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The 57 care gaps

Each card is one guideline-backed care step, with how often our analysis found it missing. The most safety-critical gaps come first. Filter by topic, then open any card for plain-language questions to bring to your clinician.

Topic

Antipsychotic safety

Baseline tests before a child starts an antipsychotic

Before a child starts an antipsychotic, baseline blood tests and measurements should be taken.

99% missed
Antipsychotic safety

Checking for movement side effects on antipsychotics

If you take an antipsychotic long-term, you should be checked from time to time for abnormal movements (a quick, non-invasive exam).

96% missed
Bipolar disorder

Thyroid checks while taking lithium

If you take lithium long-term, your thyroid (TSH) should be checked regularly.

83% missed
Substance use

An overdose-rescue medicine when on opioids and benzodiazepines

If you are prescribed both an opioid and a benzodiazepine, naloxone (an overdose rescue medicine) should be offered.

83% missed
Bipolar disorder

Valproate blood-level monitoring

If you take valproate long-term, a blood valproate level should be checked periodically.

82% missed 1.6x risk
Antipsychotic safety

A heart-rhythm check (ECG) on certain antipsychotics

If you start an antipsychotic that can affect heart rhythm, an ECG should be considered when you have risk factors.

81% missed
Bipolar disorder

Lithium blood-level monitoring

If you take lithium long-term, a blood lithium level should be checked every few months to keep the dose safe.

78% missed 3.7x risk
General

A follow-up within 7 days of leaving hospital

After a psychiatric hospital stay, you should have a follow-up appointment within 7 days.

75% missed
Children & teens

Close follow-up when a teen starts an antidepressant

When a teenager starts an antidepressant, they should be followed up closely (about weekly) in the first weeks.

73% missed
Antipsychotic safety

Blood-sugar checks on antipsychotics

If you take an antipsychotic, your blood sugar (an HbA1c test) should be checked before you start and at least once a year.

69% missed 5.1x risk
Antipsychotic safety

Cholesterol checks on antipsychotics

If you take an antipsychotic, your cholesterol (a lipid panel) should be checked at the start and yearly.

66% missed
Bipolar disorder

Kidney checks while taking lithium

If you take lithium long-term, your kidney function (creatinine) should be checked regularly.

62% missed
General

A follow-up within 30 days of leaving hospital

After a psychiatric hospital stay, you should be seen again within 30 days.

59% missed
Substance use

Medication for opioid use disorder

If you have opioid use disorder, you should be offered medication to treat it (buprenorphine, methadone, or naltrexone).

55% missed
Bipolar disorder

Blood-count and liver checks on valproate

If you take valproate, your blood counts and liver tests should be checked after starting and then periodically.

53% missed
Schizophrenia

Clozapine blood-count monitoring

If you take clozapine, your white-blood-cell count should be monitored on schedule - this is a safety requirement.

51% missed
General

Risky combinations with MAOI antidepressants

An MAOI antidepressant should not be combined with other serotonin-raising medicines without careful review.

36% missed
Antipsychotic safety

Tracking weight on antipsychotics

If you take an antipsychotic, your weight or BMI should be tracked over time, not just measured once.

18% missed 3.0x risk
General

Combining an MAOI antidepressant with a stimulant

An MAOI antidepressant should not be combined with a stimulant without careful review.

14% missed
Substance use

Opioids and benzodiazepines together

An opioid and a benzodiazepine should not be prescribed together unless there is a clear, discussed reason - the combination raises overdose risk.

14% missed 3.7x risk
Depression

Team-based (collaborative) care for depression

Depression care in primary care works best with collaborative-care support; it should be offered where available.

100% missed
Schizophrenia

A hormone check on certain antipsychotics

On risperidone or paliperidone, prolactin should be checked when symptoms suggest a problem.

99% missed
Depression

Other options when depression treatments aren't working

If several depression treatments have not worked, more intensive options (like ECT or TMS) should at least be discussed.

99% missed
Older adults

A memory check when an older adult starts a new medicine

An older adult starting a new psychiatric medicine should have their thinking and memory screened.

99% missed
Antipsychotic safety

Movement checks for children on antipsychotics

A child with autism or intellectual disability on an antipsychotic should be checked for abnormal movements.

97% missed
General

Reviewing your medication list after a hospital stay

Your medication list should be reconciled after a mental-health hospital discharge.

96% missed
Eating disorders

Frequent weight checks during anorexia treatment

During active treatment for anorexia, weight should be monitored frequently.

94% missed
Eating disorders

Monitoring a child's growth during anorexia care

A child being treated for anorexia should have their growth and development monitored.

94% missed
Anxiety

Measuring anxiety severity at diagnosis

When anxiety is newly diagnosed, a simple severity score (GAD-7) should be recorded to guide care.

92% missed
Eating disorders

A bone-density scan after long-term anorexia

After a long period of being underweight with anorexia, a bone-density scan should be considered.

91% missed
Eating disorders

Baseline blood tests in newly-diagnosed anorexia

Someone newly diagnosed with anorexia should have baseline blood tests (electrolytes and blood count).

91% missed
Substance use

Medication for alcohol use disorder

If you have alcohol use disorder, you should be offered medication that treats it (such as naltrexone or acamprosate).

87% missed
Depression

Tracking symptoms with a simple questionnaire

Your treatment should be guided by a simple symptom questionnaire (like the PHQ-9 or GAD-7) repeated over time, not just by impression.

76% missed
General

Checking back within six weeks of a medication change

After a medication change, your response should be reassessed within about six weeks.

75% missed
Eating disorders

The proven medicine for bulimia

Fluoxetine is the proven medicine for bulimia and should be offered.

72% missed
Bipolar disorder

Pregnancy-risk medicines without contraception advice

A medicine that can harm a pregnancy should not be prescribed to someone who could become pregnant without contraception counselling.

70% missed
Substance use

Help to quit smoking

If you smoke, you should be offered help to quit (medication and support), not just advised to stop.

60% missed
Depression

Giving an antidepressant a fair trial

An antidepressant should be given a fair trial - a full dose for long enough - before it is judged a failure or switched.

53% missed
Anxiety & PTSD

First-line medication for OCD

OCD should be treated with a first-line SSRI or clomipramine.

53% missed
Bipolar disorder

Bipolar disorder treated with an antidepressant alone

If you have bipolar disorder, you generally should not be left on an antidepressant alone without a mood stabiliser.

51% missed
Eating disorders

Medication for binge-eating disorder

Lisdexamfetamine is an approved treatment for binge-eating disorder and should be offered.

50% missed
Alcohol use

Following up a positive alcohol screen

If an alcohol-screening test is positive, the next step should be a proper assessment, not silence.

43% missed
Anxiety & PTSD

First-line medication for panic disorder

Panic disorder should be treated first with an SSRI or SNRI, not a benzodiazepine alone.

34% missed
Substance use

Stopping a benzodiazepine safely, not abruptly

A benzodiazepine should not be stopped abruptly - it should be tapered to avoid dangerous withdrawal.

33% missed
Substance use

PTSD treated with a sedative alone

PTSD should not be managed on a benzodiazepine alone - it is not an effective PTSD treatment.

30% missed
Substance use

Trying a safer first option before long-term anxiety sedatives

Long-term benzodiazepine use for anxiety should not happen without first trying a safer first-line treatment.

27% missed
Older adults

Too many sedating medicines in older adults

Older adults should not be left on multiple anticholinergic medicines, which add up to real cognitive risk.

10% missed
Schizophrenia

Being on three or more antipsychotics at once

Being on three or more antipsychotics at once should be rare and clearly justified.

8% missed
General

Genetic testing after an antidepressant doesn't work

After an antidepressant fails, genetic (pharmacogenomic) testing can be discussed in some cases.

100% missed
Depression

Esketamine for hard-to-treat depression

For hard-to-treat depression, esketamine is an approved option that can be discussed.

99% missed
Pregnancy

Newer options for severe postpartum depression

For severe postpartum depression, newer rapid-acting options (brexanolone/zuranolone) can be discussed.

99% missed
Schizophrenia

A long-acting injectable option for schizophrenia

If schizophrenia is hard to manage because of missed doses, a long-acting injectable should be discussed.

98% missed
Suicide safety

Prompt follow-up after a concerning screening answer

After a positive suicide-risk item, you should have a prompt follow-up within about a week.

98% missed
Depression

Checking for sleep apnoea in hard-to-treat depression

In hard-to-treat depression, undiagnosed sleep apnoea should be considered as a contributor.

93% missed
Anxiety & PTSD

Prazosin for PTSD nightmares

For PTSD with nightmares and poor sleep, prazosin can be discussed.

80% missed
Antipsychotic safety

Treating antipsychotic weight gain

If an antipsychotic has caused significant weight gain, newer weight treatments (like GLP-1 medicines) can be discussed.

77% missed
Depression

Tracking depression scores when treatment is hard

In hard-to-treat depression, symptom scores (PHQ-9) should be tracked repeatedly to guide changes.

73% missed