North East London NHS
Designed and printed by Visualize 020 8527 6225
Dr Heather Shearer (North East London Mental Health Trust), Kirsty
MacLean Steel and Lucy Calas-Prolingheur (East London and The City
Mental Health Trust) developed this glossary. We would like to thank
everyone who contributed to its production.
This glossary can be used and replicated for non-profit making purposes as
long as appropriate acknowledgement is made to North East London Mental
Health Trust and East London and The City Mental Health Trust.
This glossary is for reference and education only and is not intended to be a
substitute for independent research and judgement. Clinicians may find it
useful to help explain terms to service users however it should not replace
essential communication between clinician and service user.
This glossary is not designed to be a definitive guide and neither East London
and The City Mental Health NHS Trust nor North East London Mental Health
NHS Trust accepts responsibility or liability arising from any outdated
information or from any error in, or omission from, the glossary. We would be
grateful if readers who notice any omissions or errors could contact us. North East London Mental Health NHS Trust
A&E (Accident & Emergency) liaison
A service within A&E departments for mental healthassessments and referral to specialist services.
ADHD(see Attention deficit hyperactivity disorder)
An assessment by an external agency of an individual ororganisation against defined criteria. For example,services providing ECT (see definition) must meet thestandards set by the Royal College of Psychiatrists. If thestandards are met satisfactorily the service is accreditedby the Royal College of Psychiatrists.
An acute illness is one that occurs quickly, is intense orsevere and lasts a relatively short period of time.
The point at which a person begins an episode of care(see definition), e.g. arriving at an inpatient ward.
There are various types of advance statement/directive. They can include statements of an individual’s wishes incertain circumstances, for example instructions to
refuse some or all medical treatment or requests for
certain types of treatment.They can also state
someone to be consulted at the time a decision needs
These are therapies that are not part of current
to be made.The individual should seek advice about
standard medical practice (for example acupuncture,
the legal status of these statements/directives.They
reflexology or aromatherapy).Therapies are termed as
complementary when used in addition to conventionaltreatments and as alternative when used instead of
An advocate is a person who can support a serviceuser or carer through their contact with health services.
Advocates will attend meetings with patients and help
service users or carers to express concerns or wishesto health care professionals. Although many people canact as an advocate (friend, relative, member of staff)
there are advocacy services available that can be
This is an illness that is characterised by a refusal to eat,
accessed through the Trust.These advocates are trained
an avoidance of eating or a careful and low intake of
food.The person can become malnourished to thepoint of starvation.Their perception of their own body
size may become distorted and they will continue to
Affective disorders are also known as mood disorders.
They are marked by changes in affect (mood/emotion). The term may be used to describe depression, bipolar
disorder and mania (see definitions).
Antidepressants aim to treat the symptoms ofdepression and can help people experiencing
depression to feel more motivated and energetic.This
This is the support or care that a person can expect to
group of medication may also be used to treat
receive once discharged from inpatient care.Typically a
obsessive-compulsive disorder, anxiety and eating
disorders.There are different types of antidepressants
multidisciplinary team with the service user which will
including tricyclic and selective serotonin reuptake
make clear what care and support will be provided.
Anti psychotic medication is normally given to treat the
Agoraphobia is defined as a fear of open spaces. It also
symptoms of schizophrenia and, in some cases, manic
includes related fears such as fear of entering shops,
depression and manias.The two main types of
fear of crowds and public places, or of travelling alone.
antipsychotics are called typical and atypical (see
A person may feel an intense fear of being caught or
definitions).The main difference between the two
trapped in a situation when they can’t get help. It is
often associated with panic attacks.
This is the term used to describe experiences such as
Aromatherapy involves the use of therapeutic oils
chronic fear, tension and panic attacks. Some people
derived from plants to stimulate the body’s nerves to
have an overwhelming feeling of dread that prevents
help a person feel either more relaxed or energised. It
them getting on with everyday life. Sleepless nights and
is often used with massage or in the bath.Various oils
recurring thoughts are common, as well as nausea,
are available and are divided into different fragrance
palpitations, dizziness and difficulty in breathing. Anxiety
families: relax, body, energy, mind and soul.
is the most common mental health problem peopleexperience.
Art therapy aims to support people’s recovery using
art as a creative process and as a therapy to help
These are disorders that involve a continuous state of
people resolve emotional conflicts, be more aware
anxiety or fear, lasting at least a month, marked by
about themselves, develop social skills, reduce anxiety
constant apprehension, difficulties in concentration and
a pounding heart. Physical symptoms may also bepresent, such as headaches, sweating, irritability, and
nausea. Anxiety disorders include panic disorder and
obsessive-compulsive disorder. Depression is commonin those with anxiety disorders.
Assertive outreach services aim to support people inthe community who find it difficult keeping in contact
When in a clinical situation, the expected benefits (e.g.
improved symptoms) of care outweigh the expectednegative effects (e.g. drug side effects) to such anextent that the treatment is worth carrying out.
