Croydon Mental Health Directory - Glossary

Acknowledgements: This glossary was compiled by North East London Mental Health Trust and East London and The City Mental Health Trust - please ensure that appropriate acknowledgement is made, even if you amend or add to the content.

A&E (Accident & Emergency) liaison
A service within A&E departments for mental health assessments and referral to specialist services.

Accreditation
An assessment by an external agency of an individual or organisation against defined criteria. For example, services providing ECT (see definition) must meet the standards set by the Royal College of Psychiatrists. If the standards are met satisfactorily the service is accredited by the Royal College of Psychiatrists.

Acute
An acute illness is one that occurs quickly, is intense or severe and lasts a relatively short period of time.

ADHD
(see Attention deficit hyperactivity disorder)

Admission
The point at which a person begins an episode of care (see definition), e.g. arriving at an inpatient ward.

Advance statements/directives
There are various types of advance statement/directive. They can include statements of an individual's wishes in certain 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 to be made.The individual should seek advice about the legal status of these statements/directives.They might be called Living Wills.

Advocate
An advocate is a person who can support a service user or carer through their contact with health services. Advocates will attend meetings with patients and help service users or carers to express concerns or wishes to health care professionals. Although many people can act as an advocate (friend, relative, member of staff) there are advocacy services available that can be accessed through the Trust.These advocates are trained and independent.

Affective disorder
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).

Aftercare
This is the support or care that a person can expect to receive once discharged from inpatient care.Typically a discharge plan will be developed by the multidisciplinary team with the service user which will make clear what care and support will be provided. (see Care Plan, CPA).

Agoraphobia
Agoraphobia is defined as a fear of open spaces. It also includes related fears such as fear of entering shops, fear of crowds and public places, or of travelling alone. A person may feel an intense fear of being caught or trapped in a situation when they can't get help. It is often associated with panic attacks.

Alternative therapies
(see also Complementary therapies) These are therapies that are not part of current standard medical practice (for example acupuncture, reflexology or aromatherapy). Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment.

Alzheimer's Disease (See Dementia)

Anorexia nervosa
This is an illness that is characterised by a refusal to eat, an avoidance of eating or a careful and low intake of food.The person can become malnourished to the point of starvation.Their perception of their own body size may become distorted and they will continue to perceive themselves as being fat.

Antidepressants
Antidepressants aim to treat the symptoms of depression and can help people experiencing depression to feel more motivated and energetic.This group of medication may also be used to treat obsessive-compulsive disorder, anxiety and eating disorders.There are different types of antidepressants including tricyclic and selective serotonin reuptake inhibitors (SSRIs).

Antipsychotic medication
Anti psychotic medication is normally given to treat the symptoms of schizophrenia and, in some cases, manic depression and manias.The two main types of antipsychotics are called typical and atypical (see definitions).The main difference between the two groups is in their side effects.

Anxiety
This is the term used to describe experiences such as chronic fear, tension and panic attacks. Some people have an overwhelming feeling of dread that prevents them getting on with everyday life. Sleepless nights and recurring thoughts are common, as well as nausea, palpitations, dizziness and difficulty in breathing. Anxiety is the most common mental health problem people experience.

Anxiety disorders
These are disorders that involve a continuous state of anxiety or fear, lasting at least a month, marked by constant apprehension, difficulties in concentration and a pounding heart. Physical symptoms may also be present, such as headaches, sweating, irritability, and nausea. Anxiety disorders include panic disorder and obsessive-compulsive disorder. Depression is common in those with anxiety disorders.

Appropriateness of care
When in a clinical situation, the expected benefits (e.g. improved symptoms) of care outweigh the expected negative effects (e.g. drug side effects) to such an extent that the treatment is worth carrying out.

Approved Social Worker (ASW)
Approved Social Workers (ASW) have specialist training and experience in identifying disorders of mental health and are familiar with the problems experienced by users of 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 community mental health teams.They will organise social care support for people in contact with mental health services, such as helping with housing and getting welfare benefits.They work closely with health professionals and, under the current Mental Health Act, they work with two doctors to assess a person who may need admitting to hospital. Social workers can also act as care coordinators for people on care programmes.

Aromatherapy
Aromatherapy involves the use of therapeutic oils derived from plants to stimulate the body's nerves to help a person feel either more relaxed or energised. It is often used with massage or in the bath.Various oils are available and are divided into different fragrance families: relax, body, energy, mind and soul.

Art therapy
Art therapy aims to support people's recovery using art as a creative process and as a therapy to help people resolve emotional conflicts, be more aware about themselves, develop social skills, reduce anxiety and increase their self-esteem.

Asperger's Syndrome (see Autism)

Assertive Outreach
Assertive outreach services aim to support people in the community who find it difficult keeping in contact with mental health services.

Assessment
Assessment happens when a person first comes into contact with health services. Information is collected in order to identify the person's needs and plan treatment.

Attention deficit hyperactivity disorder (ADHD)
People with ADHD have three main kinds of problems: difficulty concentrating or paying attention, overactive behaviour and impulsive behaviour. ADHD is a developmental problem that usually starts in childhood. Some people have significant problems in concentration and attention, but are not necessarily overactive or impulsive.These people are sometimes described as having Attention Deficit Disorder (ADD) rather than ADHD.

Atypical antipsychotics (see also Antipsychotic medication)
Atypical antipsychotic medication is a group of new antipsychotic drugs that have a different set of side effects from the older, typical, antipsychotics. In general they cause fewer movement disorders such as tremor, muscle stiffness and restlessness.

Audit cycle
The process of carrying out a clinical audit project follows a cycle of identifying a topic, setting standards, measuring current practice against these standards, agreeing recommendations and implementing change. This cycle is repeated to ensure change has occurred and improvement is maintained.

Autism
Autism is a lifelong developmental disorder that affects the way a person communicates and relates to people around them. In the great majority of cases, autistic disorders are present from birth or become apparent within the first three years of life. People with typical autism have no interest in social interaction, little or no language, and tend to live in their own world. Asperger's syndrome often applies to those who are more able, who have better language development, and who have more social contact. Asperger's syndrome may first come to notice in adult life.

Baby Blues
A period of mild depression after childbirth, the baby blues tends to last a few hours or a few days and then disappears. Not to be confused with postnatal depression (see definition).

Benchmarking
A way of comparing a particular process and outcomes in one organisation with another organisation. Each organisation can then examine and change their own processes to achieve better outcomes.

Bipolar Affective Disorder
This is also known as manic depression or bipolar disorder. It is a disorder characterised by swings in a person's mood from very high (mania) to very low (depression).

Bipolar Disorder (see Bipolar Affective Disorder)

Borderline Personality Disorder (BPD)
This is a personality style marked by unstable moods and unsatisfactory personal relationships.They often have problems with impulsivity, substance abuse (see definition) and impulsive spending.Those with BPD may also suffer from depression, anxiety and the fear of being abandoned. (see also Personality Disorder)

British Psychological Society (BPS)
This is the professional body for psychologists.

Bulimia
Symptoms of bulimia may include chaotic eating, bingeing, vomiting and abuse of laxatives.

Caldicott Guardian
A senior healthcare professional in each NHS organisation is responsible for safeguarding the confidentiality of patient information.The name comes from the Caldicott Report, which identified 16 recommendations for the use and storage of patientidentifiable information.

CAMHS
(see Child and adolescent mental health services)

Capacity
This term means that a patient has the ability to understand and retain information about their medical condition and their need for treatment.

Care Co-ordinator
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 care under the Care Programme Approach they will be told who their care co-ordinator is.The care co-ordinator is likely to be community mental health nurse, social worker or occupational therapist.

Care plan
A care plan is a written plan that describes the care and support staff will give a service user. Service users should be fully involved in developing and agreeing the care plan, sign it and keep a copy. (see Care Programme Approach)

Care Programme Approach (CPA)
The Care Programme Approach is a standardised way of planning a person's care. It is a multidisciplinary (see definition) approach that includes the service user, and, where appropriate, their carer, to develop an appropriate package of care that is acceptable to health professionals, social services and the service user. The care plan and care co-ordinator are important parts of this. (see Care Plan and Care Co-ordinator).

Carer
A carer is someone who looks after their relatives or friends on an unpaid, voluntary basis often in place of paid care workers.

Casemix
Relative frequency of different diagnoses or conditions among patients.

Cause
A reason or explanation for a problem or illness based on analysis and/or investigation.

CBT (See Cognitive Behavioural Therapy)

CHI (See Commission for Health Improvement)

Child and Adolescent Mental Health Services (CAMHS)
CAMHS is a term used to refer to mental health services for children and adolescents. CAMHS are usually multidisciplinary teams including psychiatrists psychologists, nurses, social workers and others.

Chronic
A condition that develops slowly or lasts a long time.

Client (see also service user)
An alternative term for patient which emphasises the professional nature of the relationship between a clinician or therapist and the patient.

Client-centred therapy
Client-centred therapy emphasises the importance of empathy in healing.The therapist provides an environment of empathy, unconditional positive regard, acceptance and support.

Clinical audit
A process used to measure the quality of aspects of care and services and to improve that quality.

Clinical audit facilitator
A person who provides advice and technical support on the subject of clinical audit.

Clinical Psychologist
This is someone who has a Psychology Degree together with clinical training in psychology.They are trained in research, assessment and the application of different psychological therapies.

Clinical team
A team of health care professionals from different disciplines (e.g. nursing, psychiatry, occupational therapy).

Clinician
A person who provides direct care to a patient such as a doctor, nurse, therapist, pharmacist, psychologist etc.

CMHT
(see Community Mental Health Team)

Cognitive Behavioural Therapy (CBT)
This is an approach to treatment that involves working with people to help them change their emotions, thoughts and behaviour.A person's personal beliefs are addressed in order to understand and change behaviour.

College of Occupational Therapy (COT)
This is the professional body that represents occupational therapists and produces guidance.

Co-morbidity/ Co-morbid
The presence of two or more disorders at the same time. For example, a person with depression may also have co-morbid obsessive compulsive disorder.

Clinical effectiveness
Clinical effectiveness focuses on ensuring that staff are providing the best and most effective care for people using health services.This is done using a variety of methods including clinical audit and evidence-based practice.

Clinical governance
A framework that ensures that NHS organisations monitor and improve the quality of services provided and that they are accountable for the care they provide.This is monitored by the Commission for Health Improvement (see definition).

Clinical guidelines/clinical practice guidelines
Systematically developed statements, based on scientific research, which assist in decision-making about appropriate healthcare for specific clinical conditions.

Clinical information
Information about diagnoses, treatments and their outcomes.

Clinical Negligence Scheme for Trusts (CNST)
A scheme for assessing a Trust's arrangements to minimise clinical risk for service users and staff. Trusts need to pay 'insurance' which can offset the costs of legal claims against the Trust. Achieving CNST Levels (1, 2 or 3) shows the Trust's success in minimising clinical risk and reduces the premium that the Trust must pay.

Clinical pathways
Different ways of describing and/or prescribing a 'plan' for providing a particular health service.

Community Mental Health Team (CMHT)
A multidisciplinary team offering specialist assessment, treatment and care to people in their own homes and the community.

Community Psychiatric Nurse (CPN)
CPNs are registered nurses who work with people in the community.They work as part of a team and, like other members of the team, may see people in a variety of settings such as at a GP surgery, in a clinic or health centre or in a client's own home.They work closely with GPs (see General Practitioner definition) and other health professionals.They provide practical advice, ongoing support with problems, supervise medication, give injections and help with counselling. They also work out care plans with other members of the team, service users and carers.

Complementary therapies
These are therapeutic practices or techniques that are not currently considered an integral part of conventional medical practice.Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment. (see also Alternative therapies)

Complex needs
This is a combination of medical needs (e.g. diagnosis, treatment and rehabilitation) and social needs (e.g. housing, social care and independent living).

Compliance
This term means that written standards are met. It is also used to refer to service users following agreed care plans (including taking prescribed medication).

Commission for Audit and Inspection in Healthcare (CHAI)
The Commission for Healthcare Audit and Inspection (CHAI) help improve the quality of healthcare by ensuring an independent assessment of the standards of services provided to patients, whether it is provided by the NHS or privately. By routinely publishing information, it will also allow the public to assess how well tax-payers' money is being spent in delivering healthcare. CHAI will take on the functions of CHI (see definition) and other inspection bodies.

Commission for Health Improvement (CHI)
An independent body set up to monitor clinical governance in NHS organisations. (see Clinical Governance).This body was replaced by the Commission for Audit and Inspection in Healthcare (CHAI see definition) in April 2004.

Commissioner
Primary Care Trusts are responsible for buying (commissioning) specialist mental health services on behalf of the people living in the district.They have an allocation of money and decide which services to commission.The service provider is chosen and given the money to make sure the service is delivered according to the contract. Services may be commissioned from the NHS or the voluntary or private sector.

Community Care
Community Care aims to provide health and social care services in the community to enable people to live as independently as possible in their own homes or in other accommodation in the community.

Controls assurance
The way that an organisation checks that its policies are being carried out.This includes internal and external audit for financial matters, employment policies and all areas in which the organisation interacts with the public.

CORE
The CORE Outcome Measure is one way to find out if an intervention has been successful. It includes both the service user's and the clinician's assessment of the treatment.

Counselling
Counselling is a talking therapy that usually deals with a recent distressing event.The length of time that counselling is needed varies from person to person.

Court of Protection
The Court of Protection has several roles in looking after the financial affairs of people who cannot legally do it themselves.These include making Enduring Powers of Attorney (see definition), making wills, and generally giving directions and orders for the management of the property and financial affairs.

Compulsive eating
This may occur when people experience loneliness or distress and use food for comfort. Food may make them happier on a temporary basis but as food increasingly dominates a person's life, he or she becomes more unhappy, finds it more difficult to exercise real control and, gaining more weight, puts his or her own health at greater risk.

Conditional discharge
Where a restricted patient under the Mental Health Act is discharged subject to specific conditions and liable to be recalled by the Home Secretary.

Conduct Disorder
This is a persistent pattern of behaviour that involves violation of the rights of others. Verbal and physical aggression are central features of conduct disorder.

Consent to treatment
If you are an informal patient, you have the right to refuse any treatment you do not wish.You have a right to receive full information about the treatment, its purpose and possible side effects. If consent is not obtained the treatment cannot normally be given.

Consultant Psychiatrist
A Consultant Psychiatrist is a trained mental health doctor with additional specialist training in psychiatry. The consultant is medically responsible for the care of people receiving mental health services and also supervises junior doctors.

Contraindication
A situation in which medication should not be used. For example because of a physical condition, other medications, pregnancy.

CPA (see Care Programme Approach)

CPN (see Community Psychiatric Nurse)

Crisis Resolution Team
A crisis resolution team aims to respond to people in crisis. It aims to provide an assessment and treatment service, 24 hours a day, wherever people are.

Depression
Depression is one of the most common forms of mental health problem and can occur to people of all ages. Symptoms include feelings of despair, hopelessness and worthlessness, an inability to cope, sleep problems and sometimes thoughts of suicide. Often people with depression will complain of physical problems (e.g for example headaches, stomach problems) rather than depression when consulting their GP. Various treatments are available for depression including antidepressant medication, talking treatments such as CBT (see definition), or counselling (see definition).

Diagnosis
Identifying an illness or problem by its symptoms and signs.

Diagnostic and Statistical Manual (DSM)
This is a manual that classifies mental health problems and is used to diagnose people's mental health problems.The American Psychiatric Association publishes it.

Directorate
Services in NHS organisations are usually grouped into directorates. Medical services (e.g. psychiatry) are grouped into the Medical Directorate. Nursing staff and services make up the Nursing Directorate.The way in which directorates are organised changes from Trust to Trust.

Discharge
The point at which a person formally leaves services. On discharge from hospital the multidisciplinary team and the service user will develop a care plan. (see Care plan)

Deliberate self harm
Where a person injures or harms himself or herself intentionally. Common forms are self-poisoning or cutting.

Delirium
A condition including severe confusion, disorganized thinking, disorientation and restlessness. Delirium may be caused by physical agents such as infections, toxic substances, metabolic disorders or strokes. Delirium Tremens, "the trembling delirium" is a type of delirium that affects people on alcohol withdrawal after a long period of heavy drinking. Its main symptoms are uncontrollable trembling along with the symptoms mentioned above.

Delusion
A fixed, false belief.

Dementia
Dementia is characterised by confusion, memory loss, poor problem-solving and poor concentration.There are many diseases that lead to dementia, the most common being Alzheimer's disease. Dementia usually occurs in older people. Dementia in people under 65 is known as early onset dementia. Dementia with Lewy bodies (DLB) is a rarer form of dementia that shares characteristics with both Alzheimer's and Parkinson's diseases.Vascular dementia occurs when cells in the brain are deprived of oxygen. Many symptoms are the same as other forms of dementia, however there are some differences.

Dependence
Dependence refers to when a person is reliant on a substance or person to help them function on a day-to-day level. It can also be used to refer to a person who has become reliant on a medication to function in society.

Dissociative disorders
This is a disorder in which normal consciousness or identity is split or altered, often as a result of an intense psychological trauma.

Dose
A specific, set amount of medication administered.

Drama therapy
Drama therapy aims to help a person use drama as part of their recovery process. It can give a person an opportunity for reflection and to tell their story to help solve a problem and achieve a relief of strong suppressed emotions.

Dual diagnosis
Dual diagnosis refers to two or more disorders affecting one person. For example, mental illness and learning disability. It is also used to indicate that a person who has been diagnosed with a mental health problem also misuses substances, such as illegal drugs, legal drugs or alcohol.

Early intervention service
Early intervention services provide support and treatment in the community for young people with psychosis and their families.The aim is to reduce the period of untreated psychosis, which in turn, evidence shows, is likely to lessen future problems and improve the person's health and well being in the long term.

Eating disorders
Examples of eating disorders are anorexia nervosa, bulimia and compulsive eating.They are often an expression of deep emotional difficulties and low self esteem. Depression, disturbed sleep patterns, restlessness and disturbance of bodily functions are some of the effects of eating disorders.

ECT (see Electroconvulsive therapy)

Efficacy
How well something works.This term is used to refer to treatments in particular.

Electroconvulsive therapy (ECT)
In ECT a small, carefully controlled amount of electricity is sent through the brain of a person who has been given an anaesthetic and muscle relaxant. This produces a mild seizure or convulsion. It is used for cases of severe mental illness, usually depression, where the patient has not responded to other treatments or medication.The Department of Health has issued strict guidelines on the use of this therapy.

Emergency powers
The powers to detain a person for an initial assessment to determine whether the use of compulsory powers is appropriate. For example a Section 136 or a Section 5(2).

Enduring Power of Attorney (EPA)
An Enduring Power of Attorney (EPA) is a legal document that enables someone to appoint one or more persons to manage their financial affairs and property, either now or in the future.

Episode of care
The period when a service user enters the care of the Trust to when they are discharged from all services provided by the Trust. This care could be, for example a combination of care provided by inpatient stays, outpatient attendances, a CPN, or use of services from an OT and a day hospital.

Evaluation
Judging the value of something by making a comparison.

Evidence-based medicine/practice
This can be known as evidence-based healthcare, evidence-based medicine or evidence-based practice. It involves using available evidence, particularly research, to plan how to treat specific conditions.The process aims to find a comfortable compromise between the evidence, clinicians' views and experiences and service users' views.

Evidence-based recommendations
A decision about management based primarily on evidence from scientific literature.

Exposure therapy
Exposure therapy is a form of cognitive behavioural therapy used to help people who have experienced traumas. It uses careful, repeated and detailed experience of the real or imagined trauma in a safe and supportive environment to help the person face and gain control of the fear and distress that was overwhelming.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a relatively new treatment to help people deal with trauma. It involves elements of exposure therapy (see definition) and cognitive behavioural therapy (see definition), combined with other techniques.

Formal patient
This is a person who has been detained in hospital under the Mental Health Act (1983).

