Lesson 1 - Psychologically Informed Mental Health Care
1. Introduction
Psychologically informed mental health care is not a particular therapy. It is a way of understanding people and responding to them which draws on psychological knowledge alongside medical and social perspectives.
This matters for case workers because much of the therapeutic value of mental health care happens outside formal therapy sessions. The way a practitioner responds when someone is distressed, misses an appointment, becomes angry, withdraws or repeatedly seeks reassurance can either support recovery or unintentionally reinforce difficulties.
A psychologically informed approach encourages us to move away from asking, “What is wrong with this person?” and instead consider questions such as:
What might be happening for this person?
What function might this behaviour be serving?
What has helped them cope until now?
What response from us is most likely to help?
This does not mean ignoring diagnosis, medication, risk or biological factors. Good mental health care integrates these with an understanding of relationships, development, behaviour, emotions, thoughts and the person’s wider circumstances.
This lesson provides the foundation for the rest of the case worker course. Later lessons will explore recovery, the biopsychosocial model, emotional dysregulation, therapeutic communication, professional boundaries, risk and practical interventions. Psychologically informed care provides the framework that connects these areas.
Case workers are not expected to become psychologists or psychotherapists. Their role is to work in a psychologically informed way within an agreed care plan and within their competence with access to appropriate clinical supervision.
2. Learning Outcomes
By the end of this lesson learners should be able to:
Explain what psychologically informed mental health care means and distinguish it from formal psychological therapy.
Recognise that behaviour often has an understandable function even when it initially appears challenging or confusing.
Use a simple psychological formulation to think about factors contributing to a person’s current difficulties.
Apply psychologically informed principles to routine interactions with patients.
Recognise how practitioner and service responses can influence behaviour and recovery.
Identify the limits of the case worker role and recognise situations requiring discussion or escalation to a senior clinician.
3. The Lecture
What Do We Mean by Psychologically Informed Care?
Imagine that a patient has missed three appointments.
There are several ways a practitioner might interpret this.
One interpretation is that the patient is not engaging with the service. That description may be factually correct but it tells us very little.
A psychologically informed practitioner becomes curious.
Could the patient be anxious about appointments?
Could they have difficulty organising themselves?
Could previous experiences of healthcare have made them distrustful?
Could depression have affected their motivation?
Could ADHD make remembering appointments difficult?
Could they be embarrassed because they did not complete something discussed previously?
Could attending the appointment itself remind them of experiences they would rather avoid?
The important shift is from judgement to curiosity.
Psychologically informed care involves thinking about the psychological processes that may influence what we observe.
A useful sequence is:
What we observe.
Then ask what might explain it.
Consider emotions, thoughts, experiences and circumstances.
Think about how these may be influencing current behaviour.
Then decide what response is most likely to help.
The practitioner does not need to know the answer immediately.
Often the appropriate response is simply:
“I noticed that getting to appointments has been difficult recently. I wondered whether there is anything making them particularly difficult to attend.”
That question can reveal considerably more than simply labelling someone as non-compliant.
Psychologically Informed Care Is Not Psychological Therapy
This distinction is particularly important for case workers.
Psychological therapy involves structured therapeutic interventions delivered by appropriately trained practitioners. Examples include cognitive behavioural therapy, dialectical behaviour therapy, mentalisation-based treatment and trauma-focused therapies.
Psychologically informed care is broader.
A receptionist can communicate in a psychologically informed way.
A case worker can conduct a review in a psychologically informed way.
A psychiatrist can prescribe medication in a psychologically informed way.
A service can design its procedures in a psychologically informed way.
Psychologically informed care can influence everyday clinical interactions. It involves understanding psychological processes and using this understanding to guide how we communicate and respond.
Psychological therapy is different because it involves structured therapeutic work requiring specific training and competencies.
This distinction protects both the patient and the practitioner.
A case worker can listen, validate, help someone identify patterns and reinforce coping strategies that have already been agreed within the care plan.
