|
Who's who in mental health: a brief guide
Please give feedback on this information
Copyright note for Mind factsheets: Both individuals and organisations are welcome to print and photocopy any complete factsheet from the 'Information' section of Mind's website. Organisations are free to distribute them to service users and colleagues, but must ensure they always use the latest version of the factsheet, as available on the website, at the time of distribution.
Introduction
Advocate
Inpatient advocate
Legal advocate
Peer advocate
Approved mental health professional (AMHP)
Carer
Care coordinator
Care manager
Commissioner
Community mental health nurse (CMHN)
Counsellor
Graduate mental health worker
General practitioner (GP)
Mental health act commissioner (MHAC)
Occupational therapist
Patient watchdogs
Community health councils (CHC)
Patient advice and liaison services (PALS)
Independent Complaints Advocacy Service (ICAS)
Local involvement networks (LINks)
Psychiatrist
Psychologist
Clinical psychologist
Counselling psychologist
Psychotherapist
Social worker
Further reading
Useful organisations
Introduction
This factsheet explains the terms used to describe different workers and organisations that you may come across in the mental health field. Some of the names sound confusingly similar - for example, psychiatrist and psychologist - yet these job titles indicate quite different roles and approaches to mental health problems. This factsheet is primarily for carers and users of mental health services but will also be of interest to mental health professionals and students.
Details of many of the organisations mentioned in this factsheet are listed under Useful organisations.
Advocate
An advocate is someone who represents their own or someone else's interest and speaks on their behalf. There are many forms of advocacy in mental health.
Inpatient advocate
An advocate can be helpful to an individual who has been admitted to hospital. They can help with a range of issues, including claiming benefits, challenging detention and giving support in ward rounds.
How to access: Many advocacy projects provide inpatient advocacy as a central part of their service. If you are on a mental health ward and want to speak to an advocate, a member of staff such as a nurse or ward manager will be able to tell you how you can make contact.
Legal advocate
Legal advocacy in the field of mental health encompasses a broad range of activities from advice to representation. People with specialist knowledge and training, such as lawyers and advice workers, are sometimes called ‘legal advocates’. Legal advocates differ from other mental health advocates in that they represent people in formal settings such as courts, tribunals and complaints processes.
Lawyers can act as legal advocates at mental health review tribunals and at hospital managers' meetings where the release of a detained patient is being considered. They can also help with legal issues relating to housing, financial matters, family and childcare.
People with relevant training but who are not lawyers, such as patient liaison and advice services (PALS) staff and local Mind project workers, may undertake some activities, such as basic advice.
How to access: If you are on a mental health ward, ask the hospital social worker or ward manager for a list of lawyers in your area who are on the Law Society's mental health review tribunal panel, or contact The Law Society. You can also phone Mind's Legal Line for information. Details are provided under ‘Useful organisations’.
Peer advocate
Peer advocacy is support from someone with experience of using mental health services. Peer advocates can draw on their own experiences to understand and empathise with the person they are working with. Some peer advocates and advocacy schemes work on an entirely voluntary basis, but the majority are funded user/survivor-run schemes with paid workers.
How to access: Examples in the UK include user forums or networks. To find out if any operate in your area, contact your local health authority (primary care trust [PCT] or local health board) or MindinfoLine (see 'Useful organisations').
Back to top
Approved mental health professional (AMHP)
Until recently, a qualified social worker known as an approved social worker (ASW), who had undergone additional training and been approved by the local authority to carry out designated functions under the Mental Health Act (1983), had a role in mental health assessment under the Act. This was undertaken jointly with medical professionals, and looked at whether compulsory admission to hospital was necessary. ASWs had a particular responsibility to examine alternatives to hospitalisation.
Since the introduction of the Mental Health Act 2007, other mental health professionals will become eligible to perform the duties of the ASW, so the role has been renamed ‘approved mental health professional’ (AMHP). In practice, social workers are still performing the role until other professionals have received the necessary training.
How to access: Contact the duty social worker at your local social services department. In a hospital, ask for the social services office. AMHPs also work as part of community mental health teams.
Back to top
Carer
A person who supports someone who has mental health problems is referred to as a carer. Carers may or may not be related to the person they are caring for. Carers may be adults or children, working or unemployed. They may be providing help and support to their parent, partner, son or daughter, neighbour or friend.
