The intervention may have been poorly matched to their circumstances.
Do not suggest that sleep, exercise or routine changes will remove the need for clinical treatment. Lifestyle support can be valuable while still being only one part of a wider care plan.
Do not make weight loss the default purpose of physical activity. Movement can be discussed in relation to mood, sleep, mobility, enjoyment, energy or social connection without focusing on body size.
Advice for Newly Qualified Practitioners
You do not need to solve the person’s entire routine during one appointment. A focused conversation resulting in one realistic experiment is often enough.
Remain curious about the function of a behaviour. Staying awake at night may provide someone with quiet time after a chaotic day. Remaining in bed may feel like the only safe option. Understanding the function helps you identify an alternative that meets the same need.
If you are unsure whether advice is clinically appropriate, pause and discuss it in supervision. This is particularly important where there are physical health conditions, eating difficulties, medication concerns, possible bipolar symptoms or significant risk.
Situations Requiring Clinical Judgement or Escalation
Promptly discuss a person who reports sleeping for only a few hours without feeling tired, particularly when this is accompanied by increased activity, confidence, irritability, spending, risk-taking or rapid thoughts.
Escalate signs of possible sleep-disordered breathing, significant unexplained fatigue or safety-critical daytime sleepiness for medical review.
Exercise requires particular caution when there are cardiovascular symptoms, eating disorders, compulsive exercise, pregnancy-related considerations, recent surgery or medical restrictions.
Always escalate deterioration in mental state or risk according to the organisation’s clinical and emergency procedures.
5. Summary
Sleep, physical activity and daily routines can have an important influence on mental and physical wellbeing. Mental health difficulties can also disrupt these areas, creating cycles that are difficult to change.
The case worker’s role is to understand the person’s experience, identify barriers and help them test small, realistic changes. Support should be collaborative, individualised and free from judgement.
Effective plans usually begin with one manageable step, fit the person’s circumstances and include an alternative for more difficult days. Progress should be reviewed as a learning process rather than as success or failure.
Case workers must remain within their competence. Persistent or unusual sleep changes, possible medication effects, significant physical symptoms, compulsive exercise, severe fatigue and deterioration in mental state should be reported and escalated appropriately.
6. Further Reading
NHS Every Mind Matters: How to fall asleep faster and sleep better
NICE PH44: Physical activity—brief advice for adults in primary care
NICE NG134: Depression in children and young people—identification and management
NICE NG215: Medicines associated with dependence or withdrawal symptoms
Royal College of Psychiatrists: patient information about sleep, physical health and mental wellbeing.
The Sleep Charity: practical sleep information and resources.
World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: WHO; 2020.
7. Knowledge Check
Question 1
A person with depression is spending most of the day in bed and says they would like to become more active. What is the most appropriate initial response?
A. Tell them they should exercise for 30 minutes every day.
B. Explain that remaining in bed shows a lack of motivation.
C. Explore their current routine and agree one small, meaningful activity.
D. Arrange an intensive exercise programme immediately.
Correct answer: C
Explanation: Exploring the existing pattern and agreeing a small, personally meaningful step is collaborative and realistic. It allows the plan to reflect the person’s energy, interests and barriers.
A is incorrect because a daily 30-minute target may be too ambitious as an initial goal. B is incorrect because remaining in bed may reflect symptoms of depression rather than a lack of effort. D is incorrect because an intensive programme may be unsafe, overwhelming and poorly matched to the person’s current ability.
Question 2
Which finding should be discussed promptly with a senior clinician?
A. A person slept poorly before an important appointment.
B. A person occasionally stays up late watching a film.
C. A person has slept for three hours each night for a week but feels unusually energetic and has started several new projects.
D. A person prefers exercising in the evening.
Correct answer: C
Explanation: A markedly reduced need for sleep accompanied by increased energy and activity may indicate hypomania or mania. This requires prompt clinical assessment.
A describes a common response to situational stress. B may be a routine choice unless it causes significant impairment. D is not inherently concerning; the effect of evening exercise varies between individuals.
Question 3
What is the most helpful way to respond when someone does not complete an agreed walking goal?
