Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
3. Department of Health and Social Care (2022) NHS Continuing Healthcare Checklist.
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains the psychological and emotional needs domain of the NHS Continuing Healthcare Decision Support Tool. It covers mood, anxiety and depression, distress and its management, the difference between this domain and behaviour, the interventions that indicate higher levels, where needs are under-recorded and the evidence that supports an accurate level.
The psychological and emotional needs domain in the CHC Decision Support Tool
This domain covers mood, anxiety, distress and psychological wellbeing, and it is regularly confused with behaviour. The distinction is straightforward once stated: this domain is about the internal experience, behaviour is about what the person does.
What the domain covers
Mood and emotional state, anxiety, depression, distress, withdrawal, disengagement, psychological effects of illness or disability, and the interventions required to support wellbeing. It includes reassurance and one to one support, psychological input, and the effect of psychological state on the person's ability to engage with essential care.
How it differs from behaviour
Psychological needs concern the internal state, such as anxiety, low mood or distress. Behaviour concerns the outward expression, such as agitation, aggression or resistance to care. The same underlying picture may generate entries in both, and it should where both are present, but they are distinct and should not be collapsed into one.
What indicates higher levels
The level reflects the intensity of psychological need and the input required. Frequent or prolonged distress requiring sustained one to one support, psychological or psychiatric input, distress that prevents essential care being delivered, and risk arising from mood such as self neglect or refusal of food and medication all point upward.
The levels available
This domain does not carry a priority level. Where distress is expressed through behaviour that presents risk, that belongs in the behaviour domain, which does carry priority. Recording the psychological need here and the behavioural expression there gives a fuller and more accurate picture than choosing between them.
Where it is under-recorded
The most common omission is the time and skill involved in reassurance. Staff spending substantial periods calming, reorienting or reassuring someone is a real intervention, but it is rarely charted and so rarely appears in the assessment. Withdrawal and disengagement are also under-recorded, because a quiet person creates fewer entries than an agitated one.
Evidence that helps
Mental health assessments, psychology or psychiatry input, mood monitoring records, care records describing distress episodes and the response required, records of refusal of care linked to mood, antidepressant or anxiolytic prescribing, and any record of the time spent providing one to one reassurance.
Key takeaway
Record the internal experience here and the outward expression under behaviour. Capture the time and skill required for reassurance, and do not let a quiet, withdrawn presentation be recorded as an absence of need.
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Frequently asked questions
What is the difference between this domain and behaviour?
This domain covers the internal state such as anxiety, low mood or distress. Behaviour covers the outward expression such as agitation or resistance to care. Where both are present, both should be recorded.
Can this domain reach priority?
No. Only behaviour, breathing, drug therapies and medication, and altered states of consciousness carry a priority level. Distress presenting risk usually belongs in behaviour as well as here.
Does depression count?
Yes, where it affects wellbeing and the support required. Record the input in place, whether it prevents engagement with essential care, and any risk arising such as self neglect or refusal of food and medication.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.