Intended for healthcare professionals

Practice Guidelines

Rehabilitation for adults with complex psychosis: summary of NICE guidance

BMJ 2021; 372 doi: (Published 12 January 2021) Cite this as: BMJ 2021;372:n1
  1. Helen Killaspy, topic adviser and professor and honorary consultant in rehabilitation psychiatry1,
  2. Gillian Baird, chair of Guideline Committee and professor of paediatric neurodisability2,
  3. Nathan Bromham, senior systematic reviewer3,
  4. Angela Bennett, guideline lead and director of guidelines3
  5. on behalf of the Guideline Committee
  1. 1Division of Psychiatry, University College London, London, UK
  2. 2Evelina London Children’s Hospital, King’s Health Partners, St Thomas’ Hospital, London, UK
  3. 3National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
  1. Correspondence to H Killaspy h.killaspy{at}

What you need to know

  • Refer people with complex psychosis for rehabilitation as soon as it is clear that their symptoms are not responding to usual treatments and they are struggling with their social and everyday functioning

  • Provide local inpatient and community rehabilitation services, to ensure people can receive treatment and support as close to home as possible

  • Ensure rehabilitation services operate with a recovery orientation that enables people to gain the confidence and skills for successful community living

  • Offer a comprehensive physical health check on admission to rehabilitation and annually thereafter

Providing rehabilitation for people with complex psychosis enables them to achieve and sustain a rewarding life in the community.123 This article summarises the first guideline from the National Institute for Health and Care Excellence (NICE) on mental health rehabilitation for adults with complex psychosis.4 It describes how to identify people who should be offered rehabilitation, what rehabilitation services should be provided within the local mental health service, and the treatment programmes that these services should offer.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group (GC)’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

What is rehabilitation for people with complex psychosis?

Approximately 20% of people with schizophrenia and other psychoses have particularly complex problems that impair functioning and lead to recurrent admission to hospital.5 These problems include severe, treatment-resistant symptoms and cognitive impairments that affect motivation, organisational and social skills, as well as additional mental, neurodevelopmental, and physical health conditions. People in this group require longer term, specialist rehabilitation services to optimise their response to treatment and enable them to gain the skills and confidence to live as independently as possible and …

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