Assessment happens when a person first comes into
contact with health services. Information is collected inorder to identify the person’s needs and plan
Approved Social Workers (ASW) have specialist training
and experience in identifying disorders of mental healthand are familiar with the problems experienced by usersof mental health services and their families.They are
employed by Local Authority Social Services and work in
hospitals and in the community as part of the
People with ADHD have three main kinds of problems:
community mental health teams.They will organise social
difficulty concentrating or paying attention, overactive
care support for people in contact with mental health
behaviour and impulsive behaviour. ADHD is a
services, such as helping with housing and getting welfare
developmental problem that usually starts in childhood.
benefits.They work closely with health professionals and,
Some people have significant problems in concentration
under the current Mental Health Act, they work with
and attention, but are not necessarily overactive or
two doctors to assess a person who may need admitting
impulsive.These people are sometimes described as
to hospital. Social workers can also act as care co-
having Attention Deficit Disorder (ADD) rather than
ordinators for people on care programmes.
This is also known as manic depression or bipolar
Atypical antipsychotic medication is a group of new
disorder. It is a disorder characterised by swings in a
antipsychotic drugs that have a different set of side
person’s mood from very very high (mania) to very
effects from the older, typical, antipsychotics. In general
they cause fewer movement disorders such as tremor,muscle stiffness and restlessness.
Bipolar Disorder(see Bipolar Affective Disorder)
The process of carrying out a clinical audit project
follows a cycle of identifying a topic, setting standards,
This is a personality style marked by unstable moods
measuring current practice against these standards,
and unsatisfactory personal relationships.They often
agreeing recommendations and implementing change.
have problems with impulsivity, substance abuse (see
This cycle is repeated to ensure change has occurred
definition) and impulsive spending.Those with BPD may
also suffer from depression, anxiety and the fear ofbeing abandoned. (see also Personality Disorder)
Autism is a lifelong developmental disorder that affects
the way a person communicates and relates to people
This is the professional body for psychologists.
around them. In the great majority of cases, autisticdisorders are present from birth or become apparentwithin the first three years of life.
People with typical autism have no interest in social
Symptoms of bulimia may include chaotic eating,
interaction, little or no language, and tend to live in their
bingeing, vomiting and abuse of laxatives.
own world. Asperger’s syndrome often applies to thosewho are more able, who have better language
development, and who have more social contact.
A senior healthcare professional in each NHS
Asperger’s syndrome may first come to notice in adult life.
organisation is responsible for safeguarding theconfidentiality of patient information.The name comes
from the Caldicott Report, which identified 16
A period of mild depression after childbirth, the baby
recommendations for the use and storage of patient-
blues tends to last a few hours or a few days and then
disappears. Not to be confused with postnataldepression (see definition).
CAMHS(see Child and adolescent mental health services)
A way of comparing a particular process and outcomes
in one organisation with another organisation. Each
This term means that a patient has the ability to
organisation can then examine and change their own
understand and retain information about their medical
processes to achieve better outcomes.
condition and their need for treatment.
A care co-ordinator is the person responsible for
making sure that a patient gets the care that they need. Patients and carers should be able to contact their care
co-ordinator (or on-call service) at any reasonable time.
Once a patient has been assessed as needing careunder the Care Programme Approach they will be toldwho their care co-ordinator is.The care co-ordinator is
likely to be community mental health nurse, social
CAMHS is a term used to refer to mental healthservices for children and adolescents. CAMHS are
usually multidisciplinary teams including psychiatrists,
A care plan is a written plan that describes the care
psychologists, nurses, social workers and others.
and support staff will give a service user. Service usersshould be fully involved in developing and agreeing the
care plan, sign it and keep a copy. (see Care
A condition that develops slowly or lasts a long time.
The Care Programme Approach is a standardised way
An alternative term for patient which emphasises the
of planning a person’s care. It is a multidisciplinary (see
professional nature of the relationship between a
definition) approach that includes the service user, and,
clinician or therapist and the patient.
where appropriate, their carer, to develop anappropriate package of care that is acceptable to healthprofessionals, social services and the service user.The
care plan and care co-ordinator are important parts of
Client-centred therapy emphasises the importance of
this. (see Care Plan and Care Co-ordinator).
empathy in healing.The therapist provides anenvironment of empathy, unconditional positive regard,
A carer is someone who looks after their relatives orfriends on an unpaid, voluntary basis often in place of
A process used to measure the quality of aspects ofcare and services and to improve that quality.
Relative frequency of different diagnoses or conditions
A person who provides advice and technical supporton the subject of clinical audit.
A reason or explanation for a problem or illness basedon analysis and/or investigation.
