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A brief guide to who's who in mental health
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Introduction
Advocate
Citizen advocate
Inpatient advocate
Legal advocate
Peer advocate
Self advocate
Carer
Care coordinator
Care manager
Citizens Advice
Commissioner (previously known as 'purchaser')
Community mental health nurse (CMHN)
Counsellor
General practitioner (GP)
Health visitor
Mental Health Act commissioner (MHAC)
Occupational therapist
Patient watchdogs
Community health council (CHC)
Patient Advice and Liaison Services (PALS)
Independent Complaints Advocacy Service (ICAS)
Patient and Public Involvement (PPI) forums
Psychiatrist
Psychologist
Clinical psychologist
Counselling psychologist
Psychotherapist
Self-help and support groups
Social worker
Approved social worker
Volunteer
Further reading
Useful contacts
Introduction
What follows is a brief summary of the terms used to describe different workers and organisations 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 may indicate quite different roles and approaches to mental health problems. This factsheet is targeted at mental health professionals, students, carers and users of mental health services.
Please note that details of many of the organisations mentioned in this factsheet are listed under 'Useful contacts’.
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Advocate
An advocate is someone who represents their own or someone else's interest and speaks out on their behalf. There are many forms of advocacy in mental health.
Citizen advocate
Citizen advocacy is a form of one to one advocacy where disadvantaged, disempowered people are paired with ordinary citizens who will support them in obtaining their rights and meeting their needs.
How to access: contact the Advocacy Resource Exchange (ARX), which has replaced Citizen Advocacy Information and Training (CAIT) since April 2005. See ‘Useful contacts’ section for details.
Inpatient advocate
If individuals have been admitted to hospital, there can be a range of issues where an advocate can be helpful, including claiming benefits, challenging detention, supporting in ward rounds.
How to access: many advocacy projects will have inpatient advocacy as a central part of their service.
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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 or complaints processes.
Lawyers can act as legal advocates at mental health review tribunals or hospital managers' meetings, which consider whether a detained patient should be released. They can also help with housing, financial, family and child care legal issues.
Non-lawyers with relevant training, for example PALS (Patient Liaison and Advice Services) staff and local Mind project workers, may undertake some activities, such as basic advice.
How to access: 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. See ‘Useful contacts’ section for details.
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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.
Self-advocate
Self-advocacy is about expressing your needs and rights as a mental health service user. Tools and skills for self-advocacy include assertiveness training, crisis cards or advance directives, which set out your wishes in the event of crisis.
Self-advocacy groups are groups of mental health service users and ex-users who act collectively to influence service provision and treatment. Alternatively, they may support an individual’s self-advocacy.
How to access: examples in the UK, include user forums or networks such as Survivors Speak Out (see ‘Useful contacts’) and local self-advocacy projects.
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Carer
A person who supports someone who has mental health problems is referred to as a carer. Some carers are related to the person they are caring for and others are not. 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 quite a distance away. Care can include emotional care and support. The term ‘carer’ is not normally used to describe someone paid to take care of someone.
Carers UK has a network of branches and contacts offering support to carers. See ‘Useful contacts’ section for details.
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Care coordinator
A care coordinator is a named individual 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 the specialist psychiatric services advises that health and social services should agree a person to keep in close contact with a 'patient' in the community and to monitor their care. (For further information, see Mind’s factsheet Community care 2: systems for delivering services.)
The care coordinator does not come from any professional group but can, for example, be a nurse, social worker or other mental health worker as 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 the community mental health team.
How to access: contact your local specialist psychiatric services.
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Care manager
The care manager is responsible for assessing a person’s social care needs and 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 the 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’. (See Community care 2: systems for delivering services factsheet.)
The care manager differs from a care coordinator (see above) in that, to avoid a conflict of interest, a care manager should not be involved in direct service delivery, nor carry managerial responsibility for the services they arrange. Care managers need not come from any one profession and can come from statutory or voluntary organisations.
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Citizens' Advice
Specialist advisors can advise on a broad range of issues, including employment and housing rights and welfare benefits.
How to access: find details of your local Citizens’ Advice office in the phone book. Details are also available from MindinfoLine.
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Commissioner (previously known as 'purchaser')
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, primary care trusts (PCTs) are responsible for arranging or commissioning specialist mental health services on behalf of the people living in the district. 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 the contract specifies. The provider may be part of the public sector as a health and social care trust, or it may be part of the voluntary or private sector.
In Wales, from 1 April 2003, local health groups reformed to become local health boards. Since November 2004, some of these boards have been given permission to merge with hospital trusts. The expectation is that local health boards, local authorities, trusts and the voluntary sector should work together to commission services. Reforms have been intended to bridge the gap between service commissioning and delivery that had hindered joint working in the past. (More information in the Community care 4: commissioning services factsheet.)
