Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Assess what the person can do, what has changed, what matters and which internal, relational and practical resources genuinely reduce harm or support recovery, translating findings into proportionate care and review.
Function is the bridge between symptoms and life. Ask what the person could do before the current difficulty, what they do now, how much effort or prompting is required and what consequences have occurred. Basic activities include eating, washing, dressing, toileting and mobility. Instrumental activities include shopping, cooking, medicines, transport, finances, communication and household management. Add work, study, relationships, caring, sexuality, sleep, leisure, legal tasks and service use according to the person's life.
Use concrete examples rather than global independence. Someone may appear well groomed because a partner organises every step, or may stop cooking because the oven is broken rather than from cognitive decline. Distinguish ability, motivation, opportunity and environmental support. Explore symptoms, medicine effects, pain, substance use, cognition, sensory needs, poverty, discrimination and coercion as mechanisms. A sudden functional change raises the urgency of medical and collateral assessment.
Strengths are capacities that can support care: reflective ability, humour, problem solving, routines, creativity, cultural identity, advocacy, prior recovery, practical skills and willingness to seek help. Ask how they have managed difficult periods and which support felt useful. Avoid turning strengths into demands for self-reliance. A patient can be resourceful and still require intensive treatment; acknowledging competence should widen options rather than reduce entitlement.
The person cannot reliably eat, drink, wash, toilet, move or take essential treatment, creating possible immediate health and care needs.
New errors with money, travel, cooking, work or medicines reveal important impairment despite preserved conversation and personal appearance.
A skill, value, coping method or previous recovery strategy can be mobilised without implying that professional support is unnecessary.
A relationship, routine or service reduces a defined danger only when available and acceptable during the relevant period of stress.
A supporter reports exhaustion, fear, ill health or inability to continue tasks, making the current care arrangement unstable and potentially unsafe.
Good grooming during a brief appointment may depend on extensive prompting and says little about finances, cooking, medicines or overnight safety.
A responsibility that usually gives purpose may become a source of shame, entrapment or perceived burden during severe illness.
Ask how much time, exhaustion and unpaid support are required, because task completion alone can conceal an unsustainable arrangement.
Recognising resilience should support shared choices and rehabilitation, not lower access to care when risk and impairment remain substantial.
Real-world change can reveal whether the proposed mechanism and intervention are meaningful even when symptom language remains stable.
Equating a tidy appearance and fluent conversation with intact daily function.
Counting children, employment or religion automatically as protection against suicide.
Assuming relatives can continue care without asking about willingness, health and fear.
Interpreting unemployment or poor housing as personal functional failure.
Using strengths to minimise need or blame the person for incomplete recovery.
Setting goals chosen by the service rather than outcomes meaningful to the patient.
Recording a functional deficit without an action, owner or review date.
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A patient with suicidal thoughts names attending a weekly football group as protective, but the crisis occurs on a weekend when the group is closed. What should the assessor do?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Protective factors reduce the likelihood or consequence of a specified harm. Their effect depends on access, timing, quality and the person's relationship to them. A friend available by telephone during the day may not protect against impulsive overnight self-harm. Children may provide meaning but also shame or fear of custody. Medication protects only if obtained and taken. Record conditions under which each factor works and signs that it is weakening.
Translate assessment into recovery-oriented planning. Choose goals important to the person, such as preparing one meal, returning to a class, resuming contact safely or managing medicines with support. Address immediate survival and safeguarding before higher goals. Agree graded steps, rehabilitation or occupational input, social-care assessment, reasonable adjustments and carer support. Review observable function and burden, not simply attendance or a questionnaire score.