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Supported Accommodation — MRCPsych Paper B MCQ

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ModerateRehabilitationSupported AccommodationMRCPsych Paper B

A 55-year-old man with schizophrenia has spent 3 years in hospital. His positive symptoms are stable, he presents no current serious risk, and the multidisciplinary team agrees that he no longer requires inpatient treatment. He can cook, clean and take medication when repeatedly prompted but cannot yet manage these activities reliably without staff available during both the day and night. He wants a tenancy of his own and is expected to develop greater independence through an active rehabilitation programme. Which initial placement is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Supported housing tenancy with rehabilitation staff on site 24 hours a day

Explanation lettering: B = shown as A · E = shown as B · A = shown as E

The best answer is B: 24-hour staffed supported housing. He is ready to leave inpatient care but requires frequent prompting and staff availability day and night. Supported housing preserves a tenancy while providing active rehabilitation to develop daily living skills and enable later movement to less supported accommodation. Floating outreach (A) and daytime-only staffing (D) provide insufficient support. Residential care (C) also offers 24-hour staffing, but routinely provides day-to-day needs, does not confer a tenancy and is less consistent with his demonstrated rehabilitation potential and stated goal. A community inpatient rehabilitation unit (E) would be unnecessarily restrictive because he is clinically stable, presents no serious current risk and no longer needs inpatient treatment.

Reference: National Institute for Health and Care Excellence. Rehabilitation for adults with complex psychosis, NICE guideline NG181, recommendations 1.2.1, 1.3.7 and 1.5.9, and definitions of supported housing, residential care and floating outreach. 2020; reviewed 2024. https://www.nice.org.uk/guidance/NG181/chapter/recommendations