Understanding Support Systems
This is Part 5 in our series on Past Psychiatric History.
Read Part 4: Current Treatment Providers for the previous component.
Beyond formal healthcare providers, patients exist within networks of family, friends, and community supports that profoundly influence recovery. Additionally, information from these supports and from current providers offers perspectives your patient may not be able to provide themselves. Your job is to identify who comprises the support system and determine what collateral information may be valuable.
Learning Objectives
After reading this section, you should be able to:
• Identify key chart sources for existing family or community supports.
• Conduct structured interviews to elicit informal supports and assess support quality.
• Distinguish between emotional, practical, and crisis supports.
• Document support systems clearly and understand their relevance to risk assessment and discharge planning.
Start With Chart Review
Before interviewing the patient, review available documentation:
- Emergency contact information – Names, relationships, phone numbers
- Release of information forms – Who is authorized for communication?
- Previous clinical notes – References to involved family members, friends, or supports
- Social work assessments – Often document support systems in detail
- Legal documentation – Healthcare proxy, power of attorney, guardianship papers
Document who appears to be involved and in what capacity. This gives you starting points for the interview.
💡 Clinical Pearl: Pay attention to who brought the patient to the appointment or hospital. This person is likely a key support and potential collateral source.
Interview the Patient
After chart review, explore the patient’s support network and permission for collateral contact.
Identifying Informal Supports
Family involvement:
- “Is there family involved in helping you with your mental health care?”
- “Who in your family knows about your treatment?”
- “Does anyone help you remember appointments or medications?”
Friends and community:
- “Do you have close friends who support you?”
- “Are you involved in any support groups or community programs?”
- “Is there anyone outside of family who you’d want us to contact if needed?”
Living situation supports:
- “Who do you live with?”
- “Do your housemates or roommates know about your mental health treatment?”
- “Is anyone helping you manage daily tasks?”
Legal arrangements:
- “Do you have a healthcare proxy or power of attorney for medical decisions?”
- “Does anyone have guardianship or legal authority over your care?”
Assessing Support Quality and Involvement
Not all “supports” are actually supportive. Assess the quality:
- “How helpful has [person] been with your mental health?”
- “Do they understand what you’re going through?”
- “Have there been any conflicts with family or friends about your treatment?”
- “Has anyone been critical or unsupportive of you getting help?”
Understanding What Supports Provide
Different supports serve different functions:
Emotional support:
- Listening, validation, encouragement
Practical support:
- Transportation to appointments
- Help with medications
- Reminders about appointments
- Financial assistance
Crisis support:
- Who to call when struggling
- Safety planning involvement
- Emergency contacts
Ask:
“When things get difficult, who do you reach out to first?”
Current support people are often valuable sources of collateral information about longitudinal course, treatment response, and baseline functioning. However, obtaining and interpreting collateral information requires attention to consent, context, and reliability. *For detailed guidance on when to seek collateral information, how to obtain permission, what to ask, and how to interpret what you learn, see [Collateral Information](#).*
What to Document
Support system documentation:
- “Patient lives with sister who is supportive and aware of treatment. Sister provides transportation to appointments.”
- “Limited support system – estranged from family, no close friends. Lives alone.”
- “Mother is healthcare proxy. Attends appointments regularly and manages medications.”
Why This Information Matters
Support systems and collateral information serve multiple functions:
Discharge planning: Robust supports allow for more confident outpatient management, whereas limited supports may necessitate higher levels of care.
Safety assessment: Collateral sources may reveal concerning behaviors the patient minimizes or doesn’t recognize.
Treatment engagement: Involved, supportive family or friends improve treatment adherence and outcomes.
Longitudinal understanding: Providers and long-term supports offer perspective on what’s typical for this patient versus what represents change.
Understanding who comprises the support network and what information they can provide creates a more complete picture of the patient’s life, resources, and vulnerabilities.
Next in this series: Part 6: Psychotherapy History – Types of therapy tried, duration, and therapeutic benefit.
Previous post: Part 4: Current Treatment Providers – Identifying the formal treatment team.
