High-Support Rehab — MRCPsych Paper B MCQ

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EasyRehabilitationHigh-Support RehabMRCPsych Paper B

An adult with complex psychosis has completed treatment of an acute relapse. They continue to have treatment-resistant psychotic symptoms, marked impairment in daily functioning, and challenging behaviour with risks that cannot yet be managed in supported accommodation. They require structured multidisciplinary inpatient rehabilitation but do not need secure forensic care. Which setting is most appropriate?

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Correct answer: D — High-dependency rehabilitation unit

The correct answer is D, a high-dependency rehabilitation unit. NICE describes these as inpatient rehabilitation units for people with complex psychosis whose symptoms have not yet stabilised and whose associated risks or challenging behaviours remain problematic. The need for sustained multidisciplinary rehabilitation distinguishes this from an acute ward, which manages acute episodes rather than longer-term functional recovery. Independent accommodation and supported housing provide insufficient containment and clinical input while these risks remain unmanageable. A medium-secure unit is unnecessary because the stem explicitly excludes a need for secure forensic care. Placement should remain the least restrictive option capable of safely meeting the person's biological, psychological and social rehabilitation needs.

Reference: National Institute for Health and Care Excellence. Rehabilitation for adults with complex psychosis (NG181), recommendations 1.3.4 and ‘Terms used in this guideline: High-dependency rehabilitation units’. 2020. https://www.nice.org.uk/guidance/NG181/chapter/recommendations