Guideline
A recommendation of good practice usually based on research evidence.

General Practitioner (GP)
A family doctor, usually patients' first point of contact with the health service.

Hallucinations
They are disorders of perception or a perception without a stimulus.There are various different types of hallucinations including; auditory (hearing sounds or voices), olfactory (smells), tactile (sensation), visual (seeing things) or gustatory (taste).The most common are hearing voices or seeing things that don't really exist. Hallucinations are common psychotic disorders. Hallucinations may also occur after illegal drug use and some prescribed drugs (e.g. steroids).

Health Care Assistants (can also be referred to as Health Care Support Workers)
Health Care Assistants are non-qualified nursing staff who undertake assigned tasks involving direct care in support of a registered/qualified nurse.There are two grades of Health Care Assistants, A and B grade. A grades would expect to be more closely supervised, while B grades may regularly work without supervision for all or most of their shift, or lead an A grade).

Health of the Nation Outcome Scales (HONOS)
HoNOS is probably the outcome measure most widely used by English mental health services.The scales are completed after routine clinical assessments in any setting and have a variety of uses for clinicians.

Home treatment team
A team usually consisting of a psychiatrist, nurse andsocial worker. The team provides a mobile serviceoffering availability 24 hours, seven days a week and animmediate response. The team provides a gate keepingfunction to hospital admission and enables earlier discharge from hospital.

HONOS (see Health of the Nation Outcome Scales)

Human resources
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 conditions.

Huntingtons Disease
Huntingtons Disease is a genetically inherited condition that causes both physical and mental problems. It also features alternating periods of aggression, anger, excitement and depression, and progressive loss of memory and personality (Dementia).These psychiatric disturbances may appear before the movement disorder or may develop later. Bizarre behaviour alone may be the first sign of the disease.

Hyperactivity
Hyperactivity is marked by high levels of activity and restlessness. It can be treated by medication or diet.

Hypomania
This is a less severe form of mania (see mania) that 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.

Hysteria
It is a psychosomatic (see definition) disorder caused by a powerful psychological disturbance or need. Someone with it is usually completely unaware of the psychological basis of the problem. It is often impossible to convince the person that there is no physical basis for the upset, even after many investigations have ruled out the possibility of a physical cause.This is called denial.The strength of the denial in hysteria shows the enormous power of the subconscious mind. Hysteria is often a defence mechanism of the mind to protect it against the effects of some traumatic and unpleasant experience.

ICD-10 (International Classification of Disorders)
The ICD is a form of classifying mental health problems and assists clinicians in diagnosing problems.The number 10 represents the 10th edition of the book.

IM&T (see Information Management and Technology)

Incapacity
Incapacity means that a patient does not have the ability to understand and retain information about their medical condition and their need for treatment.

Informal patient
An informal patient is a person in hospital voluntarily. Most people admitted to hospital are informal patients. They are designed to be used before and after interventions so that changes attributable to the interventions (outcomes) can be measured.

Information Management and Technology (IM&T)
This refers to the use of information held by the Trust, in particular computerised information.

Information sharing
The responsibility of professionals across agencies to share relevant information to ensure that everyone involved in a person's care is informed.

Integrated Care Pathway
Integrated Care Pathways are a multi-disciplinary and multi-agency approach to mapping patients' care from admission through to discharge and ongoing care.The aim is pull together all the information into one file that will make it easier for the clinicians involved to give the best care for the patient.

Interdisciplinary
This refers to work or care that links across professional boundaries. For example, when doctors and nurses work together to provide care.

Keyworker (see Named Nurse)

Korsakoff 's syndrome
This is a problem that usually occurs in people who have had severe, long-term alcohol abuse problems. It is characterised by marked short-term memory loss.

Locality
Mental Health Trusts provide services to several localities. Localities are areas that have distinct boundaries.

Locum
A temporary health or social care professional.This person does not have a permanent contract with the Trust.

Learning disabilities
These are impairments in a specific mental process that affects learning.The conditions can exist to varying degrees in different people.

Local Implementation Team (LIT)
Local Implementation Teams bring together a wide group of stakeholders (see definition) in mental health, including service users and carers, to plan and oversee the development of mental health services in their local area. In the future they will work closely with primary care, which is responsible for commissioning mental health services.

Mania
Mania is characterised by a person feeling overexcited, elated, physically overactive and rapidly changing their ideas (scattered or tangential thoughts). It is a symptom of bipolar disorder (manic depression).

Manic depression (see Bipolar Affective Disorder)

Mental Health Act (1983) (MHA)
The Mental Health Act (1983) is a law that allows the compulsory detention of people in hospital for assessment and/or treatment for mental disorder. People who are detained under the mental health act must show signs of mental disorder and need assessment and/or treatment because they are a risk to themselves or a risk to others. People who are detained have rights to appeal against their detention.

Mental Health Act Commission (MHAC)
The Mental Health Commission (MHAC) has a legal responsibility under the Mental Health Act (MHA) to protect the interests of all patients detained under the MHA in England and Wales.

Mental Health Act Hospital Managers
For the purposes of the Mental Health Act (see definition) Trusts are defined as Mental Health Act Hospital Managers. In practice, these are usually nonexecutive directors and/or lay people appointed by the Trust to carry out the Trust's responsibilities under the Mental Health Act.

Mental Health Review Tribunal
This is an independent panel of people.A detained 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 Courts against Mental Health Review Tribunal decisions.

Mental Health Minimum Data Set
This has been developed to collect person-centred information and record packages of care received by an individual.This is collected by the Trust and submitted to the Department of Health.The data reported is numbers not names.

MIND
Mind is a leading mental health charity in England and Wales. It works to create a better life for everyone with experience of mental distress.

MRCPsych
MRCPsych is the entrance exam to the Royal College of Psychiatrists and must be passed before a doctor can become a Consultant Psychiatrist.

Monitoring
Observing activity in relation to defined specifications, standards or targets, directly or through reports or indicators - did what was intended happen? For example, monitoring the effects of antidepressants to treat depression.

Multidisciplinary
Multidisciplinary denotes an approach to care that involves more than one discipline.Typically this will mean that doctors, nurses, psychologists and occupational therapists are involved.

Music therapy
This form of therapy uses music and therapeutic approaches to help people attain goals.These goals can be mental, physical, emotional, social and/or spiritual.

Named Nurse
This is a ward nurse who will have a special responsibility for a patient while they are in hospital.

National guideline
A broad statement of principle about what constitutes appropriate care.

National Institute for Clinical Excellence (NICE)
It provides clinical staff and the public in England and Wales with guidance on current treatments. It coordinates the National Collaborating Centres from whom it commissions the development of clinical practice guidelines.

National Service Frameworks (NSF)
National Service Frameworks are issued by the government and provide guidance and standards for health services to be to working towards.There is an NSF dedicated to mental health that set standards around mental health promotion, treatment and service user involvement.There is also an NSF for Older People that has a section on mental health for older people.This term should not to be confused with the National Schizophrenia Fellowship, which is now called Rethink.

Nearest Relative (see Next of Kin)

Negative symptoms
These are psychotic symptoms characterised by a lack of expected behaviour, such as lack of energy, emotion, movement or motivation.

Neurosis
Neurosis is used to describe anxiety disorders such as anxiety and phobias.

Next of Kin
The term next of kin is widely used, but there is no statutory definition. In practice the general rule has been to recognise spouses and blood relatives as next of kin.The Mental Health Act 1983 defines a list of certain people who can be treated as the 'nearest relative' of a patient. A 'nearest relative' has a number of important powers and functions, including the right to discharge a patient who has been formally detained in hospital, make an application for a person to be admitted for assessment, treatment or guardianship and also to object to applications for treatment or guardianship being made by a social worker. Only certain categories of people can become a 'nearest relative'. First in the list are spouses, and then unmarried heterosexual couples who have lived together for 6 months. A same sex partner could only become a nearest relative after a period of 5 years.

NICE (see National Institute for Clinical Excellence)

Nominated person
A person who is appointed to represent a patient in discussions in matters related to their care.

Non-executive Director
A Non-executive Director is a member of the Trust Board.They act as a two way representative.They bring the experiences, views and wishes of the community and patients to the Trust Board.They also represent the interests of the NHS organisation to the Community

NSF (see National Service Frameworks)

Obsessive-compulsive disorder (OCD)
OCD is a problem characterised by obsessive thoughts and compulsive behaviour.The behaviour can take various forms such as cleaning or checking rituals in which the person will repeatedly clean themselves or their house or check, for example, that doors are locked and/or electrical sockets are turned off. Dermatological problems are common in people who repeatedly wash their hands. People with OCD can be treated using cognitive behavioural treatment and/or antidepressants.

Occupational Therapist
Occupational therapists use purposeful activities to treat people with physical and/or mental health problems. They work as part of a team to identify problems caused by people's conditions and find ways of coping with these to encourage independence and a better quality of life.

Occupational Therapy
Occupational therapy uses goal-directed activities, appropriate to a person's age and social role, to restore, develop or maintain the ability for independent living.

OCD (see Obsessive Compulsive Disorder)

Outcome
In health services this refers to any change in a person's wellbeing following a period of treatment.The expected outcome will usually be an improvement in symptoms or the resolution of a problem.

Outcome scale/measure
Outcome scales and measures are standard ways of assessing or evaluating the difference made to a person's wellbeing by a course of treatment. A person will usually rate himself or herself, or be rated by a health professional, against a set of questions or standards about their symptoms, feelings and wellbeing. This is usually done at the beginning of, and after a period of, treatment. Any improvement or decline will be shown by changes in the outcome scale ratings. An example of an outcome scale is HONOS (see definition).

Parkinson's disease
Parkinson's Disease is more common in older people. The disease affects the connections in the brain causing them to malfunction.This results in movement disorders such as tremor and stiffness.The disease progresses steadily over years eventually causing severe physical and mental disability. Symptoms can be treated with medication.

Patient Administration System (PAS)
A computer system used to record information about the care provided to service users.The data can only be accessed by authorised users. PAS will soon be replaced by a newer system.

PCT (see Primary Care Trust)

Personality Disorders
It is common for someone with a personality disorder to be impulsive, have high levels of sensitivity, be aggressive, attention seeking and overly dependent on others. However there is a lot of debate about this disorder. The World Health Organisation defines them as "deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations." (see also Borderline Personality Disorder).

Pharmacist
A healthcare professional who ensures that medication that service users receives are safe, effective and appropriate.

Pharmacy
The department that supplies medicines.

Patient Advice and Liaison Service (PALS)
All NHS trusts are required to have a Patient Advice and Liaison Service.The service offers patients information, advice, quick solution of problems or access to the complaints procedure.

Patient Environment Action Team (PEAT)
A team that visits hospitals to check on cleanliness.

Power of attorney (see Enduring Power of Attorney)

Primary Care
Primary care is the care that you will receive when you first come into contact with health services about a problem.These include family health services provided by GPs, dentists, pharmacists, opticians, and others such as community nurses, physiotherapists and some social workers.

Primary care liaison team
A service working closely with GPs for clients who cannot be effectively managed in an ordinary primary care setting.The team takes a key role in the organisation and delivery of service working closely with statutory and non-statutory agencies and transferring patients between services as required. The team offers risk assessment of clients, advice and short to medium term psychological therapies.

Primary Care Trust (PCT)
This is the organisation that looks after primary care (see definition). PCTs are commissioners (see definition)

Procedure
A procedure is a series of actions taken in a definite and established order.This can refer to a treatment plan or to general activities.

Protocol
A local policy or strategy that defines appropriate action. (see Policy)

Phobias
This is an extremely common problem in the general population. Phobias are irrational and uncontrollable fears of an object or situation that most people can face without anxiety.The object or situation will trigger feelings of intense panic and the sufferer will go to great lengths to avoid them. Common phobias are fear of flying, spiders and enclosed spaces.

PICU (see Psychiatric Intensive Care Unit)

Policy
Policies are produced by organisations to clearly outline what staff must do, and not do, in certain situations.

Positive symptoms
Positive symptoms refer to psychotic symptoms such as false beliefs and hallucinations (see definition).

Postnatal depression
Postnatal depression can occur any time in the first year after having a baby and most commonly occurs within 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 by feelings of guilt about not being able to cope or look after the baby. Not to be confused with baby blues (see definition).

Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops following an unusually threatening event. Symptoms include flashbacks, nightmares and intense distress when exposed to an object or situation that is related to the traumatic event.

Psychiatric Intensive Care Unit (PICU)
A Psychiatric Intensive Care Unit (PICU) is a locked ward in a hospital where some people detained under the Mental Health Act may stay. Patients are placed in PICU because they are assessed as being a risk to themselves or others on an open acute inpatient ward.

Psychiatrist
A doctor who specialises in the diagnosis and treatment of people who are mentally ill. Psychiatrists have undergone specialist training and may diagnose illness, prescribe medication and other forms of appropriate treatment.They also decide whether to admit people to and discharge from hospital.

Psychoanalysis
This is a type of therapy that focuses on unconscious motives and conflicts.The use of dream recall and free associations can be used in psychoanalysis.

Psychodynamic therapy
This is a form of psychotherapy in which the patient talks and the therapist makes interpretations about the patient's words and behaviour.

Psychodrama (see Drama Therapy)

Psychologist
Psychologists have skills in the assessment and treatment of mental illness and psychological problems. Unlike psychiatrists they are not medical doctors, their skills include assessing cognitive functions (for example, speech and thought) and providing talking interventions including psychotherapy and counselling.

Psychopharmacology
The management of psychiatric illness using medication such as antidepressants or antipsychotics.

Psychosis
Psychosis, or psychotic disorders, involves distorted perceptions of reality and irrational behaviour, often accompanied by hallucinations and delusions.

Psychosomatic disorder
In some illnesses, psychological factors seem to play a particularly important part.They can influence not only the cause of the illness, but can also worsen the symptoms and affect the course of the disorder.These illnesses are termed psychosomatic disorders. Because psychological factors are important in every illness, there is lack of agreement as to what should be considered a psychosomatic disorder.

Psychotherapist
Psychotherapists help people to be in more control of their own lives by exploring emotional difficulties and helping them understand themselves and their relationships with others.They provide consultation and intervention on a one to one basis and in groups.

Psychotherapy
The treatment of mental health, emotional and personality problems through talking with a therapist. There are many different types of psychotherapy.

Quality improvement
This is a general term for various methods of improving the quality of services that are provided to service users.

Randomised controlled trial (RCT)
A type of research or experiment used to compare the effectiveness of different treatments. Patients are randomly assigned to groups.The groups either receive the treatment being assessed or are a control group. The control group receive dummy (placebo) medication. RCTs offer the most reliable form of evidence for effectiveness.

Rapid cycling
When a person with bipolar disorder experiences four or more mood episodes (mania, hypomania or depression) within a year.

Reflexology
This is a type of alternative or complementary therapy that uses pressure points on the feet to promote health and well-being.

Rehabilitation
Improving a person's skills through treatment and/or training to enable them to live a more fulfilling life in the community.

Reliability
The ability of a data gathering tool to obtain consistent results.

Responsible Medical Officer (RMO)
The consultant psychiatrist with medical responsibility for a service user.

Restriction order
Restriction orders can be added to some sections.The person must have been convicted of an offence for which imprisonment is a possible penalty. This order means that only the Home Secretary can allow discharge or time away from the hospital.

Risk assessment
Identifying aspects of a service which could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.

Risk management
Changing aspects of a service that could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.

Royal College of Nursing
This is a professional body that represents the interests of nurses, and provides support in professional matters.

Royal College of Psychiatrists (RCPsych)
This is the professional body for psychiatrists as well as the body that sets exams for those wishing to become psychiatrists.

Royal Pharmaceutical Society
The Society provides guidance for pharmacists (see definition) and pharmacy staff.

Schizoaffective Disorder
This condition displays symptoms of both schizophrenia and bipolar disorder.

Schizophrenia
This is a psychotic disorder marked by delusions, hallucinations, disordered thinking and speech,
inappropriate emotions and/or lack of emotions. It is characterised by serious disturbances of thought and perception which cannot be attributed to brain damage.

Seasonal affective disorder (SAD)
SAD is a form of depression linked to the seasons. Sufferers become depressed during autumn and winter.

Secondary care
Secondary care is specialist care, usually provided in hospital, after a referral from a GP or health professional. Mental Health Services are included in secondary care (see also tertiary care).

Section
This is used to refer to one of the sections of any Act of Parliament. A person who is detained in hospital under the Mental Health Act (1983) is commonly referred to as 'sectioned'.

Serious Untoward Incidents (SUIs)
This is a term used by many health organisations to describe a serious incident or event which led, or may have led, to the harm of patients or staff. Members of staff who were not involved in the incident investigate these and the lessons learned from each incident are used to improve care in the future.

Service user
This is someone who uses health services. Other common terms are patient, service survivor and client. Different people prefer different terms.

SHO (see Senior House Officer)

Single Assessment Process (SAP)
The Single Assessment Process (SAP) for older people was introduced in the National Service Framework for Older People.The purpose of the single assessment process is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively.

Specialist Registrar (SpR)
SpR grade is a recognised training grade in the progression of medical staff to Consultant status. It was formally known as Senior Registrar. On completion of the Senior House Officer (SHO) rotation, and passing the MRCPysch, the Specialist Registrar continues training in their chosen area of psychiatry.

SSRI (see Selective Serotonin Reuptake Inhibitor)

Section 12 Approved
Doctors who are approved by the secretary of State, having special knowledge of mental health and who are required to be involved in assessments under the Mental Health Act 1983.

Section 17
Section 17 of the Mental Health Act (1983) makes provision for patients who are liable to be detained under various sections of the act to be granted leave of absence.

Section 136
This section of the Mental Health Act (1983) enables a police officer to remove a person from a public place and take them to a designated place of safety, which may be a police station, a hospital, or other suitable place.

Selective Serotonin Reuptake Inhibitor (SSRI)
This is a type of antidepressant medication. An example is prozac (fluoxetine)

Senior House Officer (SHO)
This is the position gained by doctors after they are registered as a doctor by the General Medical Council. It is the second tier of trainee doctor (after preregistration house officer) in a hospital.

SEPIA
SEPIA is a computer package that is used to keep information about CPA (see definition).

Serious mental illness/Severe mental illness
These are mental health problems that are serious enough to warrant contact with mental health services.

Stakeholders
A range of people and organisations that are affected by, or have an interest in, the services offered by an organisation. In the case of hospital trusts, it includes patients, carers, staff, unions, voluntary organisations, social services, health authority, GPs, primary care groups and trusts in England, local health groups in Wales.

Standard
A measure, specification or object to which objects should conform or against which others are judged.A required degree of excellence.

Substance Abuse
This refers to the abuse or misuse of non-medical or 'recreational' drugs and/or alcohol. As well as physical
problems, some substance abuse can lead to psychological problems, such as depression, anxiety and, in some cases, psychosis.

Suicide
Taking one's own life.

Support Workers
Support workers provide support for clients and their carers under the supervision of a care coordinator which has been negotiated under the care programme approach.They can help people regain lost skills and develop new interests to help regain confidence and self esteem.

SUI (see Serious Untoward Incidents)

Talking treatments
These are psychological treatments in which improvement in a person's symptoms or wellbeing is achieved by talking with a therapist or counsellor rather than, or as well as, taking medication.

Tertiary Care
When a hospital consultant decides that more specialist care is needed. Mental Health Services are included in this. (see also Secondary care).

Titration
This is a method of determining what substances are in a person's system by testing bodily fluids. It can detect substances such as prescribed medication and also illegal substances such as drugs or alcohol. Dose titration means to slowly increase the dose of a drug to a level that can be maintained.

Tolerance
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 either alcohol or illegal drugs due to repeated use or exposure.

To-take-aways (TTAs)
TTAs are medicines supplied by pharmacy for service users going on leave from the hospital.