Clinical effectiveness focuses on ensuring that staff are
This is someone who has a Psychology Degree
providing the best and most effective care for people
together with clinical training in psychology.They are
using health services.This is done using a variety of
trained in research, assessment and the application of
methods including clinical audit and evidence-based
A team of health care professionals from different
A framework that ensures that NHS organisations
disciplines (e.g. nursing, psychiatry, occupational
monitor and improve the quality of services provided
and that they are accountable for the care theyprovide.This is monitored by the Commission for
Health Improvement (see definition).
A person who provides direct care to a patient such asa doctor, nurse, therapist, pharmacist, psychologist etc.
Clinical guidelines/clinical practiceguidelines
Systematically developed statements, based on scientific
research, which assist in decision-making aboutappropriate healthcare for specific clinical conditions.
This is an approach to treatment that involves working
with people to help them change their emotions,
Information about diagnoses, treatments and their
thoughts and behaviour. A person’s personal beliefs are
addressed in order to understand and changebehaviour.
A scheme for assessing a Trust’s arrangements to
This is the professional body that represents
minimise clinical risk for service users and staff.Trusts
occupational therapists and produces guidance.
need to pay ‘insurance’ which can offset the costs oflegal claims against the Trust. Achieving CNST Levels (1,
2 or 3) is shows the Trust’s success in minimising clinical
The presence of two or more disorders at the same
risk and reduces the premium that the Trust must pay.
time. For example, a person with depression may alsohave co-morbid obsessive compulsive disorder.
Different ways of describing and/or prescribing a ‘plan’for providing a particular health service.
A multidisciplinary team offering specialist assessment,
The Commission for Healthcare Audit and Inspection
treatment and care to people in their own homes and
(CHAI) is a new body that will exist from April 2004. It
is being set up to help to improve the quality ofhealthcare by ensuring an independent assessment ofthe standards of services provided to patients, whether
it is provided by the NHS or privately. By routinely
CPNs are registered nurses who work with people in
publishing information, it will also allow the public to
the community.They work as part of a team and, like
assess how well tax-payers’ money is being spent in
other members of the team, may see people in a
delivering healthcare. CHAI will take on the functions of
variety of settings such as at a GP surgery, in a clinic or
CHI (see definition) and other inspection bodies.
health centre or in a client’s own home.They workclosely with GPs (see General Practitioner definition)
and other health professionals.They provide practical
advice, ongoing support with problems, supervisemedication, give injections and help with counselling.
An independent body set up to monitor clinical
They also work out care plans with other members of
governance in NHS organisations. (see Clinical
Governance).This body will be replaced by theCommission for Audit and Inspection in Healthcare(CHAI see definition) from April 2004.
These are therapeutic practices or techniques that are
not currently considered an integral part ofconventional medical practice.Therapies are termed as
Primary Care Trusts are responsible for buying
complementary when used in addition to conventional
(commissioning) specialist mental health services on
treatments and as alternative when used instead of
behalf of the people living in the district.They have an
conventional treatment. (see also Alternative therapies)
allocation of money and decide which services tocommission.The service provider is chosen and giventhe money to make sure the service is delivered
according to the contract. Services may be
This is a combination of medical needs (e.g. diagnosis,
commissioned from the NHS or the voluntary or
treatment and rehabilitation) and social needs (e.g.
housing, social care and independent living).
Community Care aims to provide health and social care
This term means that written standards are met. It is
services in the community to enable people to live as
also used to refer to service users following agreed
independently as possible in their own homes or in
care plans (including taking prescribed medication).
other accommodation in the community.
This may occur when people experience loneliness or
The way that an organisation checks that its policies are
distress and use food for comfort. Food may make
being carried out.This includes internal and external
them happier on a temporary basis but as food
audit for financial matters, employment policies and all
increasingly dominates a person’s life, he or she
areas in which the organisation interacts with the
becomes more unhappy, finds it more difficult to
exercise real control and, gaining more weight, puts hisor her own health at greater risk.
The CORE Outcome Measure is one way to find out if
an intervention has been successful. It includes both the
Where a restricted patient under the Mental Health
service user’s and the clinician’s assessment of the
Act is discharged subject to specific conditions and
liable to be recalled by the Home Secretary.
Counselling is a talking therapy that usually deals with a
This is a persistent pattern of behaviour that involves
recent distressing event.The length of time that
violation of the rights of others. Verbal and physical
counselling is needed varies from person to person.
aggression are central features of conduct disorder.
The Court of Protection has several roles in looking
If you are an informal patient, you have the right to
after the financial affairs of people who cannot legally
refuse any treatment you do not wish.You have a right
do it themselves.These include making Enduring Powers
to receive full information about the treatment, its
of Attorney (see definition), making wills, and generally
purpose and possible side effects. If consent is not
giving directions and orders for the management of the
obtained the treatment cannot normally be given.
A Consultant Psychiatrist is a trained mental healthdoctor with additional specialist training in psychiatry. The consultant is medically responsible for the care of
people receiving mental health services and also
A crisis resolution team aims to respond to people in
A situation in which medication should not be used. For
crisis. It aims to provide an assessment and treatment
example because of a physical condition, other
service, 24 hours a day, wherever people are.
