Good psychiatric treatment is helpful, relevant and safe, and the balance of personal cost–benefit for the patient is positive. There are two fundamental skills needed to achieve this (Poole & Higgo, 2006). The first is the ability to carry out a good quality assessment that leads to an understanding of the factors that have led this patient to develop these symptoms at this time. It involves much more than making a diagnosis. Equally as important is the ability to elicit and understand the full range of contextual factors (psychological, social and biological) that are affecting the person. The second is the ability to form, over time, a particular type of therapeutic alliance with the patient, what we have called getting alongside patients.

The next critical step in achieving good treatment is what you actually do, those specific interventions that attempt to solve problems. A well-conducted assessment will give the psychiatrist a picture of the key problems affecting the patient. These tend to be interrelated, and frequently play against a backdrop of themes in people's lives, such as their characteristic patterns of coping with difficulties (largely determined by their personality) and issues determined by culture, personal beliefs, and family or occupational environment. The clinician does not just have to select the right interventions from the menu of potential treatments. Treatment has to make sense to the patient, interventions have to be sequenced and the overall package has to have a coherence that leads it towards identifiable objectives.