TTAs (see To-take-aways)

 

Acknowledgements: This glossary was compiled by North East London Mental Health Trust and East London and The City Mental Health Trust - please ensure that appropriate acknowledgement is made, even if you amend or add to the content.

A&E (Accident & Emergency) liaison
A service within A&E departments for mental health assessments and referral to specialist services.

Accreditation
An assessment by an external agency of an individual or organisation against defined criteria. For example, services providing ECT (see definition) must meet the standards set by the Royal College of Psychiatrists. If the standards are met satisfactorily the service is accredited by the Royal College of Psychiatrists.

Acute
An acute illness is one that occurs quickly, is intense or severe and lasts a relatively short period of time.

ADHD
(see Attention deficit hyperactivity disorder)

Admission
The point at which a person begins an episode of care (see definition), e.g. arriving at an inpatient ward.

Advance statements/directives
There are various types of advance statement/directive. They can include statements of an individual's wishes in certain 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 to be made.The individual should seek advice about the legal status of these statements/directives.They might be called Living Wills.

Advocate
An advocate is a person who can support a service user or carer through their contact with health services. Advocates will attend meetings with patients and help service users or carers to express concerns or wishes to health care professionals. Although many people can act as an advocate (friend, relative, member of staff) there are advocacy services available that can be accessed through the Trust.These advocates are trained and independent.

Affective disorder
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).

Aftercare
This is the support or care that a person can expect to receive once discharged from inpatient care.Typically a discharge plan will be developed by the multidisciplinary team with the service user which will make clear what care and support will be provided. (see Care Plan, CPA).

Agoraphobia
Agoraphobia is defined as a fear of open spaces. It also includes related fears such as fear of entering shops, fear of crowds and public places, or of travelling alone. A person may feel an intense fear of being caught or trapped in a situation when they can't get help. It is often associated with panic attacks.

Alternative therapies
(see also Complementary therapies) These are therapies that are not part of current standard medical practice (for example acupuncture, reflexology or aromatherapy). Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment.

Alzheimer's Disease (See Dementia)

Anorexia nervosa
This is an illness that is characterised by a refusal to eat, an avoidance of eating or a careful and low intake of food.The person can become malnourished to the point of starvation.Their perception of their own body size may become distorted and they will continue to perceive themselves as being fat.

Antidepressants
Antidepressants aim to treat the symptoms of depression and can help people experiencing depression to feel more motivated and energetic.This group of medication may also be used to treat obsessive-compulsive disorder, anxiety and eating disorders.There are different types of antidepressants including tricyclic and selective serotonin reuptake inhibitors (SSRIs).

Antipsychotic medication
Anti psychotic medication is normally given to treat the symptoms of schizophrenia and, in some cases, manic depression and manias.The two main types of antipsychotics are called typical and atypical (see definitions).The main difference between the two groups is in their side effects.

Anxiety
This is the term used to describe experiences such as chronic fear, tension and panic attacks. Some people have an overwhelming feeling of dread that prevents them getting on with everyday life. Sleepless nights and recurring thoughts are common, as well as nausea, palpitations, dizziness and difficulty in breathing. Anxiety is the most common mental health problem people experience.

Anxiety disorders
These are disorders that involve a continuous state of anxiety or fear, lasting at least a month, marked by constant apprehension, difficulties in concentration and a pounding heart. Physical symptoms may also be present, such as headaches, sweating, irritability, and nausea. Anxiety disorders include panic disorder and obsessive-compulsive disorder. Depression is common in those with anxiety disorders.

Appropriateness of care
When in a clinical situation, the expected benefits (e.g. improved symptoms) of care outweigh the expected negative effects (e.g. drug side effects) to such an extent that the treatment is worth carrying out.

Approved Social Worker (ASW)
Approved Social Workers (ASW) have specialist training and experience in identifying disorders of mental health and are familiar with the problems experienced by users of 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 community mental health teams.They will organise social care support for people in contact with mental health services, such as helping with housing and getting welfare benefits.They work closely with health professionals and, under the current Mental Health Act, they work with two doctors to assess a person who may need admitting to hospital. Social workers can also act as care coordinators for people on care programmes.

Aromatherapy
Aromatherapy involves the use of therapeutic oils derived from plants to stimulate the body's nerves to help a person feel either more relaxed or energised. It is often used with massage or in the bath.Various oils are available and are divided into different fragrance families: relax, body, energy, mind and soul.

Art therapy
Art therapy aims to support people's recovery using art as a creative process and as a therapy to help people resolve emotional conflicts, be more aware about themselves, develop social skills, reduce anxiety and increase their self-esteem.

Asperger's Syndrome (see Autism)

Assertive Outreach
Assertive outreach services aim to support people in the community who find it difficult keeping in contact with mental health services.

Assessment
Assessment happens when a person first comes into contact with health services. Information is collected in order to identify the person's needs and plan treatment.

Attention deficit hyperactivity disorder (ADHD)
People with ADHD have three main kinds of problems: difficulty concentrating or paying attention, overactive behaviour and impulsive behaviour. ADHD is a developmental problem that usually starts in childhood. Some people have significant problems in concentration and attention, but are not necessarily overactive or impulsive.These people are sometimes described as having Attention Deficit Disorder (ADD) rather than ADHD.

Atypical antipsychotics (see also Antipsychotic medication)
Atypical antipsychotic medication is a group of new antipsychotic drugs that have a different set of side effects from the older, typical, antipsychotics. In general they cause fewer movement disorders such as tremor, muscle stiffness and restlessness.

Audit cycle
The process of carrying out a clinical audit project follows a cycle of identifying a topic, setting standards, measuring current practice against these standards, agreeing recommendations and implementing change. This cycle is repeated to ensure change has occurred and improvement is maintained.

Autism
Autism is a lifelong developmental disorder that affects the way a person communicates and relates to people around them. In the great majority of cases, autistic disorders are present from birth or become apparent within the first three years of life. People with typical autism have no interest in social interaction, little or no language, and tend to live in their own world. Asperger's syndrome often applies to those who are more able, who have better language development, and who have more social contact. Asperger's syndrome may first come to notice in adult life.

Baby Blues
A period of mild depression after childbirth, the baby blues tends to last a few hours or a few days and then disappears. Not to be confused with postnatal depression (see definition).

Benchmarking
A way of comparing a particular process and outcomes in one organisation with another organisation. Each organisation can then examine and change their own processes to achieve better outcomes.

Bipolar Affective Disorder
This is also known as manic depression or bipolar disorder. It is a disorder characterised by swings in a person's mood from very high (mania) to very low (depression).

Bipolar Disorder (see Bipolar Affective Disorder)

Borderline Personality Disorder (BPD)
This is a personality style marked by unstable moods and unsatisfactory personal relationships.They often have problems with impulsivity, substance abuse (see definition) and impulsive spending.Those with BPD may also suffer from depression, anxiety and the fear of being abandoned. (see also Personality Disorder)

British Psychological Society (BPS)
This is the professional body for psychologists.

Bulimia
Symptoms of bulimia may include chaotic eating, bingeing, vomiting and abuse of laxatives.

Caldicott Guardian
A senior healthcare professional in each NHS organisation is responsible for safeguarding the confidentiality of patient information.The name comes from the Caldicott Report, which identified 16 recommendations for the use and storage of patientidentifiable information.

CAMHS
(see Child and adolescent mental health services)

Capacity
This term means that a patient has the ability to understand and retain information about their medical condition and their need for treatment.

Care Co-ordinator
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 care under the Care Programme Approach they will be told who their care co-ordinator is.The care co-ordinator is likely to be community mental health nurse, social worker or occupational therapist.

Care plan
A care plan is a written plan that describes the care and support staff will give a service user. Service users should be fully involved in developing and agreeing the care plan, sign it and keep a copy. (see Care Programme Approach)

Care Programme Approach (CPA)
The Care Programme Approach is a standardised way of planning a person's care. It is a multidisciplinary (see definition) approach that includes the service user, and, where appropriate, their carer, to develop an appropriate package of care that is acceptable to health professionals, social services and the service user. The care plan and care co-ordinator are important parts of this. (see Care Plan and Care Co-ordinator).

Carer
A carer is someone who looks after their relatives or friends on an unpaid, voluntary basis often in place of paid care workers.

Casemix
Relative frequency of different diagnoses or conditions among patients.

Cause
A reason or explanation for a problem or illness based on analysis and/or investigation.

CBT (See Cognitive Behavioural Therapy)

CHI (See Commission for Health Improvement)

Child and Adolescent Mental Health Services (CAMHS)
CAMHS is a term used to refer to mental health services for children and adolescents. CAMHS are usually multidisciplinary teams including psychiatrists psychologists, nurses, social workers and others.

Chronic
A condition that develops slowly or lasts a long time.

Client (see also service user)
An alternative term for patient which emphasises the professional nature of the relationship between a clinician or therapist and the patient.

Client-centred therapy
Client-centred therapy emphasises the importance of empathy in healing.The therapist provides an environment of empathy, unconditional positive regard, acceptance and support.

Clinical audit
A process used to measure the quality of aspects of care and services and to improve that quality.

Clinical audit facilitator
A person who provides advice and technical support on the subject of clinical audit.

Clinical Psychologist
This is someone who has a Psychology Degree together with clinical training in psychology.They are trained in research, assessment and the application of different psychological therapies.

Clinical team
A team of health care professionals from different disciplines (e.g. nursing, psychiatry, occupational therapy).

Clinician
A person who provides direct care to a patient such as a doctor, nurse, therapist, pharmacist, psychologist etc.

CMHT
(see Community Mental Health Team)

Cognitive Behavioural Therapy (CBT)
This is an approach to treatment that involves working with people to help them change their emotions, thoughts and behaviour.A person's personal beliefs are addressed in order to understand and change behaviour.

College of Occupational Therapy (COT)
This is the professional body that represents occupational therapists and produces guidance.

Co-morbidity/ Co-morbid
The presence of two or more disorders at the same time. For example, a person with depression may also have co-morbid obsessive compulsive disorder.

Clinical effectiveness
Clinical effectiveness focuses on ensuring that staff are providing the best and most effective care for people using health services.This is done using a variety of methods including clinical audit and evidence-based practice.

Clinical governance
A framework that ensures that NHS organisations monitor and improve the quality of services provided and that they are accountable for the care they provide.This is monitored by the Commission for Health Improvement (see definition).

Clinical guidelines/clinical practice guidelines
Systematically developed statements, based on scientific research, which assist in decision-making about appropriate healthcare for specific clinical conditions.

Clinical information
Information about diagnoses, treatments and their outcomes.

Clinical Negligence Scheme for Trusts (CNST)
A scheme for assessing a Trust's arrangements to minimise clinical risk for service users and staff. Trusts need to pay 'insurance' which can offset the costs of legal claims against the Trust. Achieving CNST Levels (1, 2 or 3) shows the Trust's success in minimising clinical risk and reduces the premium that the Trust must pay.

Clinical pathways
Different ways of describing and/or prescribing a 'plan' for providing a particular health service.

Community Mental Health Team (CMHT)
A multidisciplinary team offering specialist assessment, treatment and care to people in their own homes and the community.

Community Psychiatric Nurse (CPN)
CPNs are registered nurses who work with people in the community.They work as part of a team and, like other members of the team, may see people in a variety of settings such as at a GP surgery, in a clinic or health centre or in a client's own home.They work closely with GPs (see General Practitioner definition) and other health professionals.They provide practical advice, ongoing support with problems, supervise medication, give injections and help with counselling. They also work out care plans with other members of the team, service users and carers.

Complementary therapies
These are therapeutic practices or techniques that are not currently considered an integral part of conventional medical practice.Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment. (see also Alternative therapies)

Complex needs
This is a combination of medical needs (e.g. diagnosis, treatment and rehabilitation) and social needs (e.g. housing, social care and independent living).

Compliance
This term means that written standards are met. It is also used to refer to service users following agreed care plans (including taking prescribed medication).

Commission for Audit and Inspection in Healthcare (CHAI)
The Commission for Healthcare Audit and Inspection (CHAI) help improve the quality of healthcare by ensuring an independent assessment of the standards of services provided to patients, whether it is provided by the NHS or privately. By routinely publishing information, it will also allow the public to assess how well tax-payers' money is being spent in delivering healthcare. CHAI will take on the functions of CHI (see definition) and other inspection bodies.

Commission for Health Improvement (CHI)
An independent body set up to monitor clinical governance in NHS organisations. (see Clinical Governance).This body was replaced by the Commission for Audit and Inspection in Healthcare (CHAI see definition) in April 2004.

Commissioner
Primary Care Trusts are responsible for buying (commissioning) specialist mental health services on behalf of the people living in the district.They have an allocation of money and decide which services to commission.The service provider is chosen and given the money to make sure the service is delivered according to the contract. Services may be commissioned from the NHS or the voluntary or private sector.

Community Care
Community Care aims to provide health and social care services in the community to enable people to live as independently as possible in their own homes or in other accommodation in the community.

Controls assurance
The way that an organisation checks that its policies are being carried out.This includes internal and external audit for financial matters, employment policies and all areas in which the organisation interacts with the public.

CORE
The CORE Outcome Measure is one way to find out if an intervention has been successful. It includes both the service user's and the clinician's assessment of the treatment.

Counselling
Counselling is a talking therapy that usually deals with a recent distressing event.The length of time that counselling is needed varies from person to person.

Court of Protection
The Court of Protection has several roles in looking after the financial affairs of people who cannot legally do it themselves.These include making Enduring Powers of Attorney (see definition), making wills, and generally giving directions and orders for the management of the property and financial affairs.

Compulsive eating
This may occur when people experience loneliness or distress and use food for comfort. Food may make them happier on a temporary basis but as food increasingly dominates a person's life, he or she becomes more unhappy, finds it more difficult to exercise real control and, gaining more weight, puts his or her own health at greater risk.

Conditional discharge
Where a restricted patient under the Mental Health Act is discharged subject to specific conditions and liable to be recalled by the Home Secretary.

Conduct Disorder
This is a persistent pattern of behaviour that involves violation of the rights of others. Verbal and physical aggression are central features of conduct disorder.

Consent to treatment
If you are an informal patient, you have the right to refuse any treatment you do not wish.You have a right to receive full information about the treatment, its purpose and possible side effects. If consent is not obtained the treatment cannot normally be given.

Consultant Psychiatrist
A Consultant Psychiatrist is a trained mental health doctor with additional specialist training in psychiatry. The consultant is medically responsible for the care of people receiving mental health services and also supervises junior doctors.

Contraindication
A situation in which medication should not be used. For example because of a physical condition, other medications, pregnancy.

CPA (see Care Programme Approach)

CPN (see Community Psychiatric Nurse)

Crisis Resolution Team
A crisis resolution team aims to respond to people in crisis. It aims to provide an assessment and treatment service, 24 hours a day, wherever people are.

Depression
Depression is one of the most common forms of mental health problem and can occur to people of all ages. Symptoms include feelings of despair, hopelessness and worthlessness, an inability to cope, sleep problems and sometimes thoughts of suicide. Often people with depression will complain of physical problems (e.g for example headaches, stomach problems) rather than depression when consulting their GP. Various treatments are available for depression including antidepressant medication, talking treatments such as CBT (see definition), or counselling (see definition).

Diagnosis
Identifying an illness or problem by its symptoms and signs.

Diagnostic and Statistical Manual (DSM)
This is a manual that classifies mental health problems and is used to diagnose people's mental health problems.The American Psychiatric Association publishes it.

Directorate
Services in NHS organisations are usually grouped into directorates. Medical services (e.g. psychiatry) are grouped into the Medical Directorate. Nursing staff and services make up the Nursing Directorate.The way in which directorates are organised changes from Trust to Trust.

Discharge
The point at which a person formally leaves services. On discharge from hospital the multidisciplinary team and the service user will develop a care plan. (see Care plan)

Deliberate self harm
Where a person injures or harms himself or herself intentionally. Common forms are self-poisoning or cutting.

Delirium
A condition including severe confusion, disorganized thinking, disorientation and restlessness. Delirium may be caused by physical agents such as infections, toxic substances, metabolic disorders or strokes. Delirium Tremens, "the trembling delirium" is a type of delirium that affects people on alcohol withdrawal after a long period of heavy drinking. Its main symptoms are uncontrollable trembling along with the symptoms mentioned above.

Delusion
A fixed, false belief.

Dementia
Dementia is characterised by confusion, memory loss, poor problem-solving and poor concentration.There are many diseases that lead to dementia, the most common being Alzheimer's disease. Dementia usually occurs in older people. Dementia in people under 65 is known as early onset dementia. Dementia with Lewy bodies (DLB) is a rarer form of dementia that shares characteristics with both Alzheimer's and Parkinson's diseases.Vascular dementia occurs when cells in the brain are deprived of oxygen. Many symptoms are the same as other forms of dementia, however there are some differences.

Dependence
Dependence refers to when a person is reliant on a substance or person to help them function on a day-to-day level. It can also be used to refer to a person who has become reliant on a medication to function in society.

Dissociative disorders
This is a disorder in which normal consciousness or identity is split or altered, often as a result of an intense psychological trauma.

Dose
A specific, set amount of medication administered.

Drama therapy
Drama therapy aims to help a person use drama as part of their recovery process. It can give a person an opportunity for reflection and to tell their story to help solve a problem and achieve a relief of strong suppressed emotions.

Dual diagnosis
Dual diagnosis refers to two or more disorders affecting one person. For example, mental illness and learning disability. It is also used to indicate that a person who has been diagnosed with a mental health problem also misuses substances, such as illegal drugs, legal drugs or alcohol.

Early intervention service
Early intervention services provide support and treatment in the community for young people with psychosis and their families.The aim is to reduce the period of untreated psychosis, which in turn, evidence shows, is likely to lessen future problems and improve the person's health and well being in the long term.

Eating disorders
Examples of eating disorders are anorexia nervosa, bulimia and compulsive eating.They are often an expression of deep emotional difficulties and low self esteem. Depression, disturbed sleep patterns, restlessness and disturbance of bodily functions are some of the effects of eating disorders.

ECT (see Electroconvulsive therapy)

Efficacy
How well something works.This term is used to refer to treatments in particular.

Electroconvulsive therapy (ECT)
In ECT a small, carefully controlled amount of electricity is sent through the brain of a person who has been given an anaesthetic and muscle relaxant. This produces a mild seizure or convulsion. It is used for cases of severe mental illness, usually depression, where the patient has not responded to other treatments or medication.The Department of Health has issued strict guidelines on the use of this therapy.

Emergency powers
The powers to detain a person for an initial assessment to determine whether the use of compulsory powers is appropriate. For example a Section 136 or a Section 5(2).

Enduring Power of Attorney (EPA)
An Enduring Power of Attorney (EPA) is a legal document that enables someone to appoint one or more persons to manage their financial affairs and property, either now or in the future.

Episode of care
The period when a service user enters the care of the Trust to when they are discharged from all services provided by the Trust. This care could be, for example a combination of care provided by inpatient stays, outpatient attendances, a CPN, or use of services from an OT and a day hospital.

Evaluation
Judging the value of something by making a comparison.

Evidence-based medicine/practice
This can be known as evidence-based healthcare, evidence-based medicine or evidence-based practice. It involves using available evidence, particularly research, to plan how to treat specific conditions.The process aims to find a comfortable compromise between the evidence, clinicians' views and experiences and service users' views.

Evidence-based recommendations
A decision about management based primarily on evidence from scientific literature.

Exposure therapy
Exposure therapy is a form of cognitive behavioural therapy used to help people who have experienced traumas. It uses careful, repeated and detailed experience of the real or imagined trauma in a safe and supportive environment to help the person face and gain control of the fear and distress that was overwhelming.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a relatively new treatment to help people deal with trauma. It involves elements of exposure therapy (see definition) and cognitive behavioural therapy (see definition), combined with other techniques.

Formal patient
This is a person who has been detained in hospital under the Mental Health Act (1983).

