NHSNorth East LondonMental Health NHS Trust

East London & The CityMental Health NHS Trust

Glossary:

Mental Health

Designed and printed by Visualize 020 8527 6225

NELMH/3/04

Contents Page

A 3

B 8

C 9

D 18

E 20

F, G, H 23

I 25

K, L 26

M 27

N 29

O 31

P 32

Q, R 37

S 39

T 43

U,V,W, X,Y, Z 44

Notes 45

Glossary of Mental Health Terms

1

ACKNOWLEDGEMENTS

Dr Heather Shearer (North East London Mental Health Trust), Kirsty

MacLean Steel and Lucy Calas-Prolingheur (East London and The City

Mental Health Trust) developed this glossary. We would like to thank

everyone who contributed to its production.

This glossary can be used and replicated for non-profit making purposes as

long as appropriate acknowledgement is made to North East London Mental

Health Trust and East London and The City Mental Health Trust.

DISCLAIMER

This glossary is for reference and education only and is not intended to be a

substitute for independent research and judgement. Clinicians may find it

useful to help explain terms to service users however it should not replace

essential communication between clinician and service user.

This glossary is not designed to be a definitive guide and neither East London

and The City Mental Health NHS Trust nor North East London Mental Health

NHS Trust accepts responsibility or liability arising from any outdated

information or from any error in, or omission from, the glossary. We would be

grateful if readers who notice any omissions or errors could contact us.

North East London Mental Health NHS Trust

Clinical Governance Manager

Maggie Lilley Office Suite

Goodmayes

Barley Lane

Ilford

Essex IG3 8YB

Tel: 020 8970 8171

January 2004

2

Glossary of Mental HealthTerms

A&E (Accident & Emergency) liaisonA service within A&E departments for mental healthassessments and referral to specialist services.

ADHD(see Attention deficit hyperactivity disorder)

AccreditationAn assessment by an external agency of an individual ororganisation against defined criteria. For example,services providing ECT (see definition) must meet thestandards set by the Royal College of Psychiatrists. If thestandards are met satisfactorily the service is accreditedby the Royal College of Psychiatrists.

AcuteAn acute illness is one that occurs quickly, is intense orsevere and lasts a relatively short period of time.

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

Advance statements/directivesThere are various types of advance statement/directive.They can include statements of an individual’s wishes incertain circumstances, for example instructions to

3

refuse some or all medical treatment or requests forcertain types of treatment.They can also statesomeone to be consulted at the time a decision needsto be made.The individual should seek advice aboutthe legal status of these statements/directives.Theymight be called Living Wills.

AdvocateAn advocate is a person who can support a serviceuser or carer through their contact with health services.Advocates will attend meetings with patients and helpservice users or carers to express concerns or wishesto health care professionals. Although many people canact as an advocate (friend, relative, member of staff)there are advocacy services available that can beaccessed through the Trust.These advocates are trainedand independent.

Affective disorderAffective disorders are also known as mood disorders.They are marked by changes in affect (mood/emotion).The term may be used to describe depression, bipolardisorder and mania (see definitions).

AftercareThis is the support or care that a person can expect toreceive once discharged from inpatient care.Typically adischarge plan will be developed by themultidisciplinary team with the service user which willmake clear what care and support will be provided.(see Care Plan, CPA).

AgoraphobiaAgoraphobia is defined as a fear of open spaces. It alsoincludes 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 ortrapped in a situation when they can’t get help. It isoften associated with panic attacks.

4

Alternative therapies(see also Complementary therapies)

These are therapies that are not part of currentstandard medical practice (for example acupuncture,reflexology or aromatherapy).Therapies are termed ascomplementary when used in addition to conventionaltreatments and as alternative when used instead ofconventional treatment.

Alzheimer’s Disease(See Dementia)

Anorexia nervosaThis is an illness that is characterised by a refusal to eat,an avoidance of eating or a careful and low intake offood.The person can become malnourished to thepoint of starvation.Their perception of their own bodysize may become distorted and they will continue toperceive themselves as being fat

AntidepressantsAntidepressants aim to treat the symptoms ofdepression and can help people experiencingdepression to feel more motivated and energetic.Thisgroup of medication may also be used to treatobsessive-compulsive disorder, anxiety and eatingdisorders.There are different types of antidepressantsincluding tricyclic and selective serotonin reuptakeinhibitors (SSRIs).

Antipsychotic medicationAnti psychotic medication is normally given to treat thesymptoms of schizophrenia and, in some cases, manicdepression and manias.The two main types ofantipsychotics are called typical and atypical (seedefinitions).The main difference between the twogroups is in their side effects.

5

AnxietyThis is the term used to describe experiences such aschronic fear, tension and panic attacks. Some peoplehave an overwhelming feeling of dread that preventsthem getting on with everyday life. Sleepless nights andrecurring thoughts are common, as well as nausea,palpitations, dizziness and difficulty in breathing. Anxietyis the most common mental health problem peopleexperience.