Where a person injures or harms himself or herself
Depression is one of the most common forms of
intentionally. Common forms are self-poisoning or cutting.
mental health problem and can occur to people of allages. Symptoms include feelings of despair, hopelessnessand worthlessness, an inability to cope, sleep problems
and sometimes thoughts of suicide. Often people with
A condition including severe confusion, disorganized
depression will complain of physical problems (e.g for
thinking, disorientation and restlessness. Delirium may
example headaches, stomach problems) rather than
be caused by physical agents such as infections, toxic
depression when consulting their GP. Various
substances, metabolic disorders or strokes. Delirium
treatments are available for depression including
Tremens, “the trembling delirium” is a type of delirium
antidepressant medication, talking treatments such as
that affects people on alcohol withdrawal after a long
CBT (see definition), or counselling (see definition).
period of heavy drinking. Its main symptoms areuncontrollable trembling along with the symptoms
Identifying an illness or problem by its symptoms andsigns.
This is a manual that classifies mental health problems
Dementia is characterised by confusion, memory loss,
and is used to diagnose people’s mental health
poor problem-solving and poor concentration.There
problems.The American Psychiatric Association
are many diseases that lead to dementia, the most
common being Alzheimer’s disease, Dementia usuallyoccurs in older people. Dementia in people under 65 isknown as early onset dementia.
Dementia with Lewy bodies (DLB) is a rarer form of
Services in NHS organisations are usually grouped into
dementia that shares characteristics with both
directorates. Medical services (e.g. psychiatry) are
Alzheimer’s and Parkinson’s diseases.Vascular dementia
grouped into the Medical Directorate. Nursing staff and
occurs when cells in the brain are deprived of oxygen.
services make up the Nursing Directorate.The way in
Many symptoms are the same as other forms of
which directorates are organised changes from Trust to
dementia, however there are some differences.
Dependence refers to when a person is reliant on a
The point at which a person formally leaves services.
substance or person to help them function on a day-
On discharge from hospital the multidisciplinary team
to-day level. It can also be used to refer to a person
and the service user will develop a care plan. (see Care
who has become reliant on a medication to function in
on food. Most people who suffer from eating disorders
are women although men can also suffer from them.
This is a disorder in which normal consciousness oridentity is split or altered, often as a result of an intense
A specific, set amount of medication administered.
How well something works.This term is used to referto treatments in particular.
Drama therapy aims to help a person use drama aspart of their recovery process. It can give a person an
opportunity for reflection and to tell their story to help
In ECT a small, carefully controlled amount of electricity
solve a problem and achieve a relief of strong
is sent through the brain of a person who has been
given an anaesthetic and muscle relaxant. This producesa mild seizure or convulsion. It is used for cases ofsevere mental illness, usually depression, where the
patient has not responded to other treatments or
Dual diagnosis refers to two or more disorders
medication.The Department of Health has issued strict
affecting one person. For example, mental illness and
guidelines on the use of this therapy.
learning disability. It is also used to indicate that aperson who has been diagnosed with a mental healthproblem also misuses substances, such as illegal drugs,
The powers to detain a person for an initial assessmentto determine whether the use of compulsory powers isappropriate. For example a Section 136 or a Section 5(2).
Early intervention services provide support andtreatment in the community for young people with
psychosis and their families.The aim is to reduce the
An Enduring Power of Attorney (EPA) is a legal
period of untreated psychosis, which in turn, evidence
document that enables someone to appoint one or
shows, is likely to lessen future problems and improve
more persons to manage their financial affairs and
the person’s health and well being in the long term.
property, either now or in the future.
Examples of eating disorders are anorexia nervosa,
The period when a service user enters the care of the
bulimia and compulsive eating.They are often an
Trust to when they are discharged from all services
expression of deep emotional difficulties and low self-
provided by the Trust.This care could be, for example a
esteem. Depression, disturbed sleep patterns,
combination of care provided by inpatient stays,
restlessness and disturbance of bodily functions are
outpatient attendances, a CPN, or use of services from
some of the effects of eating disorders. People who
have an eating disorder find their lives become centred
Judging the value of something by making a comparison.
This is a person who has been detained in hospitalunder the Mental Health Act (1983).
This can be known as evidence-based healthcare,evidence-based medicine or evidence-based practice. It
A recommendation of good practice usually based on
involves using available evidence, particularly research,
to plan how to treat specific conditions.The processaims to find a comfortable compromise between the
evidence, clinicians’ views and experiences and service
A family doctor, usually patients’ first point of contact
A decision about management based primarily on
They are disorders of perception or a perception
evidence from scientific literature.
without a stimulus.There are various different types ofhallucinations including; auditory (hearing sounds or
voices), olfactory (smells), tactile (sensation), visual
Exposure therapy is a form of cognitive behavioural
(seeing things) or gustatory (taste).The most common
therapy used to help people who have experienced
are hearing voices or seeing things that don’t really
traumas. It uses careful, repeated and detailed experience
exist. Hallucinations are common psychotic disorders.
of the real or imagined trauma in a safe and supportive
Hallucinations may also occur after illegal drug use and
environment to help the person face and gain control of
some prescribed drugs (e.g. steroids).
the fear and distress that was overwhelming.