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Community mental health nurse (CMHN)
A Community Mental Health Nurse (CMHN), also known as Community Psychiatric Nurse (CPN), is a registered nurse with specialist training, who works in the community. Some are attached to GP surgeries or community mental health centres, others to psychiatric units. Most work as part of the community mental health team. The role of a CMHN can be very wide and can 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, injections.
A CMHN may specialise in many different areas; for example, children, elderly people, or drug or alcohol problems.
How to access: contact your GP.
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Counsellor
Counselling is a talking treatment that aims to help people to find ways of coping with problems that they might be experiencing. The overall aim of counselling is to provide an opportunity for the individual to work towards living in a more satisfying and resourceful way.
(Talking treatments are also sometimes offered by other professionals, for example, community psychiatric nurses, psychotherapists, psychologists, occupational therapists, and social workers - see under these headings in this factsheet.)
In addition to individual treatment, there is also the possibility of joining in group therapy. Groups may deal with specific problems; for example, grief, anxiety, violence and shyness. Some groups may be run on a self-help basis.
How to access: Despite a high demand from service users, it is difficult to get talking treatments on the NHS, although 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 self-regulating membership associations, such as the British Association for Counselling and Psychotherapy, or Counsellors and Psychotherapists in Primary Care (see ‘Useful contacts’ for details). Also see Mind’s booklets Making sense of counselling and Understanding talking treatments.
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Gateway worker
These are new roles, developed within the NHS Plan to modernise mental health services.
A Gateway worker is part of a local clinical health service providing local assessment and triage for people presenting in an acute or impending mental health emergency. Gateway workers may have a clinical or strategic role in supporting access to services and ensuring the effective use of smooth pathways between primary and specialised services.
Gateway workers are experienced mental health clinicians with professional qualifications in nursing, social work or psychology but, as they should respond to local priorities, the specific roles and responsibilities of each worker will vary.
Further information on gateway workers can be found in the publication, Fast-forwarding primary care mental health - Gateway workers, (Department of Health 2003). See Department of Health website or contact them direct (see Useful contacts).
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General practitioner (GP)
A general practitioner (GP) is a doctor who provides a complete spectrum of care within the local community. GPs are the first point of contact with the NHS for most people.
Emotional or psychological difficulties make up between a quarter and a third of a GP's workload. GPs can talk through problems, prescribe medication or make referrals as they see fit.
Although most mental health problems are dealt with by GPs without referral elsewhere, they increasingly work in teams with other professionals, helping patients to take responsibility for their own health. To achieve standards two and three of the National Service Framework for Mental Health, the GP can work with multi-agency teams from health and social care trusts and social services, to ensure round-the-clock access to services and treatments. For example, GP practices may have counsellors, social workers or community psychiatric nurses attached to their surgeries. (See factsheet Community care 1: the spectrum of mental health services.)
How to access: if you have not already registered with a GP, or wish to change your GP, then your health authority should be able to supply a list of GPs in your area. For address and telephone number, check your local telephone directory.
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Health visitor
The aim of the health visiting service is to promote the health of the whole community and to help in promoting healthy lifestyles addressing concerns about physical and mental wellbeing.
Health visitors are qualified nurses or midwives, with special training and experience in child health, and health promotion and education for the whole community. They can offer practical support and advice and point the way to specialist help.
How to access: Your local GP surgery, local health centre or child health clinic give you contact information.
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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. It comprises approximately 170 part time Commissioners, drawn mainly from the professions involved in mental health services.
Mental Health Act Commissioners 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 contacts section for details).
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Occupational therapist
Occupational therapists work in psychiatric units, day hospitals and in 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 or work activities. They focus on the learning of specific skills or 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; OTs can generally be contacted through a health or social services professional, for example, GP, social worker or through self-referral.
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Patient watchdogs
Community health council (CHC)
Community health councils were originally set up as patient watchdogs for local NHS health services. They were abolished in December 2003 and their functions have since been taken on by PALS, ICAS and PPI forums (see below).
Patient Advice and Liaison Services (PALS)
The NHS Plan, published in June 2000 by the Government, announced the commitment to establishing Patient Advice and Liaison Services (PALS); these can now be found in every NHS Trust. PALS help service users and their carers to resolve problems and concerns with care and treatment within the Trusts themselves. If this is not possible, PALS make referrals to organisations external to the Trust, such as ICAS.
How to access: contact your local NHS Trust for details.
Independent Complaints Advocacy Service (ICAS)
ICAS is a free service, independent of the NHS, which supports service users and carers wishing to make a complaint about their NHS treatment or care.
How to access: contact your local NHS trust for details.
Patient and Public Involvement (PPI) forums
PPI forums have been established in every NHS Trust in England. They are made up of local people who oversee and advise health trusts on performance. This includes obtaining the views of the local community to make reports and recommendations on aspects of services. Training and development is provided to board members.