Guideline
A recommendation of good practice usually based on research evidence.

General Practitioner (GP)
A family doctor, usually patients' first point of contact with the health service.

Hallucinations
They are disorders of perception or a perception without a stimulus.There are various different types of hallucinations including; auditory (hearing sounds or voices), olfactory (smells), tactile (sensation), visual (seeing things) or gustatory (taste).The most common are hearing voices or seeing things that don't really exist. Hallucinations are common psychotic disorders. Hallucinations may also occur after illegal drug use and some prescribed drugs (e.g. steroids).

Health Care Assistants (can also be referred to as Health Care Support Workers)
Health Care Assistants are non-qualified nursing staff who undertake assigned tasks involving direct care in support of a registered/qualified nurse.There are two grades of Health Care Assistants, A and B grade. A grades would expect to be more closely supervised, while B grades may regularly work without supervision for all or most of their shift, or lead an A grade).

Health of the Nation Outcome Scales (HONOS)
HoNOS is probably the outcome measure most widely used by English mental health services.The scales are completed after routine clinical assessments in any setting and have a variety of uses for clinicians.

Home treatment team
A team usually consisting of a psychiatrist, nurse andsocial worker. The team provides a mobile serviceoffering availability 24 hours, seven days a week and animmediate response. The team provides a gate keepingfunction to hospital admission and enables earlier discharge from hospital.

HONOS (see Health of the Nation Outcome Scales)

Human resources
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 conditions.

Huntingtons Disease
Huntingtons Disease is a genetically inherited condition that causes both physical and mental problems. It also features alternating periods of aggression, anger, excitement and depression, and progressive loss of memory and personality (Dementia).These psychiatric disturbances may appear before the movement disorder or may develop later. Bizarre behaviour alone may be the first sign of the disease.

Hyperactivity
Hyperactivity is marked by high levels of activity and restlessness. It can be treated by medication or diet.

Hypomania
This is a less severe form of mania (see mania) that 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.

Hysteria
It is a psychosomatic (see definition) disorder caused by a powerful psychological disturbance or need. Someone with it is usually completely unaware of the psychological basis of the problem. It is often impossible to convince the person that there is no physical basis for the upset, even after many investigations have ruled out the possibility of a physical cause.This is called denial.The strength of the denial in hysteria shows the enormous power of the subconscious mind. Hysteria is often a defence mechanism of the mind to protect it against the effects of some traumatic and unpleasant experience.

ICD-10 (International Classification of Disorders)
The ICD is a form of classifying mental health problems and assists clinicians in diagnosing problems.The number 10 represents the 10th edition of the book.

IM&T (see Information Management and Technology)

Incapacity
Incapacity means that a patient does not have the ability to understand and retain information about their medical condition and their need for treatment.

Informal patient
An informal patient is a person in hospital voluntarily. Most people admitted to hospital are informal patients. They are designed to be used before and after interventions so that changes attributable to the interventions (outcomes) can be measured.

Information Management and Technology (IM&T)
This refers to the use of information held by the Trust, in particular computerised information.

Information sharing
The responsibility of professionals across agencies to share relevant information to ensure that everyone involved in a person's care is informed.

Integrated Care Pathway
Integrated Care Pathways are a multi-disciplinary and multi-agency approach to mapping patients' care from admission through to discharge and ongoing care.The aim is pull together all the information into one file that will make it easier for the clinicians involved to give the best care for the patient.

Interdisciplinary
This refers to work or care that links across professional boundaries. For example, when doctors and nurses work together to provide care.

Keyworker (see Named Nurse)

Korsakoff 's syndrome
This is a problem that usually occurs in people who have had severe, long-term alcohol abuse problems. It is characterised by marked short-term memory loss.

Locality
Mental Health Trusts provide services to several localities. Localities are areas that have distinct boundaries.

Locum
A temporary health or social care professional.This person does not have a permanent contract with the Trust.

Learning disabilities
These are impairments in a specific mental process that affects learning.The conditions can exist to varying degrees in different people.

Local Implementation Team (LIT)
Local Implementation Teams bring together a wide group of stakeholders (see definition) in mental health, including service users and carers, to plan and oversee the development of mental health services in their local area. In the future they will work closely with primary care, which is responsible for commissioning mental health services.

Mania
Mania is characterised by a person feeling overexcited, elated, physically overactive and rapidly changing their ideas (scattered or tangential thoughts). It is a symptom of bipolar disorder (manic depression).

Manic depression (see Bipolar Affective Disorder)

Mental Health Act (1983) (MHA)
The Mental Health Act (1983) is a law that allows the compulsory detention of people in hospital for assessment and/or treatment for mental disorder. People who are detained under the mental health act must show signs of mental disorder and need assessment and/or treatment because they are a risk to themselves or a risk to others. People who are detained have rights to appeal against their detention.

Mental Health Act Commission (MHAC)
The Mental Health Commission (MHAC) has a legal responsibility under the Mental Health Act (MHA) to protect the interests of all patients detained under the MHA in England and Wales.

Mental Health Act Hospital Managers
For the purposes of the Mental Health Act (see definition) Trusts are defined as Mental Health Act Hospital Managers. In practice, these are usually nonexecutive directors and/or lay people appointed by the Trust to carry out the Trust's responsibilities under the Mental Health Act.

Mental Health Review Tribunal
This is an independent panel of people.A detained 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 Courts against Mental Health Review Tribunal decisions.

Mental Health Minimum Data Set
This has been developed to collect person-centred information and record packages of care received by an individual.This is collected by the Trust and submitted to the Department of Health.The data reported is numbers not names.

MIND
Mind is a leading mental health charity in England and Wales. It works to create a better life for everyone with experience of mental distress.

MRCPsych
MRCPsych is the entrance exam to the Royal College of Psychiatrists and must be passed before a doctor can become a Consultant Psychiatrist.

Monitoring
Observing activity in relation to defined specifications, standards or targets, directly or through reports or indicators - did what was intended happen? For example, monitoring the effects of antidepressants to treat depression.

Multidisciplinary
Multidisciplinary denotes an approach to care that involves more than one discipline.Typically this will mean that doctors, nurses, psychologists and occupational therapists are involved.

Music therapy
This form of therapy uses music and therapeutic approaches to help people attain goals.These goals can be mental, physical, emotional, social and/or spiritual.

Named Nurse
This is a ward nurse who will have a special responsibility for a patient while they are in hospital.

National guideline
A broad statement of principle about what constitutes appropriate care.

National Institute for Clinical Excellence (NICE)
It provides clinical staff and the public in England and Wales with guidance on current treatments. It coordinates the National Collaborating Centres from whom it commissions the development of clinical practice guidelines.

National Service Frameworks (NSF)
National Service Frameworks are issued by the government and provide guidance and standards for health services to be to working towards.There is an NSF dedicated to mental health that set standards around mental health promotion, treatment and service user involvement.There is also an NSF for Older People that has a section on mental health for older people.This term should not to be confused with the National Schizophrenia Fellowship, which is now called Rethink.

Nearest Relative (see Next of Kin)

Negative symptoms
These are psychotic symptoms characterised by a lack of expected behaviour, such as lack of energy, emotion, movement or motivation.

Neurosis
Neurosis is used to describe anxiety disorders such as anxiety and phobias.

Next of Kin
The term next of kin is widely used, but there is no statutory definition. In practice the general rule has been to recognise spouses and blood relatives as next of kin.The Mental Health Act 1983 defines a list of certain people who can be treated as the 'nearest relative' of a patient. A 'nearest relative' has a number of important powers and functions, including the right to discharge a patient who has been formally detained in hospital, make an application for a person to be admitted for assessment, treatment or guardianship and also to object to applications for treatment or guardianship being made by a social worker. Only certain categories of people can become a 'nearest relative'. First in the list are spouses, and then unmarried heterosexual couples who have lived together for 6 months. A same sex partner could only become a nearest relative after a period of 5 years.

NICE (see National Institute for Clinical Excellence)

Nominated person
A person who is appointed to represent a patient in discussions in matters related to their care.

Non-executive Director
A Non-executive Director is a member of the Trust Board.They act as a two way representative.They bring the experiences, views and wishes of the community and patients to the Trust Board.They also represent the interests of the NHS organisation to the Community

NSF (see National Service Frameworks)

Obsessive-compulsive disorder (OCD)
OCD is a problem characterised by obsessive thoughts and compulsive behaviour.The behaviour can take various forms such as cleaning or checking rituals in which the person will repeatedly clean themselves or their house or check, for example, that doors are locked and/or electrical sockets are turned off. Dermatological problems are common in people who repeatedly wash their hands. People with OCD can be treated using cognitive behavioural treatment and/or antidepressants.

Occupational Therapist
Occupational therapists use purposeful activities to treat people with physical and/or mental health problems. They work as part of a team to identify problems caused by people's conditions and find ways of coping with these to encourage independence and a better quality of life.

Occupational Therapy
Occupational therapy uses goal-directed activities, appropriate to a person's age and social role, to restore, develop or maintain the ability for independent living.

OCD (see Obsessive Compulsive Disorder)

Outcome
In health services this refers to any change in a person's wellbeing following a period of treatment.The expected outcome will usually be an improvement in symptoms or the resolution of a problem.

Outcome scale/measure
Outcome scales and measures are standard ways of assessing or evaluating the difference made to a person's wellbeing by a course of treatment. A person will usually rate himself or herself, or be rated by a health professional, against a set of questions or standards about their symptoms, feelings and wellbeing. This is usually done at the beginning of, and after a period of, treatment. Any improvement or decline will be shown by changes in the outcome scale ratings. An example of an outcome scale is HONOS (see definition).

Parkinson's disease
Parkinson's Disease is more common in older people. The disease affects the connections in the brain causing them to malfunction.This results in movement disorders such as tremor and stiffness.The disease progresses steadily over years eventually causing severe physical and mental disability. Symptoms can be treated with medication.

Patient Administration System (PAS)
A computer system used to record information about the care provided to service users.The data can only be accessed by authorised users. PAS will soon be replaced by a newer system.

PCT (see Primary Care Trust)

Personality Disorders
It is common for someone with a personality disorder to be impulsive, have high levels of sensitivity, be aggressive, attention seeking and overly dependent on others. However there is a lot of debate about this disorder. The World Health Organisation defines them as "deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations." (see also Borderline Personality Disorder).

Pharmacist
A healthcare professional who ensures that medication that service users receives are safe, effective and appropriate.

Pharmacy
The department that supplies medicines.

Patient Advice and Liaison Service (PALS)
All NHS trusts are required to have a Patient Advice and Liaison Service.The service offers patients information, advice, quick solution of problems or access to the complaints procedure.

Patient Environment Action Team (PEAT)
A team that visits hospitals to check on cleanliness.

Power of attorney (see Enduring Power of Attorney)

Primary Care
Primary care is the care that you will receive when you first come into contact with health services about a problem.These include family health services provided by GPs, dentists, pharmacists, opticians, and others such as community nurses, physiotherapists and some social workers.

Primary care liaison team
A service working closely with GPs for clients who cannot be effectively managed in an ordinary primary care setting.The team takes a key role in the organisation and delivery of service working closely with statutory and non-statutory agencies and transferring patients between services as required. The team offers risk assessment of clients, advice and short to medium term psychological therapies.

Primary Care Trust (PCT)
This is the organisation that looks after primary care (see definition). PCTs are commissioners (see definition)

Procedure
A procedure is a series of actions taken in a definite and established order.This can refer to a treatment plan or to general activities.

Protocol
A local policy or strategy that defines appropriate action. (see Policy)

Phobias
This is an extremely common problem in the general population. Phobias are irrational and uncontrollable fears of an object or situation that most people can face without anxiety.The object or situation will trigger feelings of intense panic and the sufferer will go to great lengths to avoid them. Common phobias are fear of flying, spiders and enclosed spaces.

PICU (see Psychiatric Intensive Care Unit)

Policy
Policies are produced by organisations to clearly outline what staff must do, and not do, in certain situations.

Positive symptoms
Positive symptoms refer to psychotic symptoms such as false beliefs and hallucinations (see definition).

Postnatal depression
Postnatal depression can occur any time in the first year after having a baby and most commonly occurs within 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 by feelings of guilt about not being able to cope or look after the baby. Not to be confused with baby blues (see definition).

Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops following an unusually threatening event. Symptoms include flashbacks, nightmares and intense distress when exposed to an object or situation that is related to the traumatic event.

Psychiatric Intensive Care Unit (PICU)
A Psychiatric Intensive Care Unit (PICU) is a locked ward in a hospital where some people detained under the Mental Health Act may stay. Patients are placed in PICU because they are assessed as being a risk to themselves or others on an open acute inpatient ward.

Psychiatrist
A doctor who specialises in the diagnosis and treatment of people who are mentally ill. Psychiatrists have undergone specialist training and may diagnose illness, prescribe medication and other forms of appropriate treatment.They also decide whether to admit people to and discharge from hospital.

Psychoanalysis
This is a type of therapy that focuses on unconscious motives and conflicts.The use of dream recall and free associations can be used in psychoanalysis.

Psychodynamic therapy
This is a form of psychotherapy in which the patient talks and the therapist makes interpretations about the patient's words and behaviour.

Psychodrama (see Drama Therapy)

Psychologist
Psychologists have skills in the assessment and treatment of mental illness and psychological problems. Unlike psychiatrists they are not medical doctors, their skills include assessing cognitive functions (for example, speech and thought) and providing talking interventions including psychotherapy and counselling.

Psychopharmacology
The management of psychiatric illness using medication such as antidepressants or antipsychotics.

Psychosis
Psychosis, or psychotic disorders, involves distorted perceptions of reality and irrational behaviour, often accompanied by hallucinations and delusions.

Psychosomatic disorder
In some illnesses, psychological factors seem to play a particularly important part.They can influence not only the cause of the illness, but can also worsen the symptoms and affect the course of the disorder.These illnesses are termed psychosomatic disorders. Because psychological factors are important in every illness, there is lack of agreement as to what should be considered a psychosomatic disorder.

Psychotherapist
Psychotherapists help people to be in more control of their own lives by exploring emotional difficulties and helping them understand themselves and their relationships with others.They provide consultation and intervention on a one to one basis and in groups.

Psychotherapy
The treatment of mental health, emotional and personality problems through talking with a therapist. There are many different types of psychotherapy.

Quality improvement
This is a general term for various methods of improving the quality of services that are provided to service users.

Randomised controlled trial (RCT)
A type of research or experiment used to compare the effectiveness of different treatments. Patients are randomly assigned to groups.The groups either receive the treatment being assessed or are a control group. The control group receive dummy (placebo) medication. RCTs offer the most reliable form of evidence for effectiveness.

Rapid cycling
When a person with bipolar disorder experiences four or more mood episodes (mania, hypomania or depression) within a year.

Reflexology
This is a type of alternative or complementary therapy that uses pressure points on the feet to promote health and well-being.

Rehabilitation
Improving a person's skills through treatment and/or training to enable them to live a more fulfilling life in the community.

Reliability
The ability of a data gathering tool to obtain consistent results.

Responsible Medical Officer (RMO)
The consultant psychiatrist with medical responsibility for a service user.

Restriction order
Restriction orders can be added to some sections.The person must have been convicted of an offence for which imprisonment is a possible penalty. This order means that only the Home Secretary can allow discharge or time away from the hospital.

Risk assessment
Identifying aspects of a service which could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.

Risk management
Changing aspects of a service that could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.

Royal College of Nursing
This is a professional body that represents the interests of nurses, and provides support in professional matters.

Royal College of Psychiatrists (RCPsych)
This is the professional body for psychiatrists as well as the body that sets exams for those wishing to become psychiatrists.

Royal Pharmaceutical Society
The Society provides guidance for pharmacists (see definition) and pharmacy staff.

Schizoaffective Disorder
This condition displays symptoms of both schizophrenia and bipolar disorder.

Schizophrenia
This is a psychotic disorder marked by delusions, hallucinations, disordered thinking and speech,
inappropriate emotions and/or lack of emotions. It is characterised by serious disturbances of thought and perception which cannot be attributed to brain damage.

Seasonal affective disorder (SAD)
SAD is a form of depression linked to the seasons. Sufferers become depressed during autumn and winter.

Secondary care
Secondary care is specialist care, usually provided in hospital, after a referral from a GP or health professional. Mental Health Services are included in secondary care (see also tertiary care).

Section
This is used to refer to one of the sections of any Act of Parliament. A person who is detained in hospital under the Mental Health Act (1983) is commonly referred to as 'sectioned'.

Serious Untoward Incidents (SUIs)
This is a term used by many health organisations to describe a serious incident or event which led, or may have led, to the harm of patients or staff. Members of staff who were not involved in the incident investigate these and the lessons learned from each incident are used to improve care in the future.

Service user
This is someone who uses health services. Other common terms are patient, service survivor and client. Different people prefer different terms.

SHO (see Senior House Officer)

Single Assessment Process (SAP)
The Single Assessment Process (SAP) for older people was introduced in the National Service Framework for Older People.The purpose of the single assessment process is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively.

Specialist Registrar (SpR)
SpR grade is a recognised training grade in the progression of medical staff to Consultant status. It was formally known as Senior Registrar. On completion of the Senior House Officer (SHO) rotation, and passing the MRCPysch, the Specialist Registrar continues training in their chosen area of psychiatry.

SSRI (see Selective Serotonin Reuptake Inhibitor)

Section 12 Approved
Doctors who are approved by the secretary of State, having special knowledge of mental health and who are required to be involved in assessments under the Mental Health Act 1983.

Section 17
Section 17 of the Mental Health Act (1983) makes provision for patients who are liable to be detained under various sections of the act to be granted leave of absence.

Section 136
This section of the Mental Health Act (1983) enables a police officer to remove a person from a public place and take them to a designated place of safety, which may be a police station, a hospital, or other suitable place.

Selective Serotonin Reuptake Inhibitor (SSRI)
This is a type of antidepressant medication. An example is prozac (fluoxetine)

Senior House Officer (SHO)
This is the position gained by doctors after they are registered as a doctor by the General Medical Council. It is the second tier of trainee doctor (after preregistration house officer) in a hospital.

SEPIA
SEPIA is a computer package that is used to keep information about CPA (see definition).

Serious mental illness/Severe mental illness
These are mental health problems that are serious enough to warrant contact with mental health services.

Stakeholders
A range of people and organisations that are affected by, or have an interest in, the services offered by an organisation. In the case of hospital trusts, it includes patients, carers, staff, unions, voluntary organisations, social services, health authority, GPs, primary care groups and trusts in England, local health groups in Wales.

Standard
A measure, specification or object to which objects should conform or against which others are judged.A required degree of excellence.

Substance Abuse
This refers to the abuse or misuse of non-medical or 'recreational' drugs and/or alcohol. As well as physical
problems, some substance abuse can lead to psychological problems, such as depression, anxiety and, in some cases, psychosis.

Suicide
Taking one's own life.

Support Workers
Support workers provide support for clients and their carers under the supervision of a care coordinator which has been negotiated under the care programme approach.They can help people regain lost skills and develop new interests to help regain confidence and self esteem.

SUI (see Serious Untoward Incidents)

Talking treatments
These are psychological treatments in which improvement in a person's symptoms or wellbeing is achieved by talking with a therapist or counsellor rather than, or as well as, taking medication.

Tertiary Care
When a hospital consultant decides that more specialist care is needed. Mental Health Services are included in this. (see also Secondary care).

Titration
This is a method of determining what substances are in a person's system by testing bodily fluids. It can detect substances such as prescribed medication and also illegal substances such as drugs or alcohol. Dose titration means to slowly increase the dose of a drug to a level that can be maintained.

Tolerance
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 either alcohol or illegal drugs due to repeated use or exposure.

To-take-aways (TTAs)
TTAs are medicines supplied by pharmacy for service users going on leave from the hospital.