They should not independently begin trauma therapy, interpret complex psychological phenomena or provide treatment outside their training.
Behaviour Usually Makes Sense in Context
One of the most useful principles in mental health care is that behaviour which initially appears irrational can often become understandable once we understand its context and function.
Consider a patient who repeatedly contacts the service when distressed.
It may be tempting to describe them as attention-seeking.
That description is rarely useful.
Instead ask what function contacting the service serves.
Perhaps contact provides reassurance.
Perhaps reassurance temporarily reduces anxiety.
The pattern may look like this:
Distress develops.
The person thinks, “I cannot cope with this.”
They contact the service.
The service provides reassurance.
Their distress temporarily reduces.
The person has less opportunity to practise independent coping.
Distress later returns.
They contact the service again.
The contact is understandable. The person has discovered something that reduces distress.
However, if the service provides extensive reassurance every time anxiety rises the service may unintentionally strengthen the pattern.
A psychologically informed response might therefore combine validation, consistency and encouragement of coping strategies.
For example:
“It sounds as though things feel very difficult at the moment. Let’s think about what has helped you manage these feelings previously and look at the plan you developed with the team.”
The distress has not been dismissed.
At the same time the practitioner has not automatically attempted to remove all distress.
That balance is central to psychologically informed practice.
Understanding Function Rather Than Simply Describing Behaviour
Behaviour tells us what happened.
Formulation tries to understand why it might have happened.
Consider someone leaving an appointment abruptly.
Possible explanations might include:
Becoming emotionally overwhelmed.
Feeling criticised.
Anxiety.
Shame.
Sensory overload.
Trauma-related responses.
Difficulty identifying or communicating emotions.
Frustration.
Misunderstanding what was said.
Wanting to avoid a difficult subject.
The same behaviour can therefore have completely different functions for different people.
This is why psychological formulation should remain individualised and tentative.
It is usually better to think, “One possibility is…” rather than, “They did this because…”
A Simple Formulation Framework
A formulation is a structured attempt to understand why someone may be experiencing their current difficulties.
One commonly used framework is the 5 Ps.
The 5 Ps are:
Presenting problems.
Predisposing factors.
Precipitating factors.
Perpetuating factors.
Protective factors.
Presenting Problems
These describe what is happening now.
Examples might include:
Low mood.
Anxiety.
Emotional dysregulation.
Social withdrawal.
Self-harm.
Difficulty attending work.
Relationship difficulties.
Predisposing Factors
These are factors that may have increased vulnerability to the current difficulties.
Examples might include:
Developmental experiences.
Neurodevelopmental differences.
Previous mental illness.
Chronic physical illness.
Disrupted relationships.
Adverse experiences.
Genetic vulnerability.
Predisposing does not mean inevitable.
It means that a person may have been more vulnerable to developing difficulties under certain circumstances.
Precipitating Factors
These help us understand why the problem may have become more significant now.
Examples might include:
Relationship breakdown.
Bereavement.
Bullying.
Examination pressure.
Job loss.
Physical illness.
Medication changes.
Sleep disruption.
Perpetuating Factors
These are factors that may be keeping the difficulty going.
Examples include:
Avoidance.
Disrupted sleep.
Social isolation.
Substance use.
Repeated reassurance.
Inactivity.
Relationship conflict.
Unhelpful beliefs.
Inconsistent professional responses.
Perpetuating factors are particularly important because some of them may be modifiable.
Protective Factors
These are the things that help the person cope and recover.
Examples include:
Supportive relationships.
Meaningful employment.
Education.
Hobbies and interests.
Effective coping strategies.
Engagement with treatment.
Insight.
Religious or community connections.
Stable accommodation.
Psychologically informed care should not focus only on a person’s difficulties.
We also need to understand their strengths, resources and existing coping strategies.
A Worked Clinical Example
Consider Daniel who is 24.
Daniel experiences anxiety and repeatedly asks his case worker whether something bad is going to happen. He sometimes sends several messages after appointments asking whether the clinician is worried about him.