(can also be referred to as Health Care Support Workers)
Health Care Assistants are non-qualified nursing staffwho undertake assigned tasks involving direct care in
EMDR is a relatively new treatment to help people deal
support of a registered/qualified nurse.There are two
with trauma. It involves elements of exposure therapy
grades of Health Care Assistants, A and B grade. A
(see definition) and cognitive behavioural therapy (see
grades would expect to be more closely supervised,
definition), combined with other techniques.
while B grades may regularly work without supervisionfor all or most of their shift, or lead an A grade).
This form of therapy involves all relevant members of a
family, placing importance on the family as a pathway
toward helping to treat the patient.
HoNOS is probably the outcome measure most widelyused by English mental health services.The scales arecompleted after routine clinical assessments in anysetting and have a variety of uses for clinicians,
researchers and administrators.They are designed to be
used before and after interventions so that changes
This is a less severe form of mania (see mania) that
attributable to the interventions (outcomes) can be
may or may not require hospital treatment. Hypomania
is usually a symptom of bipolar disorder (see definition). It may also result from illicit drug use.
A team usually consisting of a psychiatrist, nurse and
social worker.The team provides a mobile service
It is a psychosomatic (see definition) disorder caused by
offering availability 24 hours, seven days a week and an
a powerful psychological disturbance or need. Someone
immediate response.The team provides a gate keeping
with it is usually completely unaware of the
function to hospital admission and enables earlier
psychological basis of the problem. It is often impossible
to convince the person that there is no physical basisfor the upset, even after many investigations have ruled
out the possibility of a physical cause.This is called
(see Health of the Nation Outcome Scales)
denial.The strength of the denial in hysteria shows theenormous power of the subconscious mind. Hysteria isoften a defence mechanism of the mind to protect it
against the effects of some traumatic and unpleasant
This is a department found in most organisations that
works to recruit staff, assist in their development (e.g. providing training) and ensure that staff work in good
ICD-10 (International Classification of Disorders)
The ICD is a form of classifying mental health problemsand assists clinicians in diagnosing problems.The
number 10 represents the 10th edition of the book.
Huntingtons Disease is a genetically inherited conditionthat causes both physical and mental problems. It also
features alternating periods of aggression, anger,
(see Information Management and Technology)
excitement and depression, and progressive loss ofmemory and personality (Dementia).These psychiatricdisturbances may appear before the movement
disorder or may develop later. Bizarre behaviour alone
Incapacity means that a patient does not have the
may be the first sign of the disease.
ability to understand and retain information about theirmedical condition and their need for treatment.
Hyperactivity is marked by high levels of activity and
restlessness. It can be treated by medication or diet.
An informal patient is a person in hospital voluntarily. Most people admitted to hospital are informal patients.
A temporary health or social care professional.Thisperson does not have a permanent contract with the
This refers to the use of information held by the Trust,
in particular computerised information.
These are impairments in a specific mental process that
The responsibility of professionals across agencies to
affects learning.The conditions can exist to varying
share relevant information to ensure that everyone
involved in a person’s care is informed.
Local Implementation Teams bring together a wide
Integrated Care Pathways are a multi-disciplinary and
group of stakeholders (see definition) in mental health,
multi-agency approach to mapping patients’ care from
including service users and carers, to plan and oversee
admission through to discharge and ongoing care.The
the development of mental health services in their local
aim is pull together all the information into one file that
area. In the future they will work closely with primary
will make it easier for the clinicians involved to give the
care, which is responsible for commissioning mental
This refers to work or care that links across
Mania is characterised by a person feeling overexcited,
professional boundaries. For example, when doctors
elated, physically overactive and rapidly changing their
and nurses work together to provide care.
ideas (scattered or tangential thoughts). It is a symptomof bipolar disorder (manic depression).
Manic depression(see Bipolar Affective Disorder)
This is a problem that usually occurs in people who
have had severe, long-term alcohol abuse problems. It is
The Mental Health Act (1983) is a law that allows the
characterised by marked short-term memory loss.
compulsory detention of people in hospital forassessment and/or treatment for mental disorder.
People who are detained under the mental health act
Mental Health Trusts provide services to several localities.
must show signs of mental disorder and need
Localities are areas that have distinct boundaries.
assessment and/or treatment because they are a risk tothemselves or a risk to others. People who aredetained have rights to appeal against their detention.