TTAs (see To-take-aways)

 

Acknowledgements: This glossary was compiled by North East London Mental Health Trust and East London and The City Mental Health Trust - please ensure that appropriate acknowledgement is made, even if you amend or add to the content.

A&E (Accident & Emergency) liaison
A service within A&E departments for mental health assessments and referral to specialist services.

Accreditation
An assessment by an external agency of an individual or organisation against defined criteria. For example, services providing ECT (see definition) must meet the standards set by the Royal College of Psychiatrists. If the standards are met satisfactorily the service is accredited by the Royal College of Psychiatrists.

Acute
An acute illness is one that occurs quickly, is intense or severe and lasts a relatively short period of time.

ADHD
(see Attention deficit hyperactivity disorder)

Admission
The point at which a person begins an episode of care (see definition), e.g. arriving at an inpatient ward.

Advance statements/directives
There are various types of advance statement/directive. They can include statements of an individual's wishes in certain 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 to be made.The individual should seek advice about the legal status of these statements/directives.They might be called Living Wills.

Advocate
An advocate is a person who can support a service user or carer through their contact with health services. Advocates will attend meetings with patients and help service users or carers to express concerns or wishes to health care professionals. Although many people can act as an advocate (friend, relative, member of staff) there are advocacy services available that can be accessed through the Trust.These advocates are trained and independent.

Affective disorder
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).

Aftercare
This is the support or care that a person can expect to receive once discharged from inpatient care.Typically a discharge plan will be developed by the multidisciplinary team with the service user which will make clear what care and support will be provided. (see Care Plan, CPA).

Agoraphobia
Agoraphobia is defined as a fear of open spaces. It also includes related fears such as fear of entering shops, fear of crowds and public places, or of travelling alone. A person may feel an intense fear of being caught or trapped in a situation when they can't get help. It is often associated with panic attacks.

Alternative therapies
(see also Complementary therapies) These are therapies that are not part of current standard medical practice (for example acupuncture, reflexology or aromatherapy). Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment.

Alzheimer's Disease (See Dementia)

Anorexia nervosa
This is an illness that is characterised by a refusal to eat, an avoidance of eating or a careful and low intake of food.The person can become malnourished to the point of starvation.Their perception of their own body size may become distorted and they will continue to perceive themselves as being fat.

Antidepressants
Antidepressants aim to treat the symptoms of depression and can help people experiencing depression to feel more motivated and energetic.This group of medication may also be used to treat obsessive-compulsive disorder, anxiety and eating disorders.There are different types of antidepressants including tricyclic and selective serotonin reuptake inhibitors (SSRIs).

Antipsychotic medication
Anti psychotic medication is normally given to treat the symptoms of schizophrenia and, in some cases, manic depression and manias.The two main types of antipsychotics are called typical and atypical (see definitions).The main difference between the two groups is in their side effects.

Anxiety
This is the term used to describe experiences such as chronic fear, tension and panic attacks. Some people have an overwhelming feeling of dread that prevents them getting on with everyday life. Sleepless nights and recurring thoughts are common, as well as nausea, palpitations, dizziness and difficulty in breathing. Anxiety is the most common mental health problem people experience.

Anxiety disorders
These are disorders that involve a continuous state of anxiety or fear, lasting at least a month, marked by constant apprehension, difficulties in concentration and a pounding heart. Physical symptoms may also be present, such as headaches, sweating, irritability, and nausea. Anxiety disorders include panic disorder and obsessive-compulsive disorder. Depression is common in those with anxiety disorders.

Appropriateness of care
When in a clinical situation, the expected benefits (e.g. improved symptoms) of care outweigh the expected negative effects (e.g. drug side effects) to such an extent that the treatment is worth carrying out.

Approved Social Worker (ASW)
Approved Social Workers (ASW) have specialist training and experience in identifying disorders of mental health and are familiar with the problems experienced by users of 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 community mental health teams.They will organise social care support for people in contact with mental health services, such as helping with housing and getting welfare benefits.They work closely with health professionals and, under the current Mental Health Act, they work with two doctors to assess a person who may need admitting to hospital. Social workers can also act as care coordinators for people on care programmes.

Aromatherapy
Aromatherapy involves the use of therapeutic oils derived from plants to stimulate the body's nerves to help a person feel either more relaxed or energised. It is often used with massage or in the bath.Various oils are available and are divided into different fragrance families: relax, body, energy, mind and soul.

Art therapy
Art therapy aims to support people's recovery using art as a creative process and as a therapy to help people resolve emotional conflicts, be more aware about themselves, develop social skills, reduce anxiety and increase their self-esteem.

Asperger's Syndrome (see Autism)

Assertive Outreach
Assertive outreach services aim to support people in the community who find it difficult keeping in contact with mental health services.

Assessment
Assessment happens when a person first comes into contact with health services. Information is collected in order to identify the person's needs and plan treatment.

Attention deficit hyperactivity disorder (ADHD)
People with ADHD have three main kinds of problems: difficulty concentrating or paying attention, overactive behaviour and impulsive behaviour. ADHD is a developmental problem that usually starts in childhood. Some people have significant problems in concentration and attention, but are not necessarily overactive or impulsive.These people are sometimes described as having Attention Deficit Disorder (ADD) rather than ADHD.

Atypical antipsychotics (see also Antipsychotic medication)
Atypical antipsychotic medication is a group of new antipsychotic drugs that have a different set of side effects from the older, typical, antipsychotics. In general they cause fewer movement disorders such as tremor, muscle stiffness and restlessness.

Audit cycle
The process of carrying out a clinical audit project follows a cycle of identifying a topic, setting standards, measuring current practice against these standards, agreeing recommendations and implementing change. This cycle is repeated to ensure change has occurred and improvement is maintained.

Autism
Autism is a lifelong developmental disorder that affects the way a person communicates and relates to people around them. In the great majority of cases, autistic disorders are present from birth or become apparent within the first three years of life. People with typical autism have no interest in social interaction, little or no language, and tend to live in their own world. Asperger's syndrome often applies to those who are more able, who have better language development, and who have more social contact. Asperger's syndrome may first come to notice in adult life.

Baby Blues
A period of mild depression after childbirth, the baby blues tends to last a few hours or a few days and then disappears. Not to be confused with postnatal depression (see definition).

Benchmarking
A way of comparing a particular process and outcomes in one organisation with another organisation. Each organisation can then examine and change their own processes to achieve better outcomes.

Bipolar Affective Disorder
This is also known as manic depression or bipolar disorder. It is a disorder characterised by swings in a person's mood from very high (mania) to very low (depression).

Bipolar Disorder (see Bipolar Affective Disorder)

Borderline Personality Disorder (BPD)
This is a personality style marked by unstable moods and unsatisfactory personal relationships.They often have problems with impulsivity, substance abuse (see definition) and impulsive spending.Those with BPD may also suffer from depression, anxiety and the fear of being abandoned. (see also Personality Disorder)

British Psychological Society (BPS)
This is the professional body for psychologists.

Bulimia
Symptoms of bulimia may include chaotic eating, bingeing, vomiting and abuse of laxatives.

Caldicott Guardian
A senior healthcare professional in each NHS organisation is responsible for safeguarding the confidentiality of patient information.The name comes from the Caldicott Report, which identified 16 recommendations for the use and storage of patientidentifiable information.

CAMHS
(see Child and adolescent mental health services)

Capacity
This term means that a patient has the ability to understand and retain information about their medical condition and their need for treatment.

Care Co-ordinator
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 care under the Care Programme Approach they will be told who their care co-ordinator is.The care co-ordinator is likely to be community mental health nurse, social worker or occupational therapist.

Care plan
A care plan is a written plan that describes the care and support staff will give a service user. Service users should be fully involved in developing and agreeing the care plan, sign it and keep a copy. (see Care Programme Approach)

Care Programme Approach (CPA)
The Care Programme Approach is a standardised way of planning a person's care. It is a multidisciplinary (see definition) approach that includes the service user, and, where appropriate, their carer, to develop an appropriate package of care that is acceptable to health professionals, social services and the service user. The care plan and care co-ordinator are important parts of this. (see Care Plan and Care Co-ordinator).

Carer
A carer is someone who looks after their relatives or friends on an unpaid, voluntary basis often in place of paid care workers.

Casemix
Relative frequency of different diagnoses or conditions among patients.

Cause
A reason or explanation for a problem or illness based on analysis and/or investigation.

CBT (See Cognitive Behavioural Therapy)

CHI (See Commission for Health Improvement)

Child and Adolescent Mental Health Services (CAMHS)
CAMHS is a term used to refer to mental health services for children and adolescents. CAMHS are usually multidisciplinary teams including psychiatrists psychologists, nurses, social workers and others.

Chronic
A condition that develops slowly or lasts a long time.

Client (see also service user)
An alternative term for patient which emphasises the professional nature of the relationship between a clinician or therapist and the patient.

Client-centred therapy
Client-centred therapy emphasises the importance of empathy in healing.The therapist provides an environment of empathy, unconditional positive regard, acceptance and support.

Clinical audit
A process used to measure the quality of aspects of care and services and to improve that quality.

Clinical audit facilitator
A person who provides advice and technical support on the subject of clinical audit.

Clinical Psychologist
This is someone who has a Psychology Degree together with clinical training in psychology.They are trained in research, assessment and the application of different psychological therapies.

Clinical team
A team of health care professionals from different disciplines (e.g. nursing, psychiatry, occupational therapy).

Clinician
A person who provides direct care to a patient such as a doctor, nurse, therapist, pharmacist, psychologist etc.

CMHT
(see Community Mental Health Team)

Cognitive Behavioural Therapy (CBT)
This is an approach to treatment that involves working with people to help them change their emotions, thoughts and behaviour.A person's personal beliefs are addressed in order to understand and change behaviour.

College of Occupational Therapy (COT)
This is the professional body that represents occupational therapists and produces guidance.

Co-morbidity/ Co-morbid
The presence of two or more disorders at the same time. For example, a person with depression may also have co-morbid obsessive compulsive disorder.

Clinical effectiveness
Clinical effectiveness focuses on ensuring that staff are providing the best and most effective care for people using health services.This is done using a variety of methods including clinical audit and evidence-based practice.

Clinical governance
A framework that ensures that NHS organisations monitor and improve the quality of services provided and that they are accountable for the care they provide.This is monitored by the Commission for Health Improvement (see definition).

Clinical guidelines/clinical practice guidelines
Systematically developed statements, based on scientific research, which assist in decision-making about appropriate healthcare for specific clinical conditions.

Clinical information
Information about diagnoses, treatments and their outcomes.

Clinical Negligence Scheme for Trusts (CNST)
A scheme for assessing a Trust's arrangements to minimise clinical risk for service users and staff. Trusts need to pay 'insurance' which can offset the costs of legal claims against the Trust. Achieving CNST Levels (1, 2 or 3) shows the Trust's success in minimising clinical risk and reduces the premium that the Trust must pay.

Clinical pathways
Different ways of describing and/or prescribing a 'plan' for providing a particular health service.

Community Mental Health Team (CMHT)
A multidisciplinary team offering specialist assessment, treatment and care to people in their own homes and the community.

Community Psychiatric Nurse (CPN)
CPNs are registered nurses who work with people in the community.They work as part of a team and, like other members of the team, may see people in a variety of settings such as at a GP surgery, in a clinic or health centre or in a client's own home.They work closely with GPs (see General Practitioner definition) and other health professionals.They provide practical advice, ongoing support with problems, supervise medication, give injections and help with counselling. They also work out care plans with other members of the team, service users and carers.

Complementary therapies
These are therapeutic practices or techniques that are not currently considered an integral part of conventional medical practice.Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment. (see also Alternative therapies)

Complex needs
This is a combination of medical needs (e.g. diagnosis, treatment and rehabilitation) and social needs (e.g. housing, social care and independent living).

Compliance
This term means that written standards are met. It is also used to refer to service users following agreed care plans (including taking prescribed medication).

Commission for Audit and Inspection in Healthcare (CHAI)
The Commission for Healthcare Audit and Inspection (CHAI) help improve the quality of healthcare by ensuring an independent assessment of the standards of services provided to patients, whether it is provided by the NHS or privately. By routinely publishing information, it will also allow the public to assess how well tax-payers' money is being spent in delivering healthcare. CHAI will take on the functions of CHI (see definition) and other inspection bodies.

Commission for Health Improvement (CHI)
An independent body set up to monitor clinical governance in NHS organisations. (see Clinical Governance).This body was replaced by the Commission for Audit and Inspection in Healthcare (CHAI see definition) in April 2004.

Commissioner
Primary Care Trusts are responsible for buying (commissioning) specialist mental health services on behalf of the people living in the district.They have an allocation of money and decide which services to commission.The service provider is chosen and given the money to make sure the service is delivered according to the contract. Services may be commissioned from the NHS or the voluntary or private sector.

Community Care
Community Care aims to provide health and social care services in the community to enable people to live as independently as possible in their own homes or in other accommodation in the community.

Controls assurance
The way that an organisation checks that its policies are being carried out.This includes internal and external audit for financial matters, employment policies and all areas in which the organisation interacts with the public.

CORE
The CORE Outcome Measure is one way to find out if an intervention has been successful. It includes both the service user's and the clinician's assessment of the treatment.

Counselling
Counselling is a talking therapy that usually deals with a recent distressing event.The length of time that counselling is needed varies from person to person.

Court of Protection
The Court of Protection has several roles in looking after the financial affairs of people who cannot legally do it themselves.These include making Enduring Powers of Attorney (see definition), making wills, and generally giving directions and orders for the management of the property and financial affairs.

Compulsive eating
This may occur when people experience loneliness or distress and use food for comfort. Food may make them happier on a temporary basis but as food increasingly dominates a person's life, he or she becomes more unhappy, finds it more difficult to exercise real control and, gaining more weight, puts his or her own health at greater risk.

Conditional discharge
Where a restricted patient under the Mental Health Act is discharged subject to specific conditions and liable to be recalled by the Home Secretary.

Conduct Disorder
This is a persistent pattern of behaviour that involves violation of the rights of others. Verbal and physical aggression are central features of conduct disorder.

Consent to treatment
If you are an informal patient, you have the right to refuse any treatment you do not wish.You have a right to receive full information about the treatment, its purpose and possible side effects. If consent is not obtained the treatment cannot normally be given.

Consultant Psychiatrist
A Consultant Psychiatrist is a trained mental health doctor with additional specialist training in psychiatry. The consultant is medically responsible for the care of people receiving mental health services and also supervises junior doctors.

Contraindication
A situation in which medication should not be used. For example because of a physical condition, other medications, pregnancy.

CPA (see Care Programme Approach)

CPN (see Community Psychiatric Nurse)

Crisis Resolution Team
A crisis resolution team aims to respond to people in crisis. It aims to provide an assessment and treatment service, 24 hours a day, wherever people are.

Depression
Depression is one of the most common forms of mental health problem and can occur to people of all ages. Symptoms include feelings of despair, hopelessness and worthlessness, an inability to cope, sleep problems and sometimes thoughts of suicide. Often people with depression will complain of physical problems (e.g for example headaches, stomach problems) rather than depression when consulting their GP. Various treatments are available for depression including antidepressant medication, talking treatments such as CBT (see definition), or counselling (see definition).

Diagnosis
Identifying an illness or problem by its symptoms and signs.

Diagnostic and Statistical Manual (DSM)
This is a manual that classifies mental health problems and is used to diagnose people's mental health problems.The American Psychiatric Association publishes it.

Directorate
Services in NHS organisations are usually grouped into directorates. Medical services (e.g. psychiatry) are grouped into the Medical Directorate. Nursing staff and services make up the Nursing Directorate.The way in which directorates are organised changes from Trust to Trust.

Discharge
The point at which a person formally leaves services. On discharge from hospital the multidisciplinary team and the service user will develop a care plan. (see Care plan)

Deliberate self harm
Where a person injures or harms himself or herself intentionally. Common forms are self-poisoning or cutting.

Delirium
A condition including severe confusion, disorganized thinking, disorientation and restlessness. Delirium may be caused by physical agents such as infections, toxic substances, metabolic disorders or strokes. Delirium Tremens, "the trembling delirium" is a type of delirium that affects people on alcohol withdrawal after a long period of heavy drinking. Its main symptoms are uncontrollable trembling along with the symptoms mentioned above.

Delusion
A fixed, false belief.

Dementia
Dementia is characterised by confusion, memory loss, poor problem-solving and poor concentration.There are many diseases that lead to dementia, the most common being Alzheimer's disease. Dementia usually occurs in older people. Dementia in people under 65 is known as early onset dementia. Dementia with Lewy bodies (DLB) is a rarer form of dementia that shares characteristics with both Alzheimer's and Parkinson's diseases.Vascular dementia occurs when cells in the brain are deprived of oxygen. Many symptoms are the same as other forms of dementia, however there are some differences.

Dependence
Dependence refers to when a person is reliant on a substance or person to help them function on a day-to-day level. It can also be used to refer to a person who has become reliant on a medication to function in society.

Dissociative disorders
This is a disorder in which normal consciousness or identity is split or altered, often as a result of an intense psychological trauma.

Dose
A specific, set amount of medication administered.

Drama therapy
Drama therapy aims to help a person use drama as part of their recovery process. It can give a person an opportunity for reflection and to tell their story to help solve a problem and achieve a relief of strong suppressed emotions.

Dual diagnosis
Dual diagnosis refers to two or more disorders affecting one person. For example, mental illness and learning disability. It is also used to indicate that a person who has been diagnosed with a mental health problem also misuses substances, such as illegal drugs, legal drugs or alcohol.

Early intervention service
Early intervention services provide support and treatment in the community for young people with psychosis and their families.The aim is to reduce the period of untreated psychosis, which in turn, evidence shows, is likely to lessen future problems and improve the person's health and well being in the long term.

Eating disorders
Examples of eating disorders are anorexia nervosa, bulimia and compulsive eating.They are often an expression of deep emotional difficulties and low self esteem. Depression, disturbed sleep patterns, restlessness and disturbance of bodily functions are some of the effects of eating disorders.

ECT (see Electroconvulsive therapy)

Efficacy
How well something works.This term is used to refer to treatments in particular.

Electroconvulsive therapy (ECT)
In ECT a small, carefully controlled amount of electricity is sent through the brain of a person who has been given an anaesthetic and muscle relaxant. This produces a mild seizure or convulsion. It is used for cases of severe mental illness, usually depression, where the patient has not responded to other treatments or medication.The Department of Health has issued strict guidelines on the use of this therapy.

Emergency powers
The powers to detain a person for an initial assessment to determine whether the use of compulsory powers is appropriate. For example a Section 136 or a Section 5(2).

Enduring Power of Attorney (EPA)
An Enduring Power of Attorney (EPA) is a legal document that enables someone to appoint one or more persons to manage their financial affairs and property, either now or in the future.

Episode of care
The period when a service user enters the care of the Trust to when they are discharged from all services provided by the Trust. This care could be, for example a combination of care provided by inpatient stays, outpatient attendances, a CPN, or use of services from an OT and a day hospital.

Evaluation
Judging the value of something by making a comparison.

Evidence-based medicine/practice
This can be known as evidence-based healthcare, evidence-based medicine or evidence-based practice. It involves using available evidence, particularly research, to plan how to treat specific conditions.The process aims to find a comfortable compromise between the evidence, clinicians' views and experiences and service users' views.

Evidence-based recommendations
A decision about management based primarily on evidence from scientific literature.

Exposure therapy
Exposure therapy is a form of cognitive behavioural therapy used to help people who have experienced traumas. It uses careful, repeated and detailed experience of the real or imagined trauma in a safe and supportive environment to help the person face and gain control of the fear and distress that was overwhelming.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a relatively new treatment to help people deal with trauma. It involves elements of exposure therapy (see definition) and cognitive behavioural therapy (see definition), combined with other techniques.

Formal patient
This is a person who has been detained in hospital under the Mental Health Act (1983).

Guideline
A recommendation of good practice usually based on research evidence.

