Social history is where psychiatric illness develops, where it persists, and where it recovers. The patient's housing, work, relationships, finances, legal situation, and supports together produce the context that shapes whether treatment is going to succeed. Skip the social history and you're treating in a vacuum.
Domain map. Where do they live? Who do they live with? Stable housing or precarious? Work — what do they do, how is it going, what's the financial situation? Relationships — partner status, quality of partnership, presence or absence of intimate partner violence. Family — parents, siblings, children, family of origin dynamics. Friends, community, faith communities, mutual help groups, hobbies. Legal — pending issues, criminal history, current parole or probation. Each domain matters; each may be a source of stress or support.
Screen stressors AND supports. Both are clinical data. The patient with substantial stressors and adequate supports is in different territory than the patient with the same stressors and no supports. Recovery happens through supports as much as through medication; absence of supports is a treatable problem with referral to community resources, mutual help groups, supportive psychotherapy.
Hidden risks require deliberate screening — they rarely volunteer. Intimate partner violence: screen privately, when partner is not present. "Has anyone hurt you physically or made you afraid?" Food insecurity: ask. Housing instability or homelessness: ask. Immigration concerns: ask sensitively in patients who may have these concerns. Each affects treatment substantially and may not be disclosed otherwise.
Social determinants drive outcomes as much as medications do. The patient with severe depression and unstable housing will not recover well on any antidepressant regimen until housing is addressed. The patient in an abusive relationship will not benefit from talk therapy that avoids the abuse. The patient with overwhelming financial stress needs social work as part of treatment.
Document specifics. "Lives with spouse and two children in stable apartment. Works as IT manager — stable employment, recent reorganization causing stress. Marriage strained but no IPV. Two close friends, no extended family in area. No legal involvement. Spiritual involvement: weekly church attendance, finds support there." Specifics let the next reader understand the patient as a person.