Some carers live with the person they care for; others may live some distance away. Care can include emotional care and support. The term ‘carer’ is not normally used to describe someone who is paid to take care of someone.
Carers UK has a network of branches and contacts offering support to carers (see Useful organisations).
Care coordinator
A care coordinator is a named individual who is designated as the main point of contact and support for a person who has a need for ongoing care. The Government's ‘care programme approach’ for specialist psychiatric services advises that health and social services should designate a person to keep in close contact with a 'patient' in the community and to monitor their care.
The care coordinator can be a nurse, social worker or other mental health worker – whoever is thought appropriate for the person's situation. A care coordinator should not be the same person as the care manager (see below).
Care coordinators are usually part of a community mental health team.
How to access: Contact your community mental health team or social services department.
Care manager
A care manager is responsible for assessing a person’s social care needs and for arranging delivery of community care services within available resources.
Care managers work within social services departments and organise community care for many different client groups. When arranging services for people with mental health problems, they often work as part of a community mental health team. Their role is to carry out the local authority’s duties under the NHS and Community Care Act (1990). This is called ‘care management’.
The care manager differs from a care coordinator (see above), and, to avoid a conflict of interest, he or she should not be involved in direct service delivery, nor carry managerial responsibility for the services a care coordinator arranges. Care managers can come from statutory or voluntary organisations.
Back to top
Commissioner
Strategic health authorities have responsibility for developing strategy and managing the performance of PCTs and NHS trusts, but they do not make decisions about what services to commission.
In England, PCTs are responsible for arranging (commissioning) specialist mental health services on behalf of the people living within their catchment area. They have an allocated amount of money and decide which services they will commission and who will provide those services. The chosen provider will receive money and sign a service agreement. The provider then has to make sure the service is delivered in the way specified in the contact. The provider may be part of a public sector health or social care trust, or part of the voluntary or private sectors.
In Wales, local health boards carry out the same functions as PCTs.
Community mental health nurse (CMHN)
A CMHN, also known as a community psychiatric nurse (CPN), is a registered nurse with specialist training who works in the community. Some are attached to general practice surgeries or community mental health centres, others to mental health units. Most work as part of a community mental health team. The role of a CMHN can be wide and may include:
- counselling or anxiety management, or exploring different coping strategies with people with acute short-term difficulties
- working with people who have had severe mental health problems for many years and require long-term support to enable them to establish a rewarding life in the community
- administering psychiatric drugs; for example, as injections.
How to access: Contact your general practitioner (GP) or community mental health team.
Counsellor
Counselling is a talking treatment that aims to help people find ways of coping with problems they are experiencing. The overall aim of counselling is to provide an opportunity for the person counselled to work towards living in a more satisfying and resourceful way. Counselling can involve group or family therapy as well as individual treatment.
Talking treatments are sometimes offered by professionals other than counsellors, for example, psychotherapists, psychologists, community mental health nurses, occupational therapists and social workers, as described under these headings in this factsheet.
How to access: Because of the high demand from service users, it can be difficult to get talking treatments on the NHS, though it is worth finding out from your GP, or asking a local voluntary organisation such as Mind where talking treatments are available. It is advisable to get details from professional associations with self-regulating membership, such as the British Association for Counselling and Psychotherapy, or the Association of Counsellors and Psychotherapists in Primary Care (see ‘Useful organisations’ for details).
Back to top
Graduate mental health worker
Graduate mental health workers work in primary care settings, such as general practices or health centres. Their function is to improve the capacity of primary care to manage common mental health problems. The duties of graduate mental health workers vary between health trusts but may include:
- delivering talking therapies such as cognitive behaviour therapy (CBT)
- promoting good mental health in the community
- providing information and referral to other services, including voluntary sector services.
How to access: Ask your GP or practice nurse.
General practitioner (GP)
A GP is the first point of contact with the NHS for most people. Many mental health problems are dealt with by GPs without referral elsewhere. If more specialised treatment is needed, however, a GP can make a referral to secondary mental health services such as inpatient hospital care or community mental health services.
How to access: You need to be registered with a GP. Your health authority should be able to supply a list of GPs in your area; addresses and telephone numbers can be found in your local telephone directory.
Back to top
Mental health act commissioner (MHAC)
The Mental Health Act Commission is a special health authority which was set up to protect the rights and interests of patients detained under the Mental Health Act (1983), and to draw up a code of practice, which was adopted by Parliament in December 1989. MHACs are drawn mainly from the professions involved in mental health services.