General Practitioner (GP)
A family doctor, usually patients' first point of contact with the health service.

Hallucinations
They are disorders of perception or a perception without a stimulus.There are various different types of hallucinations including; auditory (hearing sounds or voices), olfactory (smells), tactile (sensation), visual (seeing things) or gustatory (taste).The most common are hearing voices or seeing things that don't really exist. Hallucinations are common psychotic disorders. Hallucinations may also occur after illegal drug use and some prescribed drugs (e.g. steroids).

Health Care Assistants (can also be referred to as Health Care Support Workers)
Health Care Assistants are non-qualified nursing staff who undertake assigned tasks involving direct care in support of a registered/qualified nurse.There are two grades of Health Care Assistants, A and B grade. A grades would expect to be more closely supervised, while B grades may regularly work without supervision for all or most of their shift, or lead an A grade).

Health of the Nation Outcome Scales (HONOS)
HoNOS is probably the outcome measure most widely used by English mental health services.The scales are completed after routine clinical assessments in any setting and have a variety of uses for clinicians.

Home treatment team
A team usually consisting of a psychiatrist, nurse andsocial worker. The team provides a mobile serviceoffering availability 24 hours, seven days a week and animmediate response. The team provides a gate keepingfunction to hospital admission and enables earlier discharge from hospital.

HONOS (see Health of the Nation Outcome Scales)

Human resources
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 conditions.

Huntingtons Disease
Huntingtons Disease is a genetically inherited condition that causes both physical and mental problems. It also features alternating periods of aggression, anger, excitement and depression, and progressive loss of memory and personality (Dementia).These psychiatric disturbances may appear before the movement disorder or may develop later. Bizarre behaviour alone may be the first sign of the disease.

Hyperactivity
Hyperactivity is marked by high levels of activity and restlessness. It can be treated by medication or diet.

Hypomania
This is a less severe form of mania (see mania) that 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.

Hysteria
It is a psychosomatic (see definition) disorder caused by a powerful psychological disturbance or need. Someone with it is usually completely unaware of the psychological basis of the problem. It is often impossible to convince the person that there is no physical basis for the upset, even after many investigations have ruled out the possibility of a physical cause.This is called denial.The strength of the denial in hysteria shows the enormous power of the subconscious mind. Hysteria is often a defence mechanism of the mind to protect it against the effects of some traumatic and unpleasant experience.

ICD-10 (International Classification of Disorders)
The ICD is a form of classifying mental health problems and assists clinicians in diagnosing problems.The number 10 represents the 10th edition of the book.

IM&T (see Information Management and Technology)

Incapacity
Incapacity means that a patient does not have the ability to understand and retain information about their medical condition and their need for treatment.

Informal patient
An informal patient is a person in hospital voluntarily. Most people admitted to hospital are informal patients. They are designed to be used before and after interventions so that changes attributable to the interventions (outcomes) can be measured.

Information Management and Technology (IM&T)
This refers to the use of information held by the Trust, in particular computerised information.

Information sharing
The responsibility of professionals across agencies to share relevant information to ensure that everyone involved in a person's care is informed.

Integrated Care Pathway
Integrated Care Pathways are a multi-disciplinary and multi-agency approach to mapping patients' care from admission through to discharge and ongoing care.The aim is pull together all the information into one file that will make it easier for the clinicians involved to give the best care for the patient.

Interdisciplinary
This refers to work or care that links across professional boundaries. For example, when doctors and nurses work together to provide care.

Keyworker (see Named Nurse)

Korsakoff 's syndrome
This is a problem that usually occurs in people who have had severe, long-term alcohol abuse problems. It is characterised by marked short-term memory loss.

Locality
Mental Health Trusts provide services to several localities. Localities are areas that have distinct boundaries.

Locum
A temporary health or social care professional.This person does not have a permanent contract with the Trust.

Learning disabilities
These are impairments in a specific mental process that affects learning.The conditions can exist to varying degrees in different people.

Local Implementation Team (LIT)
Local Implementation Teams bring together a wide group of stakeholders (see definition) in mental health, including service users and carers, to plan and oversee the development of mental health services in their local area. In the future they will work closely with primary care, which is responsible for commissioning mental health services.

Mania
Mania is characterised by a person feeling overexcited, elated, physically overactive and rapidly changing their ideas (scattered or tangential thoughts). It is a symptom of bipolar disorder (manic depression).

Manic depression (see Bipolar Affective Disorder)

Mental Health Act (1983) (MHA)
The Mental Health Act (1983) is a law that allows the compulsory detention of people in hospital for assessment and/or treatment for mental disorder. People who are detained under the mental health act must show signs of mental disorder and need assessment and/or treatment because they are a risk to themselves or a risk to others. People who are detained have rights to appeal against their detention.

Mental Health Act Commission (MHAC)
The Mental Health Commission (MHAC) has a legal responsibility under the Mental Health Act (MHA) to protect the interests of all patients detained under the MHA in England and Wales.

Mental Health Act Hospital Managers
For the purposes of the Mental Health Act (see definition) Trusts are defined as Mental Health Act Hospital Managers. In practice, these are usually nonexecutive directors and/or lay people appointed by the Trust to carry out the Trust's responsibilities under the Mental Health Act.

Mental Health Review Tribunal
This is an independent panel of people.A detained 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 Courts against Mental Health Review Tribunal decisions.

Mental Health Minimum Data Set
This has been developed to collect person-centred information and record packages of care received by an individual.This is collected by the Trust and submitted to the Department of Health.The data reported is numbers not names.

MIND
Mind is a leading mental health charity in England and Wales. It works to create a better life for everyone with experience of mental distress.

MRCPsych
MRCPsych is the entrance exam to the Royal College of Psychiatrists and must be passed before a doctor can become a Consultant Psychiatrist.

Monitoring
Observing activity in relation to defined specifications, standards or targets, directly or through reports or indicators - did what was intended happen? For example, monitoring the effects of antidepressants to treat depression.

Multidisciplinary
Multidisciplinary denotes an approach to care that involves more than one discipline.Typically this will mean that doctors, nurses, psychologists and occupational therapists are involved.

Music therapy
This form of therapy uses music and therapeutic approaches to help people attain goals.These goals can be mental, physical, emotional, social and/or spiritual.

Named Nurse
This is a ward nurse who will have a special responsibility for a patient while they are in hospital.

National guideline
A broad statement of principle about what constitutes appropriate care.

National Institute for Clinical Excellence (NICE)
It provides clinical staff and the public in England and Wales with guidance on current treatments. It coordinates the National Collaborating Centres from whom it commissions the development of clinical practice guidelines.

National Service Frameworks (NSF)
National Service Frameworks are issued by the government and provide guidance and standards for health services to be to working towards.There is an NSF dedicated to mental health that set standards around mental health promotion, treatment and service user involvement.There is also an NSF for Older People that has a section on mental health for older people.This term should not to be confused with the National Schizophrenia Fellowship, which is now called Rethink.

Nearest Relative (see Next of Kin)

Negative symptoms
These are psychotic symptoms characterised by a lack of expected behaviour, such as lack of energy, emotion, movement or motivation.

Neurosis
Neurosis is used to describe anxiety disorders such as anxiety and phobias.

Next of Kin
The term next of kin is widely used, but there is no statutory definition. In practice the general rule has been to recognise spouses and blood relatives as next of kin.The Mental Health Act 1983 defines a list of certain people who can be treated as the 'nearest relative' of a patient. A 'nearest relative' has a number of important powers and functions, including the right to discharge a patient who has been formally detained in hospital, make an application for a person to be admitted for assessment, treatment or guardianship and also to object to applications for treatment or guardianship being made by a social worker. Only certain categories of people can become a 'nearest relative'. First in the list are spouses, and then unmarried heterosexual couples who have lived together for 6 months. A same sex partner could only become a nearest relative after a period of 5 years.

NICE (see National Institute for Clinical Excellence)

Nominated person
A person who is appointed to represent a patient in discussions in matters related to their care.

Non-executive Director
A Non-executive Director is a member of the Trust Board.They act as a two way representative.They bring the experiences, views and wishes of the community and patients to the Trust Board.They also represent the interests of the NHS organisation to the Community

NSF (see National Service Frameworks)

Obsessive-compulsive disorder (OCD)
OCD is a problem characterised by obsessive thoughts and compulsive behaviour.The behaviour can take various forms such as cleaning or checking rituals in which the person will repeatedly clean themselves or their house or check, for example, that doors are locked and/or electrical sockets are turned off. Dermatological problems are common in people who repeatedly wash their hands. People with OCD can be treated using cognitive behavioural treatment and/or antidepressants.

Occupational Therapist
Occupational therapists use purposeful activities to treat people with physical and/or mental health problems. They work as part of a team to identify problems caused by people's conditions and find ways of coping with these to encourage independence and a better quality of life.

Occupational Therapy
Occupational therapy uses goal-directed activities, appropriate to a person's age and social role, to restore, develop or maintain the ability for independent living.

OCD (see Obsessive Compulsive Disorder)

Outcome
In health services this refers to any change in a person's wellbeing following a period of treatment.The expected outcome will usually be an improvement in symptoms or the resolution of a problem.

Outcome scale/measure
Outcome scales and measures are standard ways of assessing or evaluating the difference made to a person's wellbeing by a course of treatment. A person will usually rate himself or herself, or be rated by a health professional, against a set of questions or standards about their symptoms, feelings and wellbeing. This is usually done at the beginning of, and after a period of, treatment. Any improvement or decline will be shown by changes in the outcome scale ratings. An example of an outcome scale is HONOS (see definition).

Parkinson's disease
Parkinson's Disease is more common in older people. The disease affects the connections in the brain causing them to malfunction.This results in movement disorders such as tremor and stiffness.The disease progresses steadily over years eventually causing severe physical and mental disability. Symptoms can be treated with medication.

Patient Administration System (PAS)
A computer system used to record information about the care provided to service users.The data can only be accessed by authorised users. PAS will soon be replaced by a newer system.

PCT (see Primary Care Trust)

Personality Disorders
It is common for someone with a personality disorder to be impulsive, have high levels of sensitivity, be aggressive, attention seeking and overly dependent on others. However there is a lot of debate about this disorder. The World Health Organisation defines them as "deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations." (see also Borderline Personality Disorder).

Pharmacist
A healthcare professional who ensures that medication that service users receives are safe, effective and appropriate.

Pharmacy
The department that supplies medicines.

Patient Advice and Liaison Service (PALS)
All NHS trusts are required to have a Patient Advice and Liaison Service.The service offers patients information, advice, quick solution of problems or access to the complaints procedure.

Patient Environment Action Team (PEAT)
A team that visits hospitals to check on cleanliness.

Power of attorney (see Enduring Power of Attorney)

Primary Care
Primary care is the care that you will receive when you first come into contact with health services about a problem.These include family health services provided by GPs, dentists, pharmacists, opticians, and others such as community nurses, physiotherapists and some social workers.

Primary care liaison team
A service working closely with GPs for clients who cannot be effectively managed in an ordinary primary care setting.The team takes a key role in the organisation and delivery of service working closely with statutory and non-statutory agencies and transferring patients between services as required. The team offers risk assessment of clients, advice and short to medium term psychological therapies.

Primary Care Trust (PCT)
This is the organisation that looks after primary care (see definition). PCTs are commissioners (see definition)

Procedure
A procedure is a series of actions taken in a definite and established order.This can refer to a treatment plan or to general activities.

Protocol
A local policy or strategy that defines appropriate action. (see Policy)

Phobias
This is an extremely common problem in the general population. Phobias are irrational and uncontrollable fears of an object or situation that most people can face without anxiety.The object or situation will trigger feelings of intense panic and the sufferer will go to great lengths to avoid them. Common phobias are fear of flying, spiders and enclosed spaces.

PICU (see Psychiatric Intensive Care Unit)

Policy
Policies are produced by organisations to clearly outline what staff must do, and not do, in certain situations.

Positive symptoms
Positive symptoms refer to psychotic symptoms such as false beliefs and hallucinations (see definition).

Postnatal depression
Postnatal depression can occur any time in the first year after having a baby and most commonly occurs within 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 by feelings of guilt about not being able to cope or look after the baby. Not to be confused with baby blues (see definition).

Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops following an unusually threatening event. Symptoms include flashbacks, nightmares and intense distress when exposed to an object or situation that is related to the traumatic event.

Psychiatric Intensive Care Unit (PICU)
A Psychiatric Intensive Care Unit (PICU) is a locked ward in a hospital where some people detained under the Mental Health Act may stay. Patients are placed in PICU because they are assessed as being a risk to themselves or others on an open acute inpatient ward.

Psychiatrist
A doctor who specialises in the diagnosis and treatment of people who are mentally ill. Psychiatrists have undergone specialist training and may diagnose illness, prescribe medication and other forms of appropriate treatment.They also decide whether to admit people to and discharge from hospital.

Psychoanalysis
This is a type of therapy that focuses on unconscious motives and conflicts.The use of dream recall and free associations can be used in psychoanalysis.

Psychodynamic therapy
This is a form of psychotherapy in which the patient talks and the therapist makes interpretations about the patient's words and behaviour.

Psychodrama (see Drama Therapy)

Psychologist
Psychologists have skills in the assessment and treatment of mental illness and psychological problems. Unlike psychiatrists they are not medical doctors, their skills include assessing cognitive functions (for example, speech and thought) and providing talking interventions including psychotherapy and counselling.

Psychopharmacology
The management of psychiatric illness using medication such as antidepressants or antipsychotics.

Psychosis
Psychosis, or psychotic disorders, involves distorted perceptions of reality and irrational behaviour, often accompanied by hallucinations and delusions.

Psychosomatic disorder
In some illnesses, psychological factors seem to play a particularly important part.They can influence not only the cause of the illness, but can also worsen the symptoms and affect the course of the disorder.These illnesses are termed psychosomatic disorders. Because psychological factors are important in every illness, there is lack of agreement as to what should be considered a psychosomatic disorder.

Psychotherapist
Psychotherapists help people to be in more control of their own lives by exploring emotional difficulties and helping them understand themselves and their relationships with others.They provide consultation and intervention on a one to one basis and in groups.

Psychotherapy
The treatment of mental health, emotional and personality problems through talking with a therapist. There are many different types of psychotherapy.

Quality improvement
This is a general term for various methods of improving the quality of services that are provided to service users.

Randomised controlled trial (RCT)
A type of research or experiment used to compare the effectiveness of different treatments. Patients are randomly assigned to groups.The groups either receive the treatment being assessed or are a control group. The control group receive dummy (placebo) medication. RCTs offer the most reliable form of evidence for effectiveness.

Rapid cycling
When a person with bipolar disorder experiences four or more mood episodes (mania, hypomania or depression) within a year.

Reflexology
This is a type of alternative or complementary therapy that uses pressure points on the feet to promote health and well-being.

Rehabilitation
Improving a person's skills through treatment and/or training to enable them to live a more fulfilling life in the community.

Reliability
The ability of a data gathering tool to obtain consistent results.

Responsible Medical Officer (RMO)
The consultant psychiatrist with medical responsibility for a service user.

Restriction order
Restriction orders can be added to some sections.The person must have been convicted of an offence for which imprisonment is a possible penalty. This order means that only the Home Secretary can allow discharge or time away from the hospital.

Risk assessment
Identifying aspects of a service which could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.

Risk management
Changing aspects of a service that could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.

Royal College of Nursing
This is a professional body that represents the interests of nurses, and provides support in professional matters.

Royal College of Psychiatrists (RCPsych)
This is the professional body for psychiatrists as well as the body that sets exams for those wishing to become psychiatrists.

Royal Pharmaceutical Society
The Society provides guidance for pharmacists (see definition) and pharmacy staff.

Schizoaffective Disorder
This condition displays symptoms of both schizophrenia and bipolar disorder.

Schizophrenia
This is a psychotic disorder marked by delusions, hallucinations, disordered thinking and speech,
inappropriate emotions and/or lack of emotions. It is characterised by serious disturbances of thought and perception which cannot be attributed to brain damage.

Seasonal affective disorder (SAD)
SAD is a form of depression linked to the seasons. Sufferers become depressed during autumn and winter.

Secondary care
Secondary care is specialist care, usually provided in hospital, after a referral from a GP or health professional. Mental Health Services are included in secondary care (see also tertiary care).

Section
This is used to refer to one of the sections of any Act of Parliament. A person who is detained in hospital under the Mental Health Act (1983) is commonly referred to as 'sectioned'.

Serious Untoward Incidents (SUIs)
This is a term used by many health organisations to describe a serious incident or event which led, or may have led, to the harm of patients or staff. Members of staff who were not involved in the incident investigate these and the lessons learned from each incident are used to improve care in the future.

Service user
This is someone who uses health services. Other common terms are patient, service survivor and client. Different people prefer different terms.

SHO (see Senior House Officer)

Single Assessment Process (SAP)
The Single Assessment Process (SAP) for older people was introduced in the National Service Framework for Older People.The purpose of the single assessment process is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively.

Specialist Registrar (SpR)
SpR grade is a recognised training grade in the progression of medical staff to Consultant status. It was formally known as Senior Registrar. On completion of the Senior House Officer (SHO) rotation, and passing the MRCPysch, the Specialist Registrar continues training in their chosen area of psychiatry.

SSRI (see Selective Serotonin Reuptake Inhibitor)

Section 12 Approved
Doctors who are approved by the secretary of State, having special knowledge of mental health and who are required to be involved in assessments under the Mental Health Act 1983.

Section 17
Section 17 of the Mental Health Act (1983) makes provision for patients who are liable to be detained under various sections of the act to be granted leave of absence.

Section 136
This section of the Mental Health Act (1983) enables a police officer to remove a person from a public place and take them to a designated place of safety, which may be a police station, a hospital, or other suitable place.

Selective Serotonin Reuptake Inhibitor (SSRI)
This is a type of antidepressant medication. An example is prozac (fluoxetine)

Senior House Officer (SHO)
This is the position gained by doctors after they are registered as a doctor by the General Medical Council. It is the second tier of trainee doctor (after preregistration house officer) in a hospital.

SEPIA
SEPIA is a computer package that is used to keep information about CPA (see definition).

Serious mental illness/Severe mental illness
These are mental health problems that are serious enough to warrant contact with mental health services.

Stakeholders
A range of people and organisations that are affected by, or have an interest in, the services offered by an organisation. In the case of hospital trusts, it includes patients, carers, staff, unions, voluntary organisations, social services, health authority, GPs, primary care groups and trusts in England, local health groups in Wales.

Standard
A measure, specification or object to which objects should conform or against which others are judged.A required degree of excellence.

Substance Abuse
This refers to the abuse or misuse of non-medical or 'recreational' drugs and/or alcohol. As well as physical
problems, some substance abuse can lead to psychological problems, such as depression, anxiety and, in some cases, psychosis.

Suicide
Taking one's own life.

Support Workers
Support workers provide support for clients and their carers under the supervision of a care coordinator which has been negotiated under the care programme approach.They can help people regain lost skills and develop new interests to help regain confidence and self esteem.

SUI (see Serious Untoward Incidents)

Talking treatments
These are psychological treatments in which improvement in a person's symptoms or wellbeing is achieved by talking with a therapist or counsellor rather than, or as well as, taking medication.

Tertiary Care
When a hospital consultant decides that more specialist care is needed. Mental Health Services are included in this. (see also Secondary care).

Titration
This is a method of determining what substances are in a person's system by testing bodily fluids. It can detect substances such as prescribed medication and also illegal substances such as drugs or alcohol. Dose titration means to slowly increase the dose of a drug to a level that can be maintained.

Tolerance
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 either alcohol or illegal drugs due to repeated use or exposure.

To-take-aways (TTAs)
TTAs are medicines supplied by pharmacy for service users going on leave from the hospital.

