Synopsis
Build a concise, testable account of why the person's difficulties arose, why they persist, what protects recovery and how those hypotheses determine a shared, proportionate plan without confusing formulation with diagnosis.
- Diagnosis describes a recognised syndrome; formulation explains this person's problems in context and links hypotheses to actions. The two complement but do not replace each other.
- Define the current problems and their chronology before organising evidence into predisposing, precipitating, perpetuating and protective influences.
- Cover biological factors such as genetics, neurodevelopment, illness, sleep, pain, reproductive change, medicines and substances without treating biology as destiny.
- Cover psychological processes including beliefs, coping, attachment, trauma responses, learning, avoidance, shame, grief, cognition and the meaning given to symptoms.
- Cover social conditions including relationships, culture, discrimination, housing, work, finance, immigration, caregiving, isolation, services and access barriers.
- State connections as hypotheses with supporting and conflicting evidence; avoid inventing causal certainty from temporal association alone.
- Include strengths, values, skills, supportive people, prior recovery and practical resources, then test whether each is available under foreseeable stress.
- Translate every important maintaining mechanism into a treatment target, responsible person and review marker agreed with the patient where possible.
- Revise the formulation when the course, collateral evidence or treatment response contradicts it; a static paragraph copied forward is not useful.
Key red flags
A long psychosocial narrative must not obscure sudden confusion, focal neurology, catatonia, withdrawal or another time-critical physical cause.
Current intent to die, escalating violence, inability to meet basic needs or danger to a child or dependent adult requires explicit action rather than placement under a generic perpetuating factor.
A formulation based only on diagnosis can miss trauma, poverty, racism, disability, medicine effects, substance use and relationship dynamics that alter treatment feasibility.
Describing a person as manipulative, non-compliant or attention seeking substitutes judgement for mechanism and can conceal unmet need, coercion or communication difficulty.
Protective factors are conditional resources, not guarantees; a named relationship offers limited protection if unavailable during the anticipated crisis.
Investigation priorities
Specify symptoms, functional effects, baseline, onset, turning points and intervention responses.
Understand the person's account, language, priorities, cultural meaning, feared consequences and preferred help.
Management branches
Assessment has established an initial history, mental state, function and immediate risk.
- Define a small number of current problems and place their onset, changes and consequences on a dated timeline.
- Organise relevant vulnerability, triggers, maintaining loops and protective resources across biological, psychological and social domains.
- Write an integrated explanatory paragraph with alternatives and uncertainty, then check it against the person's account and available collateral.