Understanding Structured Clinical Management (SCM)
If you’ve been offered Structured Clinical Management (SCM) you might have questions about what it is, how it works, and how it can help. This page explains the basics and answers some common questions.
What is SCM?
SCM is an evidence-based approach to providing support. SCM was designed to help people with complex emotional and relational needs who may struggle with managing difficult emotions, impulsivity and interpersonal relationships. This may include people with a diagnosis of ‘personality disorder’ – however there is growing recognition that diagnostic labels may be unhelpful for some people and can be experienced as stigmatising. Services have responded to these concerns by developing pathways of intervention (of which SCM is one) in response to people’s need rather than diagnosis.
SCM is recommended for use in the NHS by the National Institute for Health and Care Excellence (NICE). SCM can provide practical support and strategies for managing challenges and improving quality of life. SCM is collaborative and practical, focusing on building skills and strategies to help with managing emotions and distress.
Why is SCM helpful?
SCM can provide structure, consistency and regular, predictable support during challenging times. This can:
- Help you feel supported and understood.
- Teach practical skills to manage emotions and distress.
- Improve relationships and communication.
- Help you set and achieve personal goals.
- Develop healthy coping mechanisms.
SCM includes therapeutic elements, but it’s not the same as traditional talking therapies like Cognitive Behavioural Therapy (CBT) or Dialectical Behaviour Therapy (DBT). SCM focuses on practical strategies and structured support rather than in-depth exploration of past experiences.
There is good evidence that, with the right kind of support, people with complex emotional and relational needs can improve their wellbeing and quality of life. The aim of SCM is to support people on this journey, in a trauma-informed way.
What happens in SCM?
SCM is typically offered over an 18-month period, depending on your needs. Regular reviews ensure it remains helpful and relevant to your progress. SCM typically involves:
- Regular sessions: These are usually weekly and involve one-to-one meetings with a trained clinician, alongside group work (depending on your needs)
- Goal setting: Together, you and your clinician will identify areas you want to work on and set realistic goals
- Problem-solving: Sessions often focus on finding practical solutions to everyday challenges
- Crisis planning: You’ll develop a plan to manage distress and stay safe during difficult times.
SCM is often provided as part of a broader care plan and may involve collaboration with other healthcare professionals. The usual pathway involves the following phases:
- Referral to SCM pathway
- Initial screening appointment - to see if SCM is a good fit for you
- Assessment - around 4 sessions, to help the practitioner understand your needs and what might help you cope in a crisis
- Socialisation phase - building relationships with a mental health practitioner by talking about your life and experiences
- Treatment phase - 1:1 and group sessions, focused on developing skills in understanding/managing emotions and relationships, reducing impulsivity and improving problem solving skills
- Discharge planning – planning the next steps of your recovery journey
Common questions
How is SCM different from other types of therapy?
SCM is not a therapy as such - it is an approach to your mental health care that is designed to offer a structured and predictable way of getting support when you need it.
Where does SCM take place?
Recovery happens best in the community. If hospital admission is necessary at any point, it is recommended that this is relatively brief and with a clear goal and timescale in mind.
What if I find it challenging?
SCM is designed to meet you where you are. Your clinician will work alongside you, at a pace that feels manageable.
Is SCM suitable for me?
SCM can be a helpful way to support people with complex emotional and relational needs. It is designed to help people who struggle with managing emotions or relationships. This might include problems with impulsivity, self-harm or suicidal thoughts.
However, it’s not the right fit for everyone and can be challenging at times. Your clinician or mental health team will work with you to assess if it’s a good fit for your needs and in what ways it might be useful.
How long does it take?
SCM usually lasts around 18 months. We ask people to aim for at least 75% attendance of all appointments. Willingness and motivation to SCM is crucial. You are also asked to complete questionnaires to help monitor and review your progress.
How do I access SCM?
Speak to your mental health practitioner about how to access SCM or to discuss other kinds of support that may suit your individual needs and circumstances.
Where can I learn more?
Remember, you are not alone.
SCM can be a valuable tool in coping with mental health problems and improving your overall wellbeing.
As a service user, relative or carer using our services, sometimes you may need to turn to someone for help, advice, and support.
Find resources for carers and service users Contact the Trust