Observing activity in relation to defined specifications,
The Mental Health Commission (MHAC) has a legal
standards or targets, directly or through reports or
responsibility under the Mental Health Act (MHA) to
indicators – did what was intended happen? For
protect the interests of all patients detained under the
example, monitoring the effects of antidepressants to
For the purposes of the Mental Health Act (see
Multidisciplinary denotes an approach to care that
definition) Trusts are defined as Mental Health Act
involves more than one discipline.Typically this will
Hospital Managers. In practice, these are usually non-
mean that doctors, nurses, psychologists and
executive directors and/or lay people appointed by the
occupational therapists are involved.
Trust to carry out the Trust’s responsibilities under theMental Health Act.
This form of therapy uses music and therapeutic
approaches to help people attain goals.These goals can
This is an independent panel of people. A detained
be mental, physical, emotional, social and/or spiritual.
person can appeal against their detention to this panel. The panel can discharge the detained person or make
other recommendations. It is possible to appeal to High
This is a ward nurse who will have a special
Courts against Mental Health Review Tribunal decisions.
responsibility for a patient while they are in hospital.
This has been developed to collect person-centred
A broad statement of principle about what constitutes
information and record packages of care received by an
individual.This is collected by the Trust and submittedto the Department of Health.The data reported is
National Institute for Clinical Excellence
It provides clinical staff and the public in England andWales with guidance on current treatments. It co-
Mind is a leading mental health charity in England and
ordinates the National Collaborating Centres from
Wales. It works to create a better life for everyone
whom it commissions the development of clinical
MRCPsych is the entrance exam to the Royal Collegeof Psychiatrists and must be passed before a doctor canbecome a Consultant Psychiatrist.
have lived together for six months. A same-sex partner
could only become the nearest relative if they had lived
National Service Frameworks are issued by the
government and provide guidance and standards forhealth services to be to working towards.There is an
NSF dedicated to mental health that set standards
(see National Institute for Clinical Excellence)
around mental health promotion, treatment and serviceuser involvement.There is also an NSF for OlderPeople that has a section on mental health for older
people.This term should not to be confused with the
A person who is appointed to represent a patient in
National Schizophrenia Fellowship, which is now called
discussions in matters related to their care.
A Non-executive Director is a member of the Trust
Board.They act as a two way representative.They bringthe experiences, views and wishes of the community
and patients to the Trust Board.They also represent the
These are psychotic symptoms characterised by a lack
interests of the NHS organisation to the Community
of expected behaviour, such as lack of energy, emotion,movement or motivation.
Neurosis is used to describe anxiety disorders such as
OCD is a problem characterised by obsessive thoughtsand compulsive behaviour.The behaviour can take
various forms such as cleaning or checking rituals in
The term next of kin is widely used, but there is no
which the person will repeatedly clean themselves or
statutory definition. In practice the general rule has
their house or check, for example, that doors are
been to recognise spouses and blood relatives as next
locked and/or electrical sockets are turned off.
of kin.The Mental Health Act 1983 defines a list of
Dermatological problems are common in people who
certain people who can be treated as the ‘nearest
repeatedly wash their hands. People with OCD can be
treated using cognitive behavioural treatment and/or
A ‘nearest relative’ has a number of important powers
and functions, including the right to discharge a patientwho has been formally detained in hospital, make an
application for a person to be admitted for assessment,
Occupational therapists use purposeful activities to treat
treatment or guardianship and also to object to
people with physical and/or mental health problems.
applications for treatment or guardianship being made
They work as part of a team to identify problems caused
by a social worker. Only certain categories of people
by people’s conditions and find ways of coping with these
can become a ‘nearest relative’. First in the list are
to encourage independence and a better quality of life.
spouses, and then unmarried heterosexual couples who
Occupational therapy uses goal-directed activities,
Parkinson’s Disease is more common in older people.
appropriate to a person’s age and social role, to
The disease affects the connections in the brain causing
restore, develop or maintain the ability for independent
them to malfunction.This results in movement
disorders such as tremor and stiffness.The diseaseprogresses steadily over years eventually causing severephysical and mental disability. Symptoms can be treated
A computer system used to record information about
In health services this refers to any change in a person’s
the care provided to service users.The data can only
wellbeing following a period of treatment.The expected
be accessed by authorised users. PAS will soon be
outcome will usually be an improvement in symptoms
Outcome scales and measures are standard ways ofassessing or evaluating the difference made to a
person’s wellbeing by a course of treatment. A personwill usually rate himself or herself, or be rated by a
It is common for someone with a personality disorder to
health professional, against a set of questions or
be impulsive, have high levels of sensitivity, be aggressive,
standards about their symptoms, feelings and wellbeing.
attention seeking and overly dependent on others.
This is usually done at the beginning of, and after a
However there is a lot of debate about this disorder.
period of, treatment. Any improvement or decline will
The World Health Organisation defines them as
be shown by changes in the outcome scale ratings. An
“deeply ingrained and enduring behaviour patterns,
example of an outcome scale is HONOS (see
manifesting themselves as inflexible responses to a
broad range of personal and social situations.” (see alsoBorderline Personality Disorder).