Unlike PALS and ICAS, PPI forums investigate general issues rather than specific complaints. PPI forums also have a role in monitoring the effectiveness of local PALS.
How to access: contact your local NHS Trust for details.
Note: until August 2006, PPI forums will be coordinated by the Commission for Patient and Public Involvement in Health. They can provide more information about forums and how to get involved. (See Useful contacts for details).
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Psychiatrist
Psychiatry is the study of mental disorders and their diagnosis, management and prevention. Psychiatrists are qualified medical doctors, who have taken further training and specialised in 'mental illness'. Some specialise further; for example, psychogeriatricians, who work with elderly people, and forensic psychiatrists who work with 'mentally disordered offenders'.
The consultant psychiatrist is the most senior member of the team with overall responsibility for patient assessment and care, but the psychiatric patient usually has more contact with the consultant's assistant called the registrar.
Psychiatrists are not only hospital-based. In some areas, psychiatrists have close links with GP surgeries while others work in community mental health centres or multi-disciplinary 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 ECT, increasingly a combination of treatments may be used; for example, drug therapy with psychotherapy.
How to access: your GP can refer you to a psychiatrist within in your NHS Trust.
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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 covered in this factsheet because of their relevance to mental health.
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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, in multi disciplinary teams, to help individuals manage and alleviate their mental distress. Assessments may be carried out through interviews, questionnaires and direct observation; treatments include cognitive behavioural therapy and psychotherapy.
Clinical psychologists have an undergraduate degree in Psychology, followed by at least one year’s relevant work experience, then a Doctorate in Clinical Psychology.
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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, which empowers people to make positive changes in their lives.
Counselling psychologists have an undergraduate degree in Psychology, followed by a three year, full time Qualification in Counselling Psychology or appropriate work-based training.
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.
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Psychotherapist
Although the distinctions between counselling and psychotherapy are blurred at the edges, there are differences in the methods used, the intensity and length of treatment, and in the training the therapist receives.
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 to things that happen to you.
The psychotherapeutic process goes deeper than counselling and is generally longer-term.
Psychotherapy is conducted in several different ways; for example, individual, group, couple and family psychotherapy. Approaches could include cognitive behaviour, psychoanalytic, psychodynamic and humanistic therapies.
A psychotherapist may be a psychiatrist, psychologist or other mental health professional who has undergone specialist training in psychotherapy. Consultant psychiatrists in psychotherapy are medical doctors who have qualified in psychiatry and then undertaken a three or four year specialist registrar training in psychotherapy.
How to access: It is possible that your GP may be able to refer you to a psychotherapist from the NHS, although this type of service is not available everywhere. It is also available from a number of voluntary agencies. The other option, if you can afford it, is to see a private psychotherapist. (See Mind’s booklet Making sense of psychotherapy and psychoanalysis.)
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Self-help and support groups
Support groups offer an opportunity to meet up with other people who are in a similar situation. They can break down feelings of isolation and, at the same time, show how other people have coped. Finding that you support others may help you too. Issues may include bereavement, eating distress and sexual abuse.
How to access: For details of groups in your area, contact MindinfoLine, your local Mind association, or Patient Advice Liaison Services (see section above for details).
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Social worker
Social workers may be involved in mental health in a number of ways and work in a variety of settings. There appears to be a tendency for local authority social services to move away from generalist or generic social workers, to specialist teams, including a specific mental health service. However, there are no clear guidelines about the level of social services that people are entitled to expect and there is a wide variation between geographical areas in terms of what services are provided.
Social workers should be able to offer advice on practical matters, such as day care, accommodation or welfare benefits, or can link you with appropriate services. Some may offer counselling. Hospital social workers are attached to both general and psychiatric hospitals.
A psychiatric social worker is a specialist who works closely with individuals and families to support them either through crises or in the longer term.
How to access: Contact the duty social worker at your social services area office; your town hall or telephone directory should have the number. In a hospital, ask for the social services office. Social workers also work as part of the community mental health team.
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Approved social worker
An Approved Social Worker (ASW) is a qualified social worker who has undergone additional training and been approved by the local authority to carry out designated functions under the Mental Health Act (1983). An ASW has a role in mental health assessment under the Act, undertaken jointly with other medical professionals, and looks at whether compulsory admission to hospital is necessary. ASWs have a particular responsibility to examine alternatives to hospitalisation.
How to access: contact the duty social worker at your social services area office; your town hall or telephone directory should have the number. In a hospital, ask for the social services office. Social workers also work as part of the community mental health team
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Volunteer
Volunteers provide invaluable support and assistance to voluntary organisations, such as local Mind associations, and sometimes to statutory organisations. They offer their services free.