Anxiety disordersThese are disorders that involve a continuous state ofanxiety or fear, lasting at least a month, marked byconstant apprehension, difficulties in concentration anda pounding heart. Physical symptoms may also bepresent, such as headaches, sweating, irritability, andnausea. Anxiety disorders include panic disorder andobsessive-compulsive disorder. Depression is commonin those with anxiety disorders.

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

Approved Social Worker (ASW)

Approved Social Workers (ASW) have specialist trainingand experience in identifying disorders of mental healthand are familiar with the problems experienced by usersof mental health services and their families.They areemployed by Local Authority Social Services and work inhospitals and in the community as part of thecommunity mental health teams.They will organise socialcare support for people in contact with mental healthservices, such as helping with housing and getting welfarebenefits.They work closely with health professionals and,under the current Mental Health Act, they work withtwo doctors to assess a person who may need admittingto hospital. Social workers can also act as care co-ordinators for people on care programmes.

6

AromatherapyAromatherapy involves the use of therapeutic oilsderived from plants to stimulate the body’s nerves tohelp a person feel either more relaxed or energised. Itis often used with massage or in the bath.Various oilsare available and are divided into different fragrancefamilies: relax, body, energy, mind and soul.

Art therapyArt therapy aims to support people’s recovery usingart as a creative process and as a therapy to helppeople resolve emotional conflicts, be more awareabout themselves, develop social skills, reduce anxietyand increase their self-esteem.

Asperger’s Syndrome(see Autism)

Assertive OutreachAssertive outreach services aim to support people inthe community who find it difficult keeping in contactwith mental health services.

AssessmentAssessment happens when a person first comes intocontact with health services. Information is collected inorder to identify the person’s needs and plantreatment.

Attention deficit hyperactivity disorder(ADHD)

People with ADHD have three main kinds of problems:difficulty concentrating or paying attention, overactivebehaviour and impulsive behaviour. ADHD is adevelopmental problem that usually starts in childhood.Some people have significant problems in concentrationand attention, but are not necessarily overactive orimpulsive.These people are sometimes described ashaving Attention Deficit Disorder (ADD) rather thanADHD.

7

Atypical antipsychotics(see also Antipsychotic medication)

Atypical antipsychotic medication is a group of newantipsychotic drugs that have a different set of sideeffects from the older, typical, antipsychotics. In generalthey cause fewer movement disorders such as tremor,muscle stiffness and restlessness.

Audit cycleThe process of carrying out a clinical audit projectfollows 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 occurredand improvement is maintained.

AutismAutism is a lifelong developmental disorder that affectsthe way a person communicates and relates to peoplearound them. In the great majority of cases, autisticdisorders are present from birth or become apparentwithin the first three years of life.People with typical autism have no interest in socialinteraction, little or no language, and tend to live in theirown world.Asperger’s syndrome often applies to thosewho are more able, who have better languagedevelopment, and who have more social contact.Asperger’s syndrome may first come to notice in adult life.

Baby BluesA period of mild depression after childbirth, the babyblues tends to last a few hours or a few days and thendisappears. Not to be confused with postnataldepression (see definition).

BenchmarkingA way of comparing a particular process and outcomesin one organisation with another organisation. Eachorganisation can then examine and change their ownprocesses to achieve better outcomes.

8

Bipolar Affective DisorderThis is also known as manic depression or bipolardisorder. It is a disorder characterised by swings in aperson’s mood from very very high (mania) to veryvery low (depression).

Bipolar Disorder(see Bipolar Affective Disorder)

Borderline Personality Disorder (BPD)

This is a personality style marked by unstable moodsand unsatisfactory personal relationships.They oftenhave problems with impulsivity, substance abuse (seedefinition) and impulsive spending.Those with BPD mayalso suffer from depression, anxiety and the fear ofbeing abandoned. (see also Personality Disorder)

British Psychological Society (BPS)

This is the professional body for psychologists.

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

Caldicott GuardianA senior healthcare professional in each NHSorganisation is responsible for safeguarding theconfidentiality of patient information.The name comesfrom the Caldicott Report, which identified 16recommendations for the use and storage of patient-identifiable information.

CAMHS(see Child and adolescent mental health services)

CapacityThis term means that a patient has the ability tounderstand and retain information about their medicalcondition and their need for treatment.

9

Care Co-ordinatorA care co-ordinator is the person responsible formaking sure that a patient gets the care that they need.Patients and carers should be able to contact their careco-ordinator (or on-call service) at any reasonable time.Once a patient has been assessed as needing careunder the Care Programme Approach they will be toldwho their care co-ordinator is.The care co-ordinator islikely to be community mental health nurse, socialworker or occupational therapist.

Care planA care plan is a written plan that describes the careand support staff will give a service user. Service usersshould be fully involved in developing and agreeing thecare plan, sign it and keep a copy. (see CareProgramme Approach)

Care Programme Approach (CPA)

The Care Programme Approach is a standardised wayof planning a person’s care. It is a multidisciplinary (seedefinition) approach that includes the service user, and,where appropriate, their carer, to develop anappropriate package of care that is acceptable to healthprofessionals, social services and the service user.Thecare plan and care co-ordinator are important parts ofthis. (see Care Plan and Care Co-ordinator).