A purely descriptive account might say that Daniel repeatedly seeks reassurance.
A formulation tells us considerably more.
His presenting problem is anxiety and repeated reassurance seeking.
He may have longstanding anxiety and low confidence in managing uncertainty which could represent predisposing factors.
A recent relationship breakdown may have precipitated the current increase in symptoms.
Repeated reassurance produces immediate relief which may be perpetuating the pattern.
Protective factors include engagement with treatment, a supportive family and motivation to improve.
This formulation changes how we respond.
If every message receives extensive reassurance we may accidentally strengthen the cycle.
Instead the care plan might involve helping Daniel recognise anxiety, tolerate uncertainty and use agreed coping strategies before contacting the service.
This illustrates an important principle.
Our response becomes part of the clinical environment.
Thoughts, Feelings and Behaviour
Another useful framework comes from cognitive behavioural therapy.
Thoughts, emotions, physical sensations and behaviour interact with one another.
Consider someone who is invited to attend a group.
They think, “Everyone will think I’m strange.”
They feel anxious.
Their heart races.
They avoid the group.
Their anxiety immediately decreases.
That relief makes avoidance more likely next time.
The person then never discovers whether their prediction was accurate.
The cycle may look like this:
“They will judge me.”
This leads to anxiety.
The person avoids the situation.
Avoidance produces immediate relief.
The belief is never tested.
Future anxiety therefore remains.
A case worker does not need to deliver CBT to make use of this understanding.
They may simply recognise that continually helping someone avoid anxiety-provoking situations could unintentionally maintain their anxiety.
Avoidance
Avoidance is one of the most important psychological processes encountered in mental health care.
People understandably avoid things that make them uncomfortable.
Someone with social anxiety avoids social situations.
Someone with panic attacks avoids places associated with previous panic attacks.
Someone who feels ashamed avoids discussing their difficulties.
Someone experiencing low mood may withdraw from activities.
The difficulty is that short-term relief can create long-term problems.
A difficult situation creates anxiety.
The person avoids the situation.
Their anxiety falls.
The brain learns that avoidance helped them feel safe.
The person becomes more likely to avoid the situation next time.
This does not mean forcing patients into situations.
It means recognising that helping someone escape every uncomfortable situation is not always therapeutic.
Validation
Validation is another central skill.
Validation means communicating that someone’s emotional response is understandable in context.
It does not mean agreeing with everything they believe.
Imagine someone says:
“Nobody in the team cares about me.”
It would not be helpful simply to agree and say that nobody cares about them.
It may also be unhelpful to immediately respond, “That’s not true.”
A more validating response might be:
“It sounds as though you’ve felt very unsupported this week.”
The emotional experience has been recognised without confirming an inaccurate interpretation.
Validation therefore means saying, in effect, “I can understand why you feel this way” rather than, “Your interpretation must be correct.”
This distinction becomes particularly important during conflict.
Curiosity Before Correction
When someone says something we believe is inaccurate our instinct may be to correct it immediately.
Often it is more useful to understand it first.
A patient might say:
“Nobody ever listens to me.”
An immediate correction might be:
“That’s not true. We spoke for an hour last week.”
A more psychologically informed response would be:
“It sounds as though you haven’t felt heard. What has made you feel that way?”
The second response provides more information.
Perhaps the patient did not understand the previous discussion.
Perhaps they felt decisions had already been made.
Perhaps something important was missed.
Understanding the experience does not mean accepting every interpretation as fact.
The Therapeutic Relationship
Mental health care is delivered through relationships.
Consistency, reliability and communication therefore matter.
Patients may be particularly sensitive to:
Rejection.
Criticism.
Uncertainty.
Perceived abandonment.
Changes in professionals.
Inconsistent boundaries.
The practitioner should aim to be warm, predictable, respectful and appropriately boundaried.
These qualities are not contradictory.