All NHS trusts are required to have a Patient Advice
A healthcare professional who ensures that medication
and Liaison Service.The service offers patients
that service users receives are safe, effective and
information, advice, quick solution of problems or
The department that supplies medicines.
A team that visits hospitals to check on cleanliness.
Power of attorney(see Enduring Power of Attorney)
This is an extremely common problem in the generalpopulation. Phobias are irrational and uncontrollablefears of an object or situation that most people can
face without anxiety.The object or situation will trigger
Primary care is the care that you will receive when you
feelings of intense panic and the sufferer will go to
first come into contact with health services about a
great lengths to avoid them. Common phobias are fear
problem.These include family health services provided
of flying, spiders and enclosed spaces.
by GPs, dentists, pharmacists, opticians, and others suchas community nurses, physiotherapists and some social
A service working closely with GPs for clients who
Policies are produced by organisations to clearly outline
cannot be effectively managed in an ordinary primary
what staff must do, and not do, in certain situations.
care setting.The team takes a key role in theorganisation and delivery of service working closelywith statutory and non-statutory agencies and
transferring patients between services as required.The
Positive symptoms refer to psychotic symptoms such as
team offers risk assessment of clients, advice and short
false beliefs and hallucinations (see definition).
to medium term psychological therapies.
Postnatal depression can occur any time in the first year
This is the organisation that looks after primary care
after having a baby and most commonly occurs within
(see definition). PCTs are commissioners (see
the first six months. Symptoms include feeling low and
unhappy most of the time, acute anxiety, irritability,sleeplessness, tiredness and a loss of enjoyment or
desire to do anything.These can be made worse byfeelings of guilt about not being able to cope or look
A procedure is a series of actions taken in a definite
after the baby. Not to be confused with baby blues (see
and established order.This can refer to a treatment plan
Post-traumatic stress disorder (PTSD) is an anxiety
A local policy or strategy that defines appropriate
disorder that develops following an unusually
threatening event. Symptoms include flashbacks,nightmares and intense distress when exposed to anobject or situation that is related to the traumaticevent.
A Psychiatric Intensive Care Unit (PICU) is a locked
Psychosis, or psychotic disorders, involves distorted
ward in a hospital where some people detained under
perceptions of reality and irrational behaviour, often
the Mental Health Act may stay. Patients are placed in
accompanied by hallucinations and delusions.
PICU because they are assessed as being a risk tothemselves or others on an open acute inpatient ward.
In some illnesses, psychological factors seem to play a
particularly important part.They can influence not only
A doctor who specialises in the diagnosis and
the cause of the illness, but can also worsen the
treatment of people who are mentally ill. Psychiatrists
symptoms and affect the course of the disorder.These
have undergone specialist training and may diagnose
illnesses are termed psychosomatic disorders. Because
illness, prescribe medication and other forms of
psychological factors are important in every illness,
appropriate treatment.They also decide whether to
there is lack of agreement as to what should be
admit people to and discharge from hospital.
considered a psychosomatic disorder.
This is a type of therapy that focuses on unconscious
Psychotherapists help people to be in more control of
motives and conflicts.The use of dream recall and free
their own lives by exploring emotional difficulties and
associations can be used in psychoanalysis.
helping them understand themselves and theirrelationships with others.They provide consultation andintervention on a one to one basis and in groups.
This is a form of psychotherapy in which the patient
talks and the therapist makes interpretations about thepatient’s words and behaviour.
The treatment of mental health, emotional andpersonality problems through talking with a therapist. There are many different types of psychotherapy.
This is a general term for various methods of improving
the quality of services that are provided to service users.
Psychologists have skills in the assessment andtreatment of mental illness and psychological problems.
Unlike psychiatrists they are not medical doctors, theirskills include assessing cognitive functions (for example,
A type of research or experiment used to compare the
speech and thought) and providing talking interventions
effectiveness of different treatments. Patients are
including psychotherapy and counselling.
randomly assigned to groups.The groups either receivethe treatment being assessed or are a control group. The control group receive dummy (placebo)
medication. RCTs offer the most reliable form of
The management of psychiatric illness using medication
such as antidepressants or antipsychotics.
When a person with bipolar disorder experiences four
This is a professional body that represents the interests
or more mood episodes (mania, hypomania or
of nurses, and provides support in professional matters.
This is the professional body for psychiatrists as well as
This is a type of alternative or complementary therapy
the body that sets exams for those wishing to become
that uses pressure points on the feet to promote
The Society provides guidance for pharmacists (see
Improving a person’s skills through treatment and/or
training to enable them to live a more fulfilling life inthe community.
This condition displays symptoms of both schizophrenia
The ability of a data gathering tool to obtain consistentresults.