TTAs (see To-take-aways)

 

Acknowledgements: This glossary was compiled by North East London Mental Health Trust and East London and The City Mental Health Trust - please ensure that appropriate acknowledgement is made, even if you amend or add to the content.
A&E (Accident & Emergency) liaison
A service within A&E departments for mental health assessments and referral to specialist services.
Accreditation
An assessment by an external agency of an individual or organisation against defined criteria. For example, services providing ECT (see definition) must meet the standards set by the Royal College of Psychiatrists. If the standards are met satisfactorily the service is accredited by the Royal College of Psychiatrists.
Acute
An acute illness is one that occurs quickly, is intense or severe and lasts a relatively short period of time.
ADHD
(see Attention deficit hyperactivity disorder)
Admission
The point at which a person begins an episode of care (see definition), e.g. arriving at an inpatient ward.
Advance statements/directives
There are various types of advance statement/directive. They can include statements of an individual's wishes in certain 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 to be made.The individual should seek advice about the legal status of these statements/directives.They might be called Living Wills.
Advocate
An advocate is a person who can support a service user or carer through their contact with health services. Advocates will attend meetings with patients and help service users or carers to express concerns or wishes to health care professionals. Although many people can act as an advocate (friend, relative, member of staff) there are advocacy services available that can be accessed through the Trust.These advocates are trained and independent.
Affective disorder
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).
Aftercare
This is the support or care that a person can expect to receive once discharged from inpatient care.Typically a discharge plan will be developed by the multidisciplinary team with the service user which will make clear what care and support will be provided. (see Care Plan, CPA).
Agoraphobia
Agoraphobia is defined as a fear of open spaces. It also includes related fears such as fear of entering shops, fear of crowds and public places, or of travelling alone. A person may feel an intense fear of being caught or trapped in a situation when they can't get help. It is often associated with panic attacks.
Alternative therapies
(see also Complementary therapies) These are therapies that are not part of current standard medical practice (for example acupuncture, reflexology or aromatherapy). Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment.
Alzheimer's Disease (See Dementia)
Anorexia nervosa
This is an illness that is characterised by a refusal to eat, an avoidance of eating or a careful and low intake of food.The person can become malnourished to the point of starvation.Their perception of their own body size may become distorted and they will continue to perceive themselves as being fat.
Antidepressants
Antidepressants aim to treat the symptoms of depression and can help people experiencing depression to feel more motivated and energetic.This group of medication may also be used to treat obsessive-compulsive disorder, anxiety and eating disorders.There are different types of antidepressants including tricyclic and selective serotonin reuptake inhibitors (SSRIs).
Antipsychotic medication
Anti psychotic medication is normally given to treat the symptoms of schizophrenia and, in some cases, manic depression and manias.The two main types of antipsychotics are called typical and atypical (see definitions).The main difference between the two groups is in their side effects.
Anxiety
This is the term used to describe experiences such as chronic fear, tension and panic attacks. Some people have an overwhelming feeling of dread that prevents them getting on with everyday life. Sleepless nights and recurring thoughts are common, as well as nausea, palpitations, dizziness and difficulty in breathing. Anxiety is the most common mental health problem people experience.
Anxiety disorders
These are disorders that involve a continuous state of anxiety or fear, lasting at least a month, marked by constant apprehension, difficulties in concentration and a pounding heart. Physical symptoms may also be present, such as headaches, sweating, irritability, and nausea. Anxiety disorders include panic disorder and obsessive-compulsive disorder. Depression is common in those with anxiety disorders.
Appropriateness of care
When in a clinical situation, the expected benefits (e.g. improved symptoms) of care outweigh the expected negative effects (e.g. drug side effects) to such an extent that the treatment is worth carrying out.
Approved Social Worker (ASW)
Approved Social Workers (ASW) have specialist training and experience in identifying disorders of mental health and are familiar with the problems experienced by users of 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 community mental health teams.They will organise social care support for people in contact with mental health services, such as helping with housing and getting welfare benefits.They work closely with health professionals and, under the current Mental Health Act, they work with two doctors to assess a person who may need admitting to hospital. Social workers can also act as care coordinators for people on care programmes.
Aromatherapy
Aromatherapy involves the use of therapeutic oils derived from plants to stimulate the body's nerves to help a person feel either more relaxed or energised. It is often used with massage or in the bath.Various oils are available and are divided into different fragrance families: relax, body, energy, mind and soul.
Art therapy
Art therapy aims to support people's recovery using art as a creative process and as a therapy to help people resolve emotional conflicts, be more aware about themselves, develop social skills, reduce anxiety and increase their self-esteem.
Asperger's Syndrome (see Autism)
Assertive Outreach
Assertive outreach services aim to support people in the community who find it difficult keeping in contact with mental health services.
Assessment
Assessment happens when a person first comes into contact with health services. Information is collected in order to identify the person's needs and plan treatment.
Attention deficit hyperactivity disorder (ADHD)
People with ADHD have three main kinds of problems: difficulty concentrating or paying attention, overactive behaviour and impulsive behaviour. ADHD is a developmental problem that usually starts in childhood. Some people have significant problems in concentration and attention, but are not necessarily overactive or impulsive.These people are sometimes described as having Attention Deficit Disorder (ADD) rather than ADHD.
Atypical antipsychotics (see also Antipsychotic medication)
Atypical antipsychotic medication is a group of new antipsychotic drugs that have a different set of side effects from the older, typical, antipsychotics. In general they cause fewer movement disorders such as tremor, muscle stiffness and restlessness.
Audit cycle
The process of carrying out a clinical audit project follows a cycle of identifying a topic, setting standards, measuring current practice against these standards, agreeing recommendations and implementing change. This cycle is repeated to ensure change has occurred and improvement is maintained.
Autism
Autism is a lifelong developmental disorder that affects the way a person communicates and relates to people around them. In the great majority of cases, autistic disorders are present from birth or become apparent within the first three years of life. People with typical autism have no interest in social interaction, little or no language, and tend to live in their own world. Asperger's syndrome often applies to those who are more able, who have better language development, and who have more social contact. Asperger's syndrome may first come to notice in adult life.
Baby Blues
A period of mild depression after childbirth, the baby blues tends to last a few hours or a few days and then disappears. Not to be confused with postnatal depression (see definition).
Benchmarking
A way of comparing a particular process and outcomes in one organisation with another organisation. Each organisation can then examine and change their own processes to achieve better outcomes.
Bipolar Affective Disorder
This is also known as manic depression or bipolar disorder. It is a disorder characterised by swings in a person's mood from very high (mania) to very low (depression).
Bipolar Disorder (see Bipolar Affective Disorder)
Borderline Personality Disorder (BPD)
This is a personality style marked by unstable moods and unsatisfactory personal relationships.They often have problems with impulsivity, substance abuse (see definition) and impulsive spending.Those with BPD may also suffer from depression, anxiety and the fear of being abandoned. (see also Personality Disorder)
British Psychological Society (BPS)
This is the professional body for psychologists.
Bulimia
Symptoms of bulimia may include chaotic eating, bingeing, vomiting and abuse of laxatives.
Caldicott Guardian
A senior healthcare professional in each NHS organisation is responsible for safeguarding the confidentiality of patient information.The name comes from the Caldicott Report, which identified 16 recommendations for the use and storage of patientidentifiable information.
CAMHS
(see Child and adolescent mental health services)
Capacity
This term means that a patient has the ability to understand and retain information about their medical condition and their need for treatment.
Care Co-ordinator
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 care under the Care Programme Approach they will be told who their care co-ordinator is.The care co-ordinator is likely to be community mental health nurse, social worker or occupational therapist.
Care plan
A care plan is a written plan that describes the care and support staff will give a service user. Service users should be fully involved in developing and agreeing the care plan, sign it and keep a copy. (see Care Programme Approach)
Care Programme Approach (CPA)
The Care Programme Approach is a standardised way of planning a person's care. It is a multidisciplinary (see definition) approach that includes the service user, and, where appropriate, their carer, to develop an appropriate package of care that is acceptable to health professionals, social services and the service user. The care plan and care co-ordinator are important parts of this. (see Care Plan and Care Co-ordinator).
Carer
A carer is someone who looks after their relatives or friends on an unpaid, voluntary basis often in place of paid care workers.
Casemix
Relative frequency of different diagnoses or conditions among patients.
Cause
A reason or explanation for a problem or illness based on analysis and/or investigation.
CBT (See Cognitive Behavioural Therapy)
CHI (See Commission for Health Improvement)
Child and Adolescent Mental Health Services (CAMHS)
CAMHS is a term used to refer to mental health services for children and adolescents. CAMHS are usually multidisciplinary teams including psychiatrists psychologists, nurses, social workers and others.
Chronic
A condition that develops slowly or lasts a long time.
Client (see also service user)
An alternative term for patient which emphasises the professional nature of the relationship between a clinician or therapist and the patient.
Client-centred therapy
Client-centred therapy emphasises the importance of empathy in healing.The therapist provides an environment of empathy, unconditional positive regard, acceptance and support.
Clinical audit
A process used to measure the quality of aspects of care and services and to improve that quality.
Clinical audit facilitator
A person who provides advice and technical support on the subject of clinical audit.
Clinical Psychologist
This is someone who has a Psychology Degree together with clinical training in psychology.They are trained in research, assessment and the application of different psychological therapies.
Clinical team
A team of health care professionals from different disciplines (e.g. nursing, psychiatry, occupational therapy).
Clinician
A person who provides direct care to a patient such as a doctor, nurse, therapist, pharmacist, psychologist etc.
CMHT
(see Community Mental Health Team)
Cognitive Behavioural Therapy (CBT)
This is an approach to treatment that involves working with people to help them change their emotions, thoughts and behaviour.A person's personal beliefs are addressed in order to understand and change behaviour.
College of Occupational Therapy (COT)
This is the professional body that represents occupational therapists and produces guidance.
Co-morbidity/ Co-morbid
The presence of two or more disorders at the same time. For example, a person with depression may also have co-morbid obsessive compulsive disorder.
Clinical effectiveness
Clinical effectiveness focuses on ensuring that staff are providing the best and most effective care for people using health services.This is done using a variety of methods including clinical audit and evidence-based practice.
Clinical governance
A framework that ensures that NHS organisations monitor and improve the quality of services provided and that they are accountable for the care they provide.This is monitored by the Commission for Health Improvement (see definition).
Clinical guidelines/clinical practice guidelines
Systematically developed statements, based on scientific research, which assist in decision-making about appropriate healthcare for specific clinical conditions.
Clinical information
Information about diagnoses, treatments and their outcomes.
Clinical Negligence Scheme for Trusts (CNST)
A scheme for assessing a Trust's arrangements to minimise clinical risk for service users and staff. Trusts need to pay 'insurance' which can offset the costs of legal claims against the Trust. Achieving CNST Levels (1, 2 or 3) shows the Trust's success in minimising clinical risk and reduces the premium that the Trust must pay.
Clinical pathways
Different ways of describing and/or prescribing a 'plan' for providing a particular health service.
Community Mental Health Team (CMHT)
A multidisciplinary team offering specialist assessment, treatment and care to people in their own homes and the community.
Community Psychiatric Nurse (CPN)
CPNs are registered nurses who work with people in the community.They work as part of a team and, like other members of the team, may see people in a variety of settings such as at a GP surgery, in a clinic or health centre or in a client's own home.They work closely with GPs (see General Practitioner definition) and other health professionals.They provide practical advice, ongoing support with problems, supervise medication, give injections and help with counselling. They also work out care plans with other members of the team, service users and carers.
Complementary therapies
These are therapeutic practices or techniques that are not currently considered an integral part of conventional medical practice.Therapies are termed as complementary when used in addition to conventional treatments and as alternative when used instead of conventional treatment. (see also Alternative therapies)
Complex needs
This is a combination of medical needs (e.g. diagnosis, treatment and rehabilitation) and social needs (e.g. housing, social care and independent living).
Compliance
This term means that written standards are met. It is also used to refer to service users following agreed care plans (including taking prescribed medication).
Commission for Audit and Inspection in Healthcare (CHAI)
The Commission for Healthcare Audit and Inspection (CHAI) help improve the quality of healthcare by ensuring an independent assessment of the standards of services provided to patients, whether it is provided by the NHS or privately. By routinely publishing information, it will also allow the public to assess how well tax-payers' money is being spent in delivering healthcare. CHAI will take on the functions of CHI (see definition) and other inspection bodies.
Commission for Health Improvement (CHI)
An independent body set up to monitor clinical governance in NHS organisations. (see Clinical Governance).This body was replaced by the Commission for Audit and Inspection in Healthcare (CHAI see definition) in April 2004.
Commissioner
Primary Care Trusts are responsible for buying (commissioning) specialist mental health services on behalf of the people living in the district.They have an allocation of money and decide which services to commission.The service provider is chosen and given the money to make sure the service is delivered according to the contract. Services may be commissioned from the NHS or the voluntary or private sector.
Community Care
Community Care aims to provide health and social care services in the community to enable people to live as independently as possible in their own homes or in other accommodation in the community.
Controls assurance
The way that an organisation checks that its policies are being carried out.This includes internal and external audit for financial matters, employment policies and all areas in which the organisation interacts with the public.
CORE
The CORE Outcome Measure is one way to find out if an intervention has been successful. It includes both the service user's and the clinician's assessment of the treatment.
Counselling
Counselling is a talking therapy that usually deals with a recent distressing event.The length of time that counselling is needed varies from person to person.
Court of Protection
The Court of Protection has several roles in looking after the financial affairs of people who cannot legally do it themselves.These include making Enduring Powers of Attorney (see definition), making wills, and generally giving directions and orders for the management of the property and financial affairs.
Compulsive eating
This may occur when people experience loneliness or distress and use food for comfort. Food may make them happier on a temporary basis but as food increasingly dominates a person's life, he or she becomes more unhappy, finds it more difficult to exercise real control and, gaining more weight, puts his or her own health at greater risk.
Conditional discharge
Where a restricted patient under the Mental Health Act is discharged subject to specific conditions and liable to be recalled by the Home Secretary.
Conduct Disorder
This is a persistent pattern of behaviour that involves violation of the rights of others. Verbal and physical aggression are central features of conduct disorder.
Consent to treatment
If you are an informal patient, you have the right to refuse any treatment you do not wish.You have a right to receive full information about the treatment, its purpose and possible side effects. If consent is not obtained the treatment cannot normally be given.
Consultant Psychiatrist
A Consultant Psychiatrist is a trained mental health doctor with additional specialist training in psychiatry. The consultant is medically responsible for the care of people receiving mental health services and also supervises junior doctors.
Contraindication
A situation in which medication should not be used. For example because of a physical condition, other medications, pregnancy.
CPA (see Care Programme Approach)
CPN (see Community Psychiatric Nurse)
Crisis Resolution Team
A crisis resolution team aims to respond to people in crisis. It aims to provide an assessment and treatment service, 24 hours a day, wherever people are.
Depression
Depression is one of the most common forms of mental health problem and can occur to people of all ages. Symptoms include feelings of despair, hopelessness and worthlessness, an inability to cope, sleep problems and sometimes thoughts of suicide. Often people with depression will complain of physical problems (e.g for example headaches, stomach problems) rather than depression when consulting their GP. Various treatments are available for depression including antidepressant medication, talking treatments such as CBT (see definition), or counselling (see definition).
Diagnosis
Identifying an illness or problem by its symptoms and signs.
Diagnostic and Statistical Manual (DSM)
This is a manual that classifies mental health problems and is used to diagnose people's mental health problems.The American Psychiatric Association publishes it.
Directorate
Services in NHS organisations are usually grouped into directorates. Medical services (e.g. psychiatry) are grouped into the Medical Directorate. Nursing staff and services make up the Nursing Directorate.The way in which directorates are organised changes from Trust to Trust.
Discharge
The point at which a person formally leaves services. On discharge from hospital the multidisciplinary team and the service user will develop a care plan. (see Care plan)
Deliberate self harm
Where a person injures or harms himself or herself intentionally. Common forms are self-poisoning or cutting.
Delirium
A condition including severe confusion, disorganized thinking, disorientation and restlessness. Delirium may be caused by physical agents such as infections, toxic substances, metabolic disorders or strokes. Delirium Tremens, "the trembling delirium" is a type of delirium that affects people on alcohol withdrawal after a long period of heavy drinking. Its main symptoms are uncontrollable trembling along with the symptoms mentioned above.
Delusion
A fixed, false belief.
Dementia
Dementia is characterised by confusion, memory loss, poor problem-solving and poor concentration.There are many diseases that lead to dementia, the most common being Alzheimer's disease. Dementia usually occurs in older people. Dementia in people under 65 is known as early onset dementia. Dementia with Lewy bodies (DLB) is a rarer form of dementia that shares characteristics with both Alzheimer's and Parkinson's diseases.Vascular dementia occurs when cells in the brain are deprived of oxygen. Many symptoms are the same as other forms of dementia, however there are some differences.
Dependence
Dependence refers to when a person is reliant on a substance or person to help them function on a day-to-day level. It can also be used to refer to a person who has become reliant on a medication to function in society.
Dissociative disorders
This is a disorder in which normal consciousness or identity is split or altered, often as a result of an intense psychological trauma.
Dose
A specific, set amount of medication administered.
Drama therapy
Drama therapy aims to help a person use drama as part of their recovery process. It can give a person an opportunity for reflection and to tell their story to help solve a problem and achieve a relief of strong suppressed emotions.
Dual diagnosis
Dual diagnosis refers to two or more disorders affecting one person. For example, mental illness and learning disability. It is also used to indicate that a person who has been diagnosed with a mental health problem also misuses substances, such as illegal drugs, legal drugs or alcohol.
Early intervention service
Early intervention services provide support and treatment in the community for young people with psychosis and their families.The aim is to reduce the period of untreated psychosis, which in turn, evidence shows, is likely to lessen future problems and improve the person's health and well being in the long term.
Eating disorders
Examples of eating disorders are anorexia nervosa, bulimia and compulsive eating.They are often an expression of deep emotional difficulties and low self esteem. Depression, disturbed sleep patterns, restlessness and disturbance of bodily functions are some of the effects of eating disorders.
ECT (see Electroconvulsive therapy)
Efficacy
How well something works.This term is used to refer to treatments in particular.
Electroconvulsive therapy (ECT)
In ECT a small, carefully controlled amount of electricity is sent through the brain of a person who has been given an anaesthetic and muscle relaxant. This produces a mild seizure or convulsion. It is used for cases of severe mental illness, usually depression, where the patient has not responded to other treatments or medication.The Department of Health has issued strict guidelines on the use of this therapy.
Emergency powers
The powers to detain a person for an initial assessment to determine whether the use of compulsory powers is appropriate. For example a Section 136 or a Section 5(2).
Enduring Power of Attorney (EPA)
An Enduring Power of Attorney (EPA) is a legal document that enables someone to appoint one or more persons to manage their financial affairs and property, either now or in the future.
Episode of care
The period when a service user enters the care of the Trust to when they are discharged from all services provided by the Trust. This care could be, for example a combination of care provided by inpatient stays, outpatient attendances, a CPN, or use of services from an OT and a day hospital.
Evaluation
Judging the value of something by making a comparison.
Evidence-based medicine/practice
This can be known as evidence-based healthcare, evidence-based medicine or evidence-based practice. It involves using available evidence, particularly research, to plan how to treat specific conditions.The process aims to find a comfortable compromise between the evidence, clinicians' views and experiences and service users' views.
Evidence-based recommendations
A decision about management based primarily on evidence from scientific literature.
Exposure therapy
Exposure therapy is a form of cognitive behavioural therapy used to help people who have experienced traumas. It uses careful, repeated and detailed experience of the real or imagined trauma in a safe and supportive environment to help the person face and gain control of the fear and distress that was overwhelming.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a relatively new treatment to help people deal with trauma. It involves elements of exposure therapy (see definition) and cognitive behavioural therapy (see definition), combined with other techniques.