CarerA carer is someone who looks after their relatives orfriends on an unpaid, voluntary basis often in place ofpaid care workers.

CasemixRelative frequency of different diagnoses or conditionsamong patients.

CauseA reason or explanation for a problem or illness basedon analysis and/or investigation.

10

CBT(See Cognitive Behavioural Therapy)

CHI(See Commission for Health Improvement)

Child and Adolescent Mental HealthServices (CAMHS)

CAMHS is a term used to refer to mental healthservices for children and adolescents. CAMHS areusually multidisciplinary teams including psychiatrists,psychologists, nurses, social workers and others.

ChronicA condition that develops slowly or lasts a long time.

Client(see also service user)

An alternative term for patient which emphasises theprofessional nature of the relationship between aclinician or therapist and the patient.

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

Clinical auditA process used to measure the quality of aspects ofcare and services and to improve that quality.

Clinical audit facilitatorA person who provides advice and technical supporton the subject of clinical audit.

11

Clinical PsychologistThis is someone who has a Psychology Degreetogether with clinical training in psychology.They aretrained in research, assessment and the application ofdifferent psychological therapies.

Clinical teamA team of health care professionals from differentdisciplines (e.g. nursing, psychiatry, occupationaltherapy).

ClinicianA person who provides direct care to a patient such asa doctor, nurse, therapist, pharmacist, psychologist etc.

CMHT(see Community Mental Health Team)

Cognitive Behavioural Therapy (CBT)

This is an approach to treatment that involves workingwith people to help them change their emotions,thoughts and behaviour. A person’s personal beliefs areaddressed in order to understand and changebehaviour.

College of Occupational Therapy (COT)

This is the professional body that representsoccupational therapists and produces guidance.

Co-morbidity/ Co-morbidThe presence of two or more disorders at the sametime. For example, a person with depression may alsohave co-morbid obsessive compulsive disorder.

13

Clinical effectivenessClinical effectiveness focuses on ensuring that staff areproviding the best and most effective care for peopleusing health services.This is done using a variety ofmethods including clinical audit and evidence-basedpractice.

Clinical governanceA framework that ensures that NHS organisationsmonitor and improve the quality of services providedand that they are accountable for the care theyprovide.This is monitored by the Commission forHealth Improvement (see definition).

Clinical guidelines/clinical practiceguidelines

Systematically developed statements, based on scientificresearch, which assist in decision-making aboutappropriate healthcare for specific clinical conditions.

Clinical informationInformation about diagnoses, treatments and theiroutcomes.

Clinical Negligence Scheme for Trusts(CNST)

A scheme for assessing a Trust’s arrangements tominimise clinical risk for service users and staff.Trustsneed to pay ‘insurance’ which can offset the costs oflegal claims against the Trust. Achieving CNST Levels (1,2 or 3) is shows the Trust’s success in minimising clinicalrisk and reduces the premium that the Trust must pay.

Clinical pathwaysDifferent ways of describing and/or prescribing a ‘plan’for providing a particular health service.

12

Community Mental Health Team(CMHT)

A multidisciplinary team offering specialist assessment,treatment and care to people in their own homes andthe community.

Community Psychiatric Nurse (CPN)

CPNs are registered nurses who work with people inthe community.They work as part of a team and, likeother members of the team, may see people in avariety of settings such as at a GP surgery, in a clinic orhealth centre or in a client’s own home.They workclosely with GPs (see General Practitioner definition)and other health professionals.They provide practicaladvice, ongoing support with problems, supervisemedication, give injections and help with counselling.They also work out care plans with other members ofthe team, service users and carers.

Complementary therapiesThese are therapeutic practices or techniques that arenot currently considered an integral part ofconventional medical practice.Therapies are termed ascomplementary when used in addition to conventionaltreatments and as alternative when used instead ofconventional treatment. (see also Alternative therapies)

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

ComplianceThis term means that written standards are met. It isalso used to refer to service users following agreedcare plans (including taking prescribed medication).

15

Commission for Audit and Inspection inHealthcare (CHAI)

The Commission for Healthcare Audit and Inspection(CHAI) is a new body that will exist from April 2004. Itis being set up to help to improve the quality ofhealthcare by ensuring an independent assessment ofthe standards of services provided to patients, whetherit is provided by the NHS or privately. By routinelypublishing information, it will also allow the public toassess how well tax-payers’ money is being spent indelivering healthcare. CHAI will take on the functions ofCHI (see definition) and other inspection bodies.

Commission for Health Improvement(CHI)

An independent body set up to monitor clinicalgovernance in NHS organisations. (see ClinicalGovernance).This body will be replaced by theCommission for Audit and Inspection in Healthcare(CHAI see definition) from April 2004.

CommissionerPrimary Care Trusts are responsible for buying(commissioning) specialist mental health services onbehalf of the people living in the district.They have anallocation of money and decide which services tocommission.The service provider is chosen and giventhe money to make sure the service is deliveredaccording to the contract. