Early diagnosis and the optimal control of inflammation, with a continuous cycle of assessment, treatment, monitoring and adjustment of therapy is best practice for the management of IBD. However, patients express frustration with ongoing challenging symptoms, often discordant with inflammation, including abdominal pain, fatigue, depression, anxiety and emotional wellness; these are often not optimally addressed by IBD clinicians due to lack of time or resources. This review will highlight the burden of these symptoms and issues; suggest ways of assessing these in clinical practice; highlight the importance of acknowledging and validating the symptoms and issues with patients, reassuring them that they are being heard; and discuss different possible models of service delivery for psycho-social support, from fully integrated gastropsychology models to referral pathways that optimize community support.