MHACs can visit and privately interview patients detained in hospitals and mental health nursing homes. They have limited powers to investigate complaints and appoint panels to give second opinions on consent to treatment.
How to access: Contact the Mental Health Act Commission (see ‘Useful organisations’ for details).
Occupational therapist
Occupational therapists work in mental health units, day hospitals and the community. They may be employed by a health authority, social services department or voluntary organisation.
Their role is to help people with mental health problems to build up the confidence and skills needed for personal, social, domestic, leisure and work activities. They focus on the learning of specific skills and techniques, including arts, crafts, drama, dance, writing, group work (such as anxiety management and assertion training), individual counselling and training activities in daily living.
How to access: Access varies according to health authority; occupational therapists can generally be contacted through a health or social services professional such as a GP or social worker, or through self-referral.
Back to top
Patient watchdogs
Community Health Councils (CHC)
CHCs were originally set up as independent patient watchdogs for local NHS health services. They were abolished in England in December 2003 and their functions taken on by PALS, the Independent Complaints Advocacy Service (ICAS) and local involvement networks (LINks) (see below). CHCs still operate in Wales.
Patient Advice and Liaison Services (PALS)
The NHS Plan, published by the Government in June 2000, announced a commitment to establishing PALS; these can now be found in every NHS trust in England. PALS help service users and their carers to resolve problems and concerns with care and treatment with the trusts themselves. If this is not possible, PALS make referrals to organisations external to the trust, such as ICAS (see below).
How to access: Contact your local NHS trust for details.
Independent Complaints Advocacy Service (ICAS)
ICAS is a free service that is independent of the NHS. It supports service users and carers who wish to make a complaint about their NHS treatment or care.
How to access: Contact your local NHS trust for details.
Local involvement networks (LINks)
Since April 2008, LINks have replaced Patient and Public Involvement (PPI) forums in each NHS Trust in England. LINks, in common with PPIs, are made up of local people whose remit is to oversee and advise health trusts on performance. However, LINks have a wider remit as they cover social care as well as health services.
LINks are expected to obtain the views of the local community in order to make reports and recommendations on aspects of services. Training and development is provided to board members.
How to access: Contact your local health authority or social services department for details.
Back to top
Psychiatrist
Psychiatry is the study of mental disorders and their diagnosis, management and prevention. Psychiatrists are qualified medical doctors who have specialised and taken further training in 'mental illnesses'.
The consultant psychiatrist is the most senior member of the multidisciplinary team that plans and delivers patient care; other team members may include a psychologist, a social worker and other workers described in this factsheet. The consultant psychiatrist has overall responsibility for patient assessment and care. Patients usually have more contact with the consultant's assistant, the registrar.
Psychiatrists are not only hospital based. In some areas, psychiatrists have close links with GP surgeries; others work in community mental health centres or multidisciplinary teams. They work closely with a number of different mental health professionals, such as psychologists, social workers and psychotherapists.
While treatments within psychiatry tend to be predominantly physical, such as drug therapy and electroconvulsive therapy, a combination of treatments may be used; for example, drug therapy and psychotherapy.
How to access: Your GP can refer you to a psychiatrist within your NHS trust.
Back to top
Psychologist
Psychology is the scientific study of human behaviour and mental processes. It is concerned with the thoughts, feelings and motivations that underlie human action. Although there are different types of psychologists, clinical and counselling psychologists are included in this factsheet because of their relevance to mental health.
Clinical psychologist
Clinical psychology concerns the assessment and treatment of mental health problems. Clinical psychologists work in a range of health and social care settings, usually in multidisciplinary teams, to help individuals manage and alleviate their mental distress. Assessments may be carried out through interviews, questionnaires and direct observation; treatments include cognitive behaviour therapy and psychotherapy.
Counselling psychologist
Counselling psychologists apply the talking treatments developed in psychology to help individuals and groups manage mental and emotional problems. Counselling psychologists may use a range of approaches, but common to all is an active collaborative relationship that empowers people to make positive changes in their lives.
How to access: Your GP can refer you to a psychologist within your NHS trust. In some areas you can approach the NHS district psychology services directly.