This is a psychotic disorder marked by delusions,
hallucinations, disordered thinking and speech
The consultant psychiatrist with medical responsibility
inappropriate emotions and/or lack of emotions. It is
characterised by serious disturbances of thought andperception which cannot be attributed to brain damage.
Restriction orders can be added to some sections.Theperson must have been convicted of an offence for
SAD is a form of depression linked to the seasons.
which imprisonment is a possible penalty.This order
Sufferers become depressed during autumn and winter.
means that only the Home Secretary can allowdischarge or time away from the hospital.
Secondary care is specialist care, usually provided in
hospital, after a referral from a GP or health
Identifying aspects of a service which could lead to
professional. Mental Health Services are included in
injury to a patient or staff member and/or to financial
secondary care (see also tertiary care).
This is used to refer to one of the sections of any Act
Changing aspects of a service that could lead to injury
of Parliament. A person who is detained in hospital
to a patient or staff member and/or to financial loss for
under the Mental Health Act (1983) is commonly
Doctors who are approved by the secretary of State,
This is a term used by many health organisations to
having special knowledge of mental health and who are
describe a serious incident or event which led, or may
required to be involved in assessments under the
have led, to the harm of patients or staff. Members of
staff who were not involved in the incident investigatethese and the lessons learned from each incident areused to improve care in the future.
Section 17 of the Mental Health Act (1983) makes
provision for patients who are liable to be detainedunder various sections of the act to be granted leave of
This is someone who uses health services. Other
common terms are patient, service survivor and client. Different people prefer different terms.
This section of the Mental Health Act (1983) enables a
police officer to remove a person from a public placeand take them to a designated place of safety, whichmay be a police station, a hospital, or other suitable
The Single Assessment Process (SAP) for older peoplewas introduced in the National Service Framework for
Older People.The purpose of the single assessment
process is to ensure that older people receiveappropriate, effective and timely responses to their
This is a type of antidepressant medication. An example
health and social care needs, and that professional
This is the position gained by doctors after they are
SpR grade is a recognised training grade in the
registered as a doctor by the General Medical Council.
progression of medical staff to Consultant status. It was
It is the second tier of trainee doctor (after
formally known as Senior Registrar. On completion of
preregistration house officer) in a hospital.
the Senior House Officer (SHO) rotation, and passingthe MRCPysch, the Specialist Registrar continues
training in their chosen area of psychiatry.
SEPIA is a computer package that is used to keepinformation about CPA (see definition).
SSRI(see Selective Serotonin Reuptake Inhibitor)
Serious mental illness/Severe mentalillness
These are mental health problems that are seriousenough to warrant contact with mental health services.
A range of people and organisations that are affected
These are psychological treatments in which
by, or have an interest in, the services offered by an
improvement in a person’s symptoms or wellbeing is
organisation. In the case of hospital trusts, it includes
achieved by talking with a therapist or counsellor rather
patients, carers, staff, unions, voluntary organisations,
than, or as well as, taking medication.
social services, health authority, GPs, primary caregroups and trusts in England, local health groups in
When a hospital consultant decides that more specialistcare is needed. Mental Health Services are included in
A measure, specification or object to which objectsshould conform or against which others are judged. A
This is a method of determining what substances are ina person’s system by testing bodily fluids. It can detect
substances such as prescribed medication and also
This refers to the abuse or misuse of non-medical or
illegal substances such as drugs or alcohol. Dose
‘recreational’ drugs and/or alcohol. As well as physical
titration means to slowly increase the dose of a drug to
problems, some substance abuse can lead to
psychological problems, such as depression, anxiety and,in some cases, psychosis.
Tolerance refers the body’s capacity to endure levels of
medication over periods of time. It can also be used to
refer to an addict’s capacity to consume levels of eitheralcohol or illegal drugs due to repeated use orexposure
Support workers provide support for clients and their
carers under the supervision of a care coordinatorwhich has been negotiated under the care programme
TTAs are medicines supplied by pharmacy for service
approach.They can help people regain lost skills and
users going on leave from the hospital.
develop new interests to help regain confidence andself esteem.
User involvement refers to a variety of ways in whichpeople who use health services can be involved in thedevelopment, maintenance and improvement ofservices.This includes patient satisfaction questionnaires,focus groups, representation on committees,involvement in training and user-led presentations andprojects.
A data collection instrument’s ability to actuallymeasure or test what it is intended to measure or test.
This is the act of informing a relevant person in anorganisation of instances or services in which patientsare at risk.
607 14th Street, NW, Suite 800 Washington, D.C. 20005 Tel: (202) 783-6040 Fax: (202) 783-6031 Email: firstname.lastname@example.org Steven Lieberman Mr. Lieberman was born in New York City and admitted to the Bar of the State of New York in 1985 and the Bar of the District of Columbia in 1993. He is also admitted to practice before the United States Supreme Court; the United States Cour
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