Formal patient
This is a person who has been detained in hospital under the Mental Health Act (1983).
Guideline
A recommendation of good practice usually based on research evidence.
General Practitioner (GP)
A family doctor, usually patients' first point of contact with the health service.
Hallucinations
They are disorders of perception or a perception without a stimulus.There are various different types of hallucinations including; auditory (hearing sounds or voices), olfactory (smells), tactile (sensation), visual (seeing things) or gustatory (taste).The most common are hearing voices or seeing things that don't really exist. Hallucinations are common psychotic disorders. Hallucinations may also occur after illegal drug use and some prescribed drugs (e.g. steroids).
Health Care Assistants (can also be referred to as Health Care Support Workers)
Health Care Assistants are non-qualified nursing staff who undertake assigned tasks involving direct care in support of a registered/qualified nurse.There are two grades of Health Care Assistants, A and B grade. A grades would expect to be more closely supervised, while B grades may regularly work without supervision for all or most of their shift, or lead an A grade).
Health of the Nation Outcome Scales (HONOS)
HoNOS is probably the outcome measure most widely used by English mental health services.The scales are completed after routine clinical assessments in any setting and have a variety of uses for clinicians.
Home treatment team
A team usually consisting of a psychiatrist, nurse andsocial worker. The team provides a mobile serviceoffering availability 24 hours, seven days a week and animmediate response. The team provides a gate keepingfunction to hospital admission and enables earlier discharge from hospital.
HONOS (see Health of the Nation Outcome Scales)
Human resources
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 conditions.
Huntingtons Disease
Huntingtons Disease is a genetically inherited condition that causes both physical and mental problems. It also features alternating periods of aggression, anger, excitement and depression, and progressive loss of memory and personality (Dementia).These psychiatric disturbances may appear before the movement disorder or may develop later. Bizarre behaviour alone may be the first sign of the disease.
Hyperactivity
Hyperactivity is marked by high levels of activity and restlessness. It can be treated by medication or diet.
Hypomania
This is a less severe form of mania (see mania) that 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.
Hysteria
It is a psychosomatic (see definition) disorder caused by a powerful psychological disturbance or need. Someone with it is usually completely unaware of the psychological basis of the problem. It is often impossible to convince the person that there is no physical basis for the upset, even after many investigations have ruled out the possibility of a physical cause.This is called denial.The strength of the denial in hysteria shows the enormous power of the subconscious mind. Hysteria is often a defence mechanism of the mind to protect it against the effects of some traumatic and unpleasant experience.
ICD-10(International Classification of Disorders)
The ICD is a form of classifying mental health problems and assists clinicians in diagnosing problems.The number 10 represents the 10th edition of the book.
IM&T (see Information Management and Technology)
Incapacity
Incapacity means that a patient does not have the ability to understand and retain information about their medical condition and their need for treatment.
Informal patient
An informal patient is a person in hospital voluntarily. Most people admitted to hospital are informal patients. They are designed to be used before and after interventions so that changes attributable to the interventions (outcomes) can be measured.
Information Management and Technology (IM&T)
This refers to the use of information held by the Trust, in particular computerised information.
Information sharing
The responsibility of professionals across agencies to share relevant information to ensure that everyone involved in a person's care is informed.
Integrated Care Pathway
Integrated Care Pathways are a multi-disciplinary and multi-agency approach to mapping patients' care from admission through to discharge and ongoing care.The aim is pull together all the information into one file that will make it easier for the clinicians involved to give the best care for the patient.
Interdisciplinary
This refers to work or care that links across professional boundaries. For example, when doctors and nurses work together to provide care.
Keyworker(see Named Nurse)
Korsakoff 's syndrome
This is a problem that usually occurs in people who have had severe, long-term alcohol abuse problems. It is characterised by marked short-term memory loss.
Locality
Mental Health Trusts provide services to several localities. Localities are areas that have distinct boundaries.
Locum
A temporary health or social care professional.This person does not have a permanent contract with the Trust.
Learning disabilities
These are impairments in a specific mental process that affects learning.The conditions can exist to varying degrees in different people.
Local Implementation Team (LIT)
Local Implementation Teams bring together a wide group of stakeholders (see definition) in mental health, including service users and carers, to plan and oversee the development of mental health services in their local area. In the future they will work closely with primary care, which is responsible for commissioning mental health services.
Mania
Mania is characterised by a person feeling overexcited, elated, physically overactive and rapidly changing their ideas (scattered or tangential thoughts). It is a symptom of bipolar disorder (manic depression).
Manic depression (see Bipolar Affective Disorder)
Mental Health Act (1983) (MHA)
The Mental Health Act (1983) is a law that allows the compulsory detention of people in hospital for assessment and/or treatment for mental disorder. People who are detained under the mental health act must show signs of mental disorder and need assessment and/or treatment because they are a risk to themselves or a risk to others. People who are detained have rights to appeal against their detention.
Mental Health Act Commission (MHAC)
The Mental Health Commission (MHAC) has a legal responsibility under the Mental Health Act (MHA) to protect the interests of all patients detained under the MHA in England and Wales.
Mental Health Act Hospital Managers
For the purposes of the Mental Health Act (see definition) Trusts are defined as Mental Health Act Hospital Managers. In practice, these are usually nonexecutive directors and/or lay people appointed by the Trust to carry out the Trust's responsibilities under the Mental Health Act.
Mental Health Review Tribunal
This is an independent panel of people.A detained 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 Courts against Mental Health Review Tribunal decisions.
Mental Health Minimum Data Set
This has been developed to collect person-centred information and record packages of care received by an individual.This is collected by the Trust and submitted to the Department of Health.The data reported is numbers not names.
MIND
Mind is a leading mental health charity in England and Wales. It works to create a better life for everyone with experience of mental distress.
MRCPsych
MRCPsych is the entrance exam to the Royal College of Psychiatrists and must be passed before a doctor can become a Consultant Psychiatrist.
Monitoring
Observing activity in relation to defined specifications, standards or targets, directly or through reports or indicators - did what was intended happen? For example, monitoring the effects of antidepressants to treat depression.
Multidisciplinary
Multidisciplinary denotes an approach to care that involves more than one discipline.Typically this will mean that doctors, nurses, psychologists and occupational therapists are involved.
Music therapy
This form of therapy uses music and therapeutic approaches to help people attain goals.These goals can be mental, physical, emotional, social and/or spiritual.
Named Nurse
This is a ward nurse who will have a special responsibility for a patient while they are in hospital.
National guideline
A broad statement of principle about what constitutes appropriate care.
National Institute for Clinical Excellence (NICE)
It provides clinical staff and the public in England and Wales with guidance on current treatments. It coordinates the National Collaborating Centres from whom it commissions the development of clinical practice guidelines.
National Service Frameworks (NSF)
National Service Frameworks are issued by the government and provide guidance and standards for health services to be to working towards.There is an NSF dedicated to mental health that set standards around mental health promotion, treatment and service user involvement.There is also an NSF for Older People that has a section on mental health for older people.This term should not to be confused with the National Schizophrenia Fellowship, which is now called Rethink.
Nearest Relative (see Next of Kin)
Negative symptoms
These are psychotic symptoms characterised by a lack of expected behaviour, such as lack of energy, emotion, movement or motivation.
Neurosis
Neurosis is used to describe anxiety disorders such as anxiety and phobias.
Next of Kin
The term next of kin is widely used, but there is no statutory definition. In practice the general rule has been to recognise spouses and blood relatives as next of kin.The Mental Health Act 1983 defines a list of certain people who can be treated as the 'nearest relative' of a patient. A 'nearest relative' has a number of important powers and functions, including the right to discharge a patient who has been formally detained in hospital, make an application for a person to be admitted for assessment, treatment or guardianship and also to object to applications for treatment or guardianship being made by a social worker. Only certain categories of people can become a 'nearest relative'. First in the list are spouses, and then unmarried heterosexual couples who have lived together for 6 months. A same sex partner could only become a nearest relative after a period of 5 years.
NICE (see National Institute for Clinical Excellence)
Nominated person
A person who is appointed to represent a patient in discussions in matters related to their care.
Non-executive Director
A Non-executive Director is a member of the Trust Board.They act as a two way representative.They bring the experiences, views and wishes of the community and patients to the Trust Board.They also represent the interests of the NHS organisation to the Community
NSF (see National Service Frameworks)
Obsessive-compulsive disorder (OCD)
OCD is a problem characterised by obsessive thoughts and compulsive behaviour.The behaviour can take various forms such as cleaning or checking rituals in which the person will repeatedly clean themselves or their house or check, for example, that doors are locked and/or electrical sockets are turned off. Dermatological problems are common in people who repeatedly wash their hands. People with OCD can be treated using cognitive behavioural treatment and/or antidepressants.
Occupational Therapist
Occupational therapists use purposeful activities to treat people with physical and/or mental health problems. They work as part of a team to identify problems caused by people's conditions and find ways of coping with these to encourage independence and a better quality of life.
Occupational Therapy
Occupational therapy uses goal-directed activities, appropriate to a person's age and social role, to restore, develop or maintain the ability for independent living.
OCD (see Obsessive Compulsive Disorder)
Outcome
In health services this refers to any change in a person's wellbeing following a period of treatment.The expected outcome will usually be an improvement in symptoms or the resolution of a problem.
Outcome scale/measure
Outcome scales and measures are standard ways of assessing or evaluating the difference made to a person's wellbeing by a course of treatment. A person will usually rate himself or herself, or be rated by a health professional, against a set of questions or standards about their symptoms, feelings and wellbeing. This is usually done at the beginning of, and after a period of, treatment. Any improvement or decline will be shown by changes in the outcome scale ratings. An example of an outcome scale is HONOS (see definition).
Parkinson's disease
Parkinson's Disease is more common in older people. The disease affects the connections in the brain causing them to malfunction.This results in movement disorders such as tremor and stiffness.The disease progresses steadily over years eventually causing severe physical and mental disability. Symptoms can be treated with medication.
Patient Administration System (PAS)
A computer system used to record information about the care provided to service users.The data can only be accessed by authorised users. PAS will soon be replaced by a newer system.
PCT (see Primary Care Trust)
Personality Disorders
It is common for someone with a personality disorder to be impulsive, have high levels of sensitivity, be aggressive, attention seeking and overly dependent on others. However there is a lot of debate about this disorder. The World Health Organisation defines them as "deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations." (see also Borderline Personality Disorder).
Pharmacist
A healthcare professional who ensures that medication that service users receives are safe, effective and appropriate.
Pharmacy
The department that supplies medicines.
Patient Advice and Liaison Service (PALS)
All NHS trusts are required to have a Patient Advice and Liaison Service.The service offers patients information, advice, quick solution of problems or access to the complaints procedure.
Patient Environment Action Team (PEAT)
A team that visits hospitals to check on cleanliness.
Power of attorney (see Enduring Power of Attorney)
Primary Care
Primary care is the care that you will receive when you first come into contact with health services about a problem.These include family health services provided by GPs, dentists, pharmacists, opticians, and others such as community nurses, physiotherapists and some social workers.
Primary care liaison team
A service working closely with GPs for clients who cannot be effectively managed in an ordinary primary care setting.The team takes a key role in the organisation and delivery of service working closely with statutory and non-statutory agencies and transferring patients between services as required. The team offers risk assessment of clients, advice and short to medium term psychological therapies.
Primary Care Trust (PCT)
This is the organisation that looks after primary care (see definition). PCTs are commissioners (see definition)
Procedure
A procedure is a series of actions taken in a definite and established order.This can refer to a treatment plan or to general activities.
Protocol
A local policy or strategy that defines appropriate action. (see Policy)
Phobias
This is an extremely common problem in the general population. Phobias are irrational and uncontrollable fears of an object or situation that most people can face without anxiety.The object or situation will trigger feelings of intense panic and the sufferer will go to great lengths to avoid them. Common phobias are fear of flying, spiders and enclosed spaces.
PICU (see Psychiatric Intensive Care Unit)
Policy
Policies are produced by organisations to clearly outline what staff must do, and not do, in certain situations.
Positive symptoms
Positive symptoms refer to psychotic symptoms such as false beliefs and hallucinations (see definition).
Postnatal depression
Postnatal depression can occur any time in the first year after having a baby and most commonly occurs within 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 by feelings of guilt about not being able to cope or look after the baby. Not to be confused with baby blues (see definition).
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops following an unusually threatening event. Symptoms include flashbacks, nightmares and intense distress when exposed to an object or situation that is related to the traumatic event.
Psychiatric Intensive Care Unit (PICU)
A Psychiatric Intensive Care Unit (PICU) is a locked ward in a hospital where some people detained under the Mental Health Act may stay. Patients are placed in PICU because they are assessed as being a risk to themselves or others on an open acute inpatient ward.
Psychiatrist
A doctor who specialises in the diagnosis and treatment of people who are mentally ill. Psychiatrists have undergone specialist training and may diagnose illness, prescribe medication and other forms of appropriate treatment.They also decide whether to admit people to and discharge from hospital.
Psychoanalysis
This is a type of therapy that focuses on unconscious motives and conflicts.The use of dream recall and free associations can be used in psychoanalysis.
Psychodynamic therapy
This is a form of psychotherapy in which the patient talks and the therapist makes interpretations about the patient's words and behaviour.
Psychodrama (see Drama Therapy)
Psychologist
Psychologists have skills in the assessment and treatment of mental illness and psychological problems. Unlike psychiatrists they are not medical doctors, their skills include assessing cognitive functions (for example, speech and thought) and providing talking interventions including psychotherapy and counselling.
Psychopharmacology
The management of psychiatric illness using medication such as antidepressants or antipsychotics.
Psychosis
Psychosis, or psychotic disorders, involves distorted perceptions of reality and irrational behaviour, often accompanied by hallucinations and delusions.
Psychosomatic disorder
In some illnesses, psychological factors seem to play a particularly important part.They can influence not only the cause of the illness, but can also worsen the symptoms and affect the course of the disorder.These illnesses are termed psychosomatic disorders. Because psychological factors are important in every illness, there is lack of agreement as to what should be considered a psychosomatic disorder.
Psychotherapist
Psychotherapists help people to be in more control of their own lives by exploring emotional difficulties and helping them understand themselves and their relationships with others.They provide consultation and intervention on a one to one basis and in groups.
Psychotherapy
The treatment of mental health, emotional and personality problems through talking with a therapist. There are many different types of psychotherapy.
Quality improvement
This is a general term for various methods of improving the quality of services that are provided to service users.
Randomised controlled trial (RCT)
A type of research or experiment used to compare the effectiveness of different treatments. Patients are randomly assigned to groups.The groups either receive the treatment being assessed or are a control group. The control group receive dummy (placebo) medication. RCTs offer the most reliable form of evidence for effectiveness.
Rapid cycling
When a person with bipolar disorder experiences four or more mood episodes (mania, hypomania or depression) within a year.
Reflexology
This is a type of alternative or complementary therapy that uses pressure points on the feet to promote health and well-being.
Rehabilitation
Improving a person's skills through treatment and/or training to enable them to live a more fulfilling life in the community.
Reliability
The ability of a data gathering tool to obtain consistent results.
Responsible Medical Officer (RMO)
The consultant psychiatrist with medical responsibility for a service user.
Restriction order
Restriction orders can be added to some sections.The person must have been convicted of an offence for which imprisonment is a possible penalty. This order means that only the Home Secretary can allow discharge or time away from the hospital.
Risk assessment
Identifying aspects of a service which could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.
Risk management
Changing aspects of a service that could lead to injury to a patient or staff member and/or to financial loss for an individual or Trust.
Royal College of Nursing
This is a professional body that represents the interests of nurses, and provides support in professional matters.
Royal College of Psychiatrists (RCPsych)
This is the professional body for psychiatrists as well as the body that sets exams for those wishing to become psychiatrists.
Royal Pharmaceutical Society
The Society provides guidance for pharmacists (see definition) and pharmacy staff.
Schizoaffective Disorder
This condition displays symptoms of both schizophrenia and bipolar disorder.
Schizophrenia
This is a psychotic disorder marked by delusions, hallucinations, disordered thinking and speech,
inappropriate emotions and/or lack of emotions. It is characterised by serious disturbances of thought and perception which cannot be attributed to brain damage.
Seasonal affective disorder (SAD)
SAD is a form of depression linked to the seasons. Sufferers become depressed during autumn and winter.
Secondary care
Secondary care is specialist care, usually provided in hospital, after a referral from a GP or health professional. Mental Health Services are included in secondary care (see also tertiary care).
Section
This is used to refer to one of the sections of any Act of Parliament. A person who is detained in hospital under the Mental Health Act (1983) is commonly referred to as 'sectioned'.
Serious Untoward Incidents (SUIs)
This is a term used by many health organisations to describe a serious incident or event which led, or may have led, to the harm of patients or staff. Members of staff who were not involved in the incident investigate these and the lessons learned from each incident are used to improve care in the future.
Service user
This is someone who uses health services. Other common terms are patient, service survivor and client. Different people prefer different terms.
SHO (see Senior House Officer)
Single Assessment Process (SAP)
The Single Assessment Process (SAP) for older people was introduced in the National Service Framework for Older People.The purpose of the single assessment process is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively.
Specialist Registrar (SpR)
SpR grade is a recognised training grade in the progression of medical staff to Consultant status. It was formally known as Senior Registrar. On completion of the Senior House Officer (SHO) rotation, and passing the MRCPysch, the Specialist Registrar continues training in their chosen area of psychiatry.
SSRI (see Selective Serotonin Reuptake Inhibitor)
Section 12 Approved
Doctors who are approved by the secretary of State, having special knowledge of mental health and who are required to be involved in assessments under the Mental Health Act 1983.
Section 17
Section 17 of the Mental Health Act (1983) makes provision for patients who are liable to be detained under various sections of the act to be granted leave of absence.
Section 136
This section of the Mental Health Act (1983) enables a police officer to remove a person from a public place and take them to a designated place of safety, which may be a police station, a hospital, or other suitable place.
Selective Serotonin Reuptake Inhibitor (SSRI)
This is a type of antidepressant medication. An example is prozac (fluoxetine)
Senior House Officer (SHO)
This is the position gained by doctors after they are registered as a doctor by the General Medical Council. It is the second tier of trainee doctor (after preregistration house officer) in a hospital.
SEPIA
SEPIA is a computer package that is used to keep information about CPA (see definition).
Serious mental illness/Severe mental illness
These are mental health problems that are serious enough to warrant contact with mental health services.
Stakeholders
A range of people and organisations that are affected by, or have an interest in, the services offered by an organisation. In the case of hospital trusts, it includes patients, carers, staff, unions, voluntary organisations, social services, health authority, GPs, primary care groups and trusts in England, local health groups in Wales.
Standard
A measure, specification or object to which objects should conform or against which others are judged.A required degree of excellence.
Substance Abuse
This refers to the abuse or misuse of non-medical or 'recreational' drugs and/or alcohol. As well as physical
problems, some substance abuse can lead to psychological problems, such as depression, anxiety and, in some cases, psychosis.
Suicide
Taking one's own life.
Support Workers
Support workers provide support for clients and their carers under the supervision of a care coordinator which has been negotiated under the care programme approach.They can help people regain lost skills and develop new interests to help regain confidence and self esteem.
SUI (see Serious Untoward Incidents)
Talking treatments
These are psychological treatments in which improvement in a person's symptoms or wellbeing is achieved by talking with a therapist or counsellor rather than, or as well as, taking medication.
Tertiary Care
When a hospital consultant decides that more specialist care is needed. Mental Health Services are included in this. (see also Secondary care).
Titration
This is a method of determining what substances are in a person's system by testing bodily fluids. It can detect substances such as prescribed medication and also illegal substances such as drugs or alcohol. Dose titration means to slowly increase the dose of a drug to a level that can be maintained.
Tolerance
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 either alcohol or illegal drugs due to repeated use or exposure.
To-take-aways (TTAs)
TTAs are medicines supplied by pharmacy for service users going on leave from the hospital.

TTAs (see To-take-aways)