You can be compassionate while maintaining boundaries.
You can validate distress without agreeing to inappropriate requests.
You can say no respectfully.
Boundaries Can Be Therapeutic
Practitioners sometimes worry that boundaries are unkind.
In reality, inconsistent boundaries can often be much more difficult for patients.
Imagine one practitioner answers messages immediately at any time.
Another only responds during working hours.
Another tells the patient to stop contacting the service.
The patient receives three different messages about what is expected.
Predictability reduces uncertainty.
Helpful boundaries should therefore be:
Clear.
Consistent.
Proportionate.
Explained.
Agreed across the team where possible.
A boundary should never be used as punishment.
Emotional Dysregulation
People sometimes experience emotions so intensely that their ability to think clearly temporarily reduces.
During significant emotional arousal a person may:
Struggle to process complex information.
Become impulsive.
Interpret situations differently.
Struggle to consider alternatives.
Become angry.
Withdraw.
Repeatedly seek reassurance.
Trying to have a complicated discussion at the height of emotional distress may therefore achieve very little.
A more useful sequence is often:
First consider immediate safety.
Then validate the distress.
Support emotional regulation.
Once the person is calmer, move towards reflection.
Problem-solving can then follow.
Trying to jump directly from distress to problem-solving is a common mistake.
Trauma-Informed Thinking
Psychologically informed practice also incorporates trauma-informed principles.
Previous experiences may influence how people interpret present situations.
Someone who has experienced coercion may find loss of control particularly distressing.
Someone who has experienced unstable relationships may react strongly to changes in clinicians.
Someone who has repeatedly felt dismissed by services may approach professionals defensively.
This does not mean assuming everyone has experienced trauma.
It also does not mean interpreting every difficulty through trauma.
The useful principle is to consider whether previous experiences might help us understand the person’s current response.
Neurodevelopmentally Informed Practice
Psychological understanding should also include neurodevelopmental differences.
For example, an autistic person who becomes distressed during an appointment might be experiencing:
Sensory overload.
Uncertainty.
Difficulty processing several questions.
Difficulty identifying or communicating emotions.
Distress caused by unexpected change.
A person with ADHD who repeatedly forgets appointments may be experiencing difficulties with:
Working memory.
Organisation.
Time perception.
Planning.
Prospective memory.
Interpreting these behaviours simply as unwillingness to engage could lead to poor care.
Reasonable adaptations might include:
Written information.
Appointment reminders.
Predictable appointments.
Clearer questions.
Additional processing time.
Reducing unnecessary sensory demands.
The Importance of Language
Language influences how teams think.
Consider the difference between saying:
“She is manipulative.”
and:
“She sometimes threatens to end contact with the service when she feels that support may be withdrawn.”
The second statement describes behaviour.
It leaves room for understanding.
Instead of saying “attention-seeking” we might write that the person frequently seeks contact when distressed.
Instead of saying “non-compliant” we might write that the person has not been taking medication consistently.
Instead of saying that someone “refuses to engage” we might write that they have declined the last three appointments.
Descriptive language improves clinical thinking because it separates observation from interpretation.
The Practitioner Is Part of the System
Psychologically informed practice also requires us to consider our own reactions.
Some patients may leave practitioners feeling:
Anxious.
Frustrated.
Unusually protective.
Helpless.
Criticised.
Pressured to act immediately.
These feelings can contain useful information.
They can also influence clinical decisions.
Imagine a patient becomes distressed.
The practitioner becomes anxious.
The practitioner provides extensive reassurance.
The patient temporarily calms.
The practitioner also feels relief because the immediate situation has settled.
When distress returns the same pattern is repeated.
Both people can therefore become part of the same reinforcing cycle.
This is one reason supervision and reflective practice are essential.
Psychological Safety and Risk
Psychologically informed care must never replace appropriate risk assessment.
A practitioner should not assume that a significant change in presentation is simply emotional dysregulation or part of an existing pattern.