The members of management committees of voluntary organisations are volunteers. Volunteers may work in day centres, charity shops, befriending and advice schemes, and in various projects provided by voluntary groups.
Volunteers may themselves have had experience of mental health services. They may use the services of the voluntary organisation on occasions, as well as work within them.
How to access: To become or find a volunteer, contact your local Volunteer Bureau, local Mind association, National Council for Voluntary Organisations, or voluntary service organisers at the local hospital or social services department. Contact details can be found in the telephone book.
Originally written by Sarah Teevan.
Updated by Rachael Twomey, Mind Information Unit, April 2005 .
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Further reading
Mind has produced a range of Information booklets, factsheets and brief guides addressing different mental health problems that relate to this topic, all available on this website. To order booklets, call Mind Publications on 0844 448 4448, email publications@mind.org.uk or visit the bookshop.
Factsheets
- Careers in mental health
- Community care 1: the spectrum of mental health services
- Community care 2: systems for delivering mental health services
- Community care 3: how to assess community care services (a brief guide)
- Community care 4: commissioning services
- How to access services - information for carers
Booklets
- Getting the best from your approved social worker
- How to cope as a carer
- Making sense of cognitive behaviour therapy
- Making sense of counselling
- Making sense of psychotherapy and psychoanalysis
- The Mind guide to advocacy
- Understanding talking treatments
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Useful contacts
Advocacy Resource Exchange (ARX) (formerly CAIT)
Unit 162, Lee Valley Technopark, Ashley Road, Tottenham, London N17 9LN
tel: 020 8880 4547, fax: 020 8880 4113
email: arx@advocacyresource.net
website: www.advocacyresource.net
British Association for Counselling and Psychotherapy
BACP House, 35-37 Albert Street, Rugby CV21 2SG
tel: 0870 443 5252
email: bac@bac.co.uk
website: www.bacp.co.uk
British Association for Behavioural and Cognitive Therapy
The Globe Centre, PO Box 9, Accrington, Lancashire BB5 0XB
tel: 01254 875 277
email: babcp@babcp.com
website: www.babcp.com
Carers UK
20-25 Glasshouse Yard, London EC1A 4JT
tel: 020 7490 88178 (general), 0808 808 7777 (CarersLine)
email: info@carersuk.org
website: www.carersuk.org
Citizens Advice
(formerly known as National Association of Citizens' Advice Bureaux)
Myddleton House, 115-123 Pentonville Road, London N1 9LZ
tel: 020 7833 2181
website: www.citizensadvice.org.uk
Citizens Advice Cymru (Mid West Wales)
Unit 16A, Science Park, Llanbadarn Fawr, Aberystwyth, Ceredigion SY23 3AH
tel: 01970 625 377
Citizens Advice Cymru (South Wales)
Ground Floor, Quebec House, Castlebridge, 5-19 Cowbridge Road East, Cardiff CF11 9AB
tel: 029 2037 6750
The Commission for Patient and Public Involvement in Health
The Help Desk, 7th Floor, 120 Edmund Street
Birmingham B3 2ES
tel: 0845 120 7111, fax: 0121 222 4511
email: enquiries@cppih.org
website: www.cppih.org
Counsellors and Psychotherapists in Primary Care
Queensway House, Queensway, Bognor Regis, West Sussex PO21 1QT
tel: 01243 870 701, fax: 01243 870 702
email: cpc@cpc-online.co.uk
Department of Health
PO Box 777, London SE1 6XH
tel: 08701 555 455
web: www.dh.gov.uk
Healthcare Commission
London (Head Office), Finsbury Park, 103-105 Bunhill Road, London EC1Y 8TG
tel: 020 7448 9200
email: feedback@healthcarecommission.org.uk
website: www.healthcarecommission.org.uk
The Law Society
113 Chancery Lane, London WC2A 1PL
tel: 020 7242 1222
email: info.services@lawsociety.org.uk
website: www.lawsociety.org.uk
Mental Health Act Commission
Maid Marian House, 56 Hounds Gate, Nottingham NG1 6BG
tel: 0115 943 7100
email: chief.executive@ms.mhac.trent.nhs.uk
website: www.mhac.org.uk
The National Council for Voluntary Organisations
Regents Wharf, 8 All Saints Street, London N1 9RL
tel: 020 7713 6161
email: ncvo@ncvo-vol.org.uk
website: www.ncvo-vol.org.uk
Survivors Speak Out
44 Seldon House, Stewarts Road, London SW8 4DP
tel: 020 7622 5738 (24 hours)
A nationwide organisation of survivors of the psychiatric system campaigning for change.
United Kingdom Council for Psychotherapy
167-169 Great Portland Street, London W1N 5FB
tel: 020 7436 3002
email: ukcp@psychotherapy.org.uk
website: www.psychotherapy.org.uk
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