Back to top
Psychotherapist
Although the distinctions between counselling and psychotherapy are blurred, there are differences in the methods used, the intensity and length of treatment, and in the training the therapist receives. The psychotherapeutic process may go deeper than some forms of counselling and is generally longer term.
The overall aim of psychotherapy is to help you to understand why you feel the way you do, and what lies behind your responses to other people and things that happen to you. Like counselling, psychotherapy can involve individual sessions or therapy in couples, groups or families.
How to access: Your GP may be able to refer you to a psychotherapist from the NHS, though this type of service is not available everywhere. A number of voluntary agencies offer psychotherapy services. You can also see a private psychotherapist, though this can be expensive.
Social worker
Social workers are involved in mental health in a number of ways and work in a variety of settings. Local authority social services are tending to move away from generalist social workers towards specialist teams, including specific mental health social service teams. However, there are no clear guidelines about the level of social services that people are entitled to expect and there is wide variation between geographical areas in terms of the services provided.
Social workers should be able to offer advice on practical matters such as day care, accommodation and welfare benefits, or can link you with appropriate services. Some may offer counselling. Hospital social workers are attached to both general hospitals and mental health hospitals. A psychiatric social worker is a specialist who works closely with individuals and families to support them through crises or in the longer term.
How to access: Contact the duty social worker at your social services area office; you will be able to find the number in your local telephone directory. In a hospital, ask for the social services office. Social workers also work as part of community mental health teams.
Back to top
Further reading
Mind factsheets
Booklets (available to purchase from Mind Publications on 0844 448 4448 or email publications@mind.org.uk)
Other publications (available from Mind publications)
Mental health jargon and acronym buster, S Heyes (Speak out Somerset 2007)
Useful organisations
Advocacy Resource Exchange (ARX)
Unit 3, 60 Duke Street, Liverpool L1 5AA
tel: 0151 734 3047
advocacy finder helpline: 08451 228 633 (Mon–Fri 2–5pm)
email: joe@advocacyresource.net
website: www.advocacyresource.net
Provides details of advocacy services across the UK.
Association of Counsellors and Psychotherapists in Primary Care
Queensway House, Queensway, Bognor Regis PO21 1QT
tel: 01243 870 701
email: cpc@cpc-online.co.uk
website: www.cpc-online.co.uk
A self-regulating membership association for counsellors and psychotherapists working in primary care.
British Association for Counselling and Psychotherapy
BACP House, 15 St John’s Business Park, Lutterworth LE17 4HB
tel: 01455 883 300 (general enquiries); tel 0870 443 5220 (to find a therapist)
email: bacp@bacp.co.uk
website: www.bacp.co.uk
The largest self-regulating membership organisation for counsellors and psychotherapists working in the UK.
Carers UK
20 Great Dover Street, London SE1 4LX
tel: 020 7378 4999 (general); carers line: 0808 808 7777
email: info@carersuk.org
website: www.carersuk.org
Led and run by carers, Carers UK provides information and advice on all aspects of caring and campaigns for changes to improve the lives of carers.
Healthcare Commission
Head Office, Finsbury Tower, 103–105 Bunhill Road, London EC1Y 8TG
tel: 020 7448 9200
email: feedback@healthcarecommission.org.uk
website: www.healthcarecommission.org.uk
Has statutory powers to regulate healthcare organisations in England, including making inspections and taking action where organisations have not met required standards.
Law Society
The Law Society’s Hall, 113 Chancery Lane, London WC2A 1PL
tel: 020 7242 1222
email: contact@lawsociety.org.uk
website: www.lawsociety.org.uk
The representative body for solicitors working in England and Wales, also provides a searchable database of solicitors for the public.
Mental Health Act Commission
Maid Marian House, 56 Hounds Gate, Nottingham NG1 6BG
tel: 0115 943 7100
email: via website
website: www.mhac.org.uk
Has statutory powers to safeguard the interests of people detained under the Mental Health Act, including reviewing the operations of the Act and meeting and interviewing patients.
MindinfoLine
Mind, PO Box 277, Manchester M60 3XN
tel: 0845 766 0163
email: info@mind.org.uk
Provides information to the public on mental health and related issues.
Mind Legal Line
Mind, PO Box 277, Manchester M60 3XN
tel: 0845 225 s9393
email: legal@mind.org.uk
Provides information to the public on the law relating to mental health.
Originally written by Sarah Teevan. Updated by Rachael Twomey, Mind Information Unit, August 2008.
|