A. Tell them that the intervention will not work unless they comply.
B. Record that they are unmotivated.
C. Abandon activity-based goals entirely.
D. Explore what happened and adapt the plan using what was learned.
Correct answer: D
Explanation: A missed goal provides information about barriers, timing, difficulty or support needs. The plan can then be adjusted collaboratively.
A is punitive and may damage engagement. B makes an unsupported judgement. C is premature because a different or smaller activity may still be useful.
Question 4
Which is the best example of a realistic initial activity goal?
A. “I will become fitter.”
B. “I will walk for ten minutes after lunch on Tuesday and Thursday.”
C. “I will complete 150 minutes of exercise regardless of how I feel.”
D. “I will go to the gym every day.”
Correct answer: B
Explanation: This goal identifies the activity, duration and timing. It is specific and can be reviewed.
A is too vague to guide action or review. C is rigid and does not account for health or current ability. D may be unrealistic and does not specify the activity or duration.
Question 5
A person reports taking several hours to fall asleep because they are worried about work. What should the case worker do first?
A. Recommend sleeping medication.
B. Tell them to remove all electronic devices immediately.
C. Explore their evening pattern, worries and strategies they have already tried.
D. Diagnose insomnia.
Correct answer: C
Explanation: Assessment should come before advice. Exploring the pattern helps the case worker understand the difficulty and identify an appropriate collaborative strategy.
A is outside the case worker’s role. B may be overly rigid and may not address the main cause. D is a diagnostic decision outside the case worker’s competence.
Question 6
Which statement about physical activity is most accurate?
A. Only structured exercise counts as physical activity.
B. Physical activity should replace psychological treatment where possible.
C. Movement such as walking, gardening or dancing may contribute to physical activity.
D. Everyone should begin at the full national recommended target.
Correct answer: C
Explanation: Physical activity includes a wide range of movements and does not have to take place in a gym or formal exercise programme.
A is too narrow. B is incorrect because physical activity may support treatment but should not automatically replace indicated care. D is inappropriate because the starting point should reflect the individual’s current health and ability.
Question 7
A person experiences chest pain and feels faint while increasing their physical activity. What is the most appropriate response?
A. Encourage them to continue so that their fitness improves.
B. Suggest reducing the intensity slightly but continuing that day.
C. Stop the activity and obtain appropriate medical advice, using emergency services if indicated.
D. Reassure them that this is a normal response to exercise.
Correct answer: C
Explanation: Chest pain and faintness during activity may represent a serious physical health concern. The activity should stop and urgent or emergency medical support should be obtained according to the severity of the symptoms.
A and B could expose the person to further harm. D offers reassurance without adequate assessment and is outside the case worker’s competence.
Question 8
Which approach is most likely to support a sustainable routine?
A. Changing sleep, meals, exercise and social activity simultaneously.
B. Establishing one or two reliable routine anchors and building gradually.
C. Planning every hour of the person’s day without their involvement.
D. Removing all rest periods from the routine.
Correct answer: B
Explanation: A small number of dependable anchors can create structure without overwhelming the person. Further changes can be added when these become established.
A may involve too much change at once. C is not collaborative and may not reflect the person’s needs. D is inappropriate because rest is an important part of wellbeing.
Question 9
A person says they use their phone in bed because calming audio helps them manage trauma-related anxiety. What is the best response?
A. Insist that all phones must be removed from the bedroom.
B. Explore how the phone helps and whether notifications or stimulating content could be reduced.
C. Tell them that their sleep difficulty is entirely caused by screen use.
D. End the discussion because phone use is a personal choice.
Correct answer: B
Explanation: This response recognises the supportive function of the phone while considering practical adaptations that may reduce unwanted stimulation.
A applies a rigid rule without considering the person’s needs. C makes an unsupported assumption and ignores trauma-related anxiety. D misses an opportunity to offer collaborative support.
Question 10
Which action falls outside the appropriate case worker role?
A. Helping someone identify barriers to a regular morning routine.
B. Supporting someone to set a small walking goal.
C. Monitoring whether a routine change affects mood and sleep.
D. Advising someone to stop prescribed medication because it may affect sleep.
Correct answer: D
Explanation: Case workers must not advise people to stop or change prescribed medication. Suspected medication effects should be documented and discussed with the prescribing clinician.
A, B and C are appropriate when completed collaboratively, safely and within the person’s agreed care plan.
