The biopsychosocial (BPS) approach to psychiatry

According to the Royal College of Psychiatrists Strategic Plan (2024–2026), psychiatrists will address the treatment gap (the disparity between those who need mental healthcare and those who received high-quality, safe, timely, therapeutic care) by taking a leadership role in re-establishing therapeutic relationships in mental healthcare.

This includes developing relational skills, engaging in psychological approaches to personal development, normalising reflective practice, and embedding psychotherapeutic approaches within psychiatric training to support comprehensive BPS case formulation.

The Royal College of Psychiatrists advocates for a holistic approach to psychiatry in which all aspects of a person’s lived experience, as well as their resources and vulnerabilities, are considered in building a comprehensive understanding of their mental health difficulties.

The therapeutic importance of relationships within mental health services

As leaders of clinical teams, psychiatrists need to be equipped with high-level communication, relational, and containment skills in order to offer compassionate, therapeutic, and safe care. There is emerging evidence of the importance of a trusting relationship with a psychiatrist in predicting response to medication (Konstantinidou et al., 2022).

Biopsychosocial (BPS) formulation

The capacity to formulate is at the heart of psychiatric care and is a core competency in training. The RCPsych supports a BPS approach to formulation in order to provide safe and effective care.

This BPS approach recognises the complex interplay between a person’s biological makeup (genetics, physical health, response to medication, etc.), psychological factors (personality development, attachment and relationship patterns, experience of trauma, etc.), and social factors (socioeconomic status, culture and diversity, employment, experience of discrimination, etc.) in conferring vulnerability to mental disorders.

Formulation brings together all available information to develop a coherent understanding of how a person’s mental health difficulties have arisen, how they are maintained, and how they may be resolved. It is a dynamic, collaborative process involving clinical teams, patients, and carers. It underpins patient-centred care by ensuring that the individual is seen beyond their symptoms.

The purpose of a formulation is multifaceted. In addition to describing the patient’s presentation, it seeks to explore a deeper understanding. It emphasises the central role of relationships in care and supports the development of management plans that are meaningful to the patient. The importance of safety planning, based on holistic risk formulation and psychosocial assessment, is strongly supported in NICE guidance and by NHS England (Self Harm, NICE Guidance, NG225, 2022., Staying Safe from Suicide, NHS England, 2025).

Alongside being experts in pharmacological, psychological, and social treatments and interventions, psychiatrists need to be equipped with high-level communication, relational, and containment skills in order to understand the central importance of clinical relationships and how these may be challenged and experienced by their patients, so that they can offer compassionate, therapeutic, and safe care. The ability to model this approach, and to support clinical teams to do so, is key to providing a trauma-informed approach to psychiatric management.

Job planning guidance and the BPS approach

All psychiatrists must be equipped to deliver a holistic, BPS approach that prioritises a therapeutic relationship with their patients. Given the high prevalence of early trauma and social adversity among patients, psychiatrists must demonstrate leadership in navigating emotional distress and tolerating uncertainty. This involves containing complex emotional responses and understanding team dynamics. Furthermore, consultant psychiatrists must be equipped to hold in mind their patient’s physical health concerns, family dynamics, and social disadvantage to ensure the delivery of truly comprehensive, person-centred care.

Psychiatrists must maintain competence in the full range of BPS treatments, encompassing medical, social, and psychological therapies, to deliver holistic, person-centred care based on containing complex clinical relationships and formulation. To support this, consultant job planning and CPD frameworks should explicitly recognise the diverse skill set needed within the practice of psychiatry.

The RCPsych Strategic Plan highlights the importance of reflective practice, including Balint groups, as well as coaching and mentoring. It also emphasises personal development as a core component of psychiatric practice. Psychiatrists may undertake additional training in psychological therapies to strengthen their relational and psychotherapeutic skills or engage in personal therapy to support their resilience and capacity to work with complex mental states. These activities should be recognised and incorporated within individual job plans.