A change in presentation may indicate:
Increasing suicidal intent.
Psychosis.
Mania.
Intoxication.
Medication adverse effects.
Safeguarding concerns.
Significant physical illness.
Psychological formulation helps us understand behaviour.
It does not remove the need for clinical assessment.
When there is uncertainty about risk the case worker should escalate rather than attempt to resolve complex clinical questions independently.
A Practical Framework for Case Workers
A simple framework for difficult interactions is:
Pause.
Understand.
Respond.
Review.
Pause
Avoid reacting immediately to the emotional intensity of the situation.
Understand
Ask:
What has happened?
What is the person feeling?
What might they be thinking?
What might this behaviour achieve for them?
Is there an agreed formulation or care plan?
Has something changed?
Respond
Ask:
What is within my role?
What response is consistent with the care plan?
Can I validate without reinforcing an unhelpful pattern?
Is there a safety concern requiring escalation?
Review
Afterwards ask:
What happened?
What helped?
What did not help?
How did I respond emotionally?
Does this need supervision?
Does the care plan need reviewing?
4. Clinical Perspective
Clinical Pearls
Behaviour is information.
Rather than immediately deciding that behaviour is difficult, manipulative or uncooperative ask what it may communicate.
Validation does not mean agreement.
You can recognise someone’s emotional experience without agreeing with their interpretation.
Short-term relief is not always long-term recovery.
Reassurance and avoidance can reduce distress immediately while maintaining difficulties over time.
Consistency is therapeutic.
Predictable responses from the team often provide greater psychological safety than repeatedly changing the approach.
Formulations are hypotheses rather than facts.
Remain curious and update your understanding as new information emerges.
Notice your own reactions.
Feeling unusually frustrated, anxious or protective may be worth discussing in supervision.
Practical Tips for Everyday Practice
When someone becomes distressed:
Listen before problem-solving.
Validate the emotional experience.
Keep communication simple.
Check immediate safety where appropriate.
Refer back to previously agreed strategies.
Avoid making promises you cannot keep.
Maintain agreed boundaries.
Document significant changes.
Discuss recurring patterns in supervision.
Common Pitfalls and Misconceptions
Trying to Fix Everything
The practitioner does not need to remove every difficult emotion.
Supporting someone to tolerate manageable distress can sometimes be more therapeutic than immediately removing it.
Providing Repeated Reassurance
Repeated reassurance can maintain anxiety and reinforce reassurance-seeking patterns.
Becoming Overly Involved
Compassion does not require taking responsibility for every aspect of someone’s life.
Becoming Punitive
Boundaries should support treatment rather than punish behaviour.
Making Assumptions
Do not assume you know why someone behaved in a particular way.
Ask.
Working Outside Competence
Being psychologically informed does not make someone a psychotherapist.
Advice for Newly Qualified Practitioners
You will encounter situations where you do not know what to say.
You do not need to produce an immediate psychological explanation.
Sometimes a very effective response is:
“That sounds difficult. I’d like to understand a little more about what happened.”
When unsure, slow the interaction down.
Gather information.
Check the care plan.
Use supervision.
Do not feel pressured into making clinical decisions outside your role.
When to Escalate
Case workers should seek senior clinical advice when there is:
New or increasing suicidal ideation or intent.
Significant self-harm or escalation in self-harm.
Risk to others.
Suspected psychosis.
Suspected mania or significant behavioural change.
Significant deterioration in mental state.
Safeguarding concerns.
Concerns about abuse, exploitation or neglect.
Significant medication concerns or adverse effects.
Intoxication or significant substance-related risk.
Uncertainty about capacity or consent.
An unexplained major change from the person’s usual presentation.
Repeated crisis presentations despite the existing care plan.
Uncertainty about whether an intervention is within the practitioner’s competence.
Escalation is not a failure of case working.
Recognising the limits of your role is a core clinical competency.
5. Summary
Psychologically informed mental health care involves understanding behaviour in its psychological, social, developmental and clinical context.
The key principles are:
Be curious rather than judgemental.
Understand function as well as behaviour.
Validate without necessarily agreeing.
Recognise patterns that maintain difficulties.
Promote recovery rather than dependence.
Maintain warm and consistent boundaries.
Reflect on your own responses.
Work within your competence.
Escalate when risk or complexity requires it.
The case worker does not need to provide psychotherapy to make an important therapeutic contribution.
Every interaction can be psychologically informed.
6. Further Reading
NICE Guidance
Useful NICE guidance includes:
NICE NG222: Depression in adults: treatment and management.
NICE CG113: Generalised anxiety disorder and panic disorder in adults.
NICE NG116: Post-traumatic stress disorder.
NICE NG225: Self-harm: assessment, management and preventing recurrence.
NICE CG78: Borderline personality disorder: recognition and management.
National Guidance and Resources
NHS England provides useful resources on trauma-informed practice and psychologically informed approaches to health and social care.
The Royal College of Psychiatrists provides accessible information about mental health conditions, treatment and recovery for both professionals and patients.
The NHS Mental Health website provides patient-friendly information about mental health conditions, treatments and accessing support.
Key Research and Literature
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977.
Linehan MM. Research and clinical work relating to emotional dysregulation and dialectical behaviour therapy.
Bateman AW and Fonagy P. Research and clinical work relating to mentalisation and mentalisation-based treatment.
Beck AT and colleagues. Foundational work on cognitive models of emotional disorders.
Recommended Books
The Compassionate Mind by Paul Gilbert provides an accessible introduction to compassion-focused psychological thinking.
Cognitive Behavior Therapy: Basics and Beyond by Judith S Beck provides a detailed introduction to cognitive behavioural principles.
DBT Skills Training Manual by Marsha M Linehan is a specialist text and is not required reading for case workers although it can be useful for practitioners who would like a deeper understanding of emotional regulation.
7. Knowledge Check
Question 1
A patient has missed three consecutive appointments. Which is the most psychologically informed initial response?
A. Record that the patient is non-compliant.
B. Discharge the patient because they are not motivated.
C. Explore what may be making attendance difficult.
D. Assume their mental health has deteriorated.
Correct answer: C.
Psychologically informed practice involves curiosity about the function or explanation for behaviour before reaching conclusions.
Answer A describes the behaviour using a judgement rather than explaining it.
Answer B assumes lack of motivation without evidence.
Answer D is possible but should not be assumed.
Answer C allows the practitioner to gather information and develop an individualised understanding.
Question 2
A patient says, “Nobody in this service cares about me.”
Which response best demonstrates validation?
A. “That’s not true.”
B. “Yes, nobody here cares about you.”
C. “It sounds as though you’ve felt very unsupported recently.”
D. “You shouldn’t think like that.”
Correct answer: C.
Validation acknowledges the emotional experience without necessarily agreeing with the person’s interpretation.
Answer A immediately contradicts the person.
Answer B confirms the interpretation rather than validating the underlying emotional experience.
Answer D dismisses the person’s experience.
Answer C recognises how the person feels while leaving room to explore what has happened.
Question 3
A patient developed anxiety following redundancy. They now avoid leaving home because going outside makes them anxious.
Which of the following is a perpetuating factor?
A. Redundancy.
B. Avoidance.
C. Previous good mental health.
D. A supportive partner.
Correct answer: B.
Avoidance may maintain anxiety because it prevents opportunities for anxiety to reduce naturally and for feared predictions to be tested.
Redundancy is more likely to represent a precipitating factor.
A supportive partner is likely to be a protective factor.
Previous good mental health does not explain the current maintenance cycle.
Question 4
Which statement best describes psychologically informed care?
A. It is another name for CBT.
B. It can only be delivered by psychologists.
C. It involves applying psychological understanding to routine care.
D. It means explaining all mental illness through childhood experiences.
Correct answer: C.
Psychologically informed care involves using psychological understanding across routine mental health care.
It is not synonymous with CBT.
It is not restricted to psychologists.
It should integrate biological, psychological and social understanding rather than assuming that all difficulties originate in childhood.
Question 5
A patient repeatedly contacts their case worker for reassurance about anxiety. Reassurance immediately reduces their anxiety but they contact the service again several hours later.
What psychological process may be occurring?
A. Reassurance may be reinforcing reassurance seeking.
B. The patient is deliberately wasting staff time.
C. Reassurance proves that the treatment is working.
D. The patient should immediately be discharged.
Correct answer: A.
When reassurance produces immediate relief it can unintentionally reinforce further reassurance seeking.
This does not mean reassurance is always inappropriate.
It also does not imply that the behaviour is deliberate.
The team should understand the pattern and develop a consistent approach which validates distress while supporting independent coping.
Question 6
A patient becomes extremely distressed during an appointment and struggles to process what the practitioner is saying.
What should generally happen first?
A. Give detailed advice about everything they should change.
B. Help reduce immediate emotional arousal and establish safety.
C. Challenge their thinking.
D. Explain why their behaviour is inappropriate.
Correct answer: B.
High emotional arousal can affect a person’s ability to process complex information.
Safety, validation and emotional regulation usually need to come before detailed problem-solving.
The other responses may increase distress or simply be ineffective while the person is significantly dysregulated.
Question 7
Which statement about boundaries is most accurate?
A. Boundaries damage therapeutic relationships.
B. Good practitioners should make exceptions whenever patients become distressed.
C. Boundaries should be rigid regardless of circumstances.
D. Clear and consistent boundaries can provide psychological safety.
Correct answer: D.
Predictability can help people understand what to expect from services.
Boundaries should be compassionate and proportionate rather than punitive or inflexible.
Repeated exceptions can sometimes create uncertainty and inadvertently reinforce unhelpful patterns.
Question 8
A patient with ADHD repeatedly forgets appointments.
Which response is most appropriate?
A. Assume they are not interested in treatment.
B. Consider whether executive functioning difficulties contribute and explore practical adaptations.
C. Tell them they need to take more responsibility.
D. Ignore missed appointments indefinitely.
Correct answer: B.
ADHD can affect organisation, prospective memory, planning and time management.
Psychologically and neurodevelopmentally informed care considers these mechanisms and possible adaptations such as reminders.
This does not remove personal responsibility or service boundaries.
It allows those boundaries to be applied with an understanding of the person’s needs.
Question 9
A case worker notices that they feel unusually anxious about one patient and frequently want to provide additional reassurance outside the agreed care plan.
What should they do?
A. Ignore the feeling because practitioners’ emotions are irrelevant.
B. Provide unlimited reassurance.
C. Reflect on the response and discuss the pattern in supervision.
D. Immediately stop working with the patient.
Correct answer: C.
Practitioner reactions can provide important information about interpersonal patterns.
They may also influence clinical decision-making.
Supervision allows the practitioner to consider whether their response is clinically helpful and consistent with the wider care plan.
Question 10
A case worker supports a patient who is usually anxious but coherent. During today’s appointment the patient suddenly states that strangers are controlling their thoughts and appears frightened and confused.
What is the most appropriate response?
A. Assume this represents their usual anxiety.
B. Explore the belief through psychological therapy.
C. Arrange prompt escalation for clinical assessment.
D. Reassure them that nobody is controlling their thoughts and continue the appointment normally.
Correct answer: C.
This represents a significant change in mental state and possible psychotic symptoms.
It requires appropriate clinical assessment.
A psychologically informed approach should never be used to explain away a potentially significant deterioration.
The case worker should recognise the change, consider immediate safety and escalate according to the service’s clinical procedures.
Answer A is unsafe because it assumes the presentation is simply anxiety.
Answer B would be outside the case worker role and could delay appropriate assessment.
Answer D may be well intentioned but does not adequately address the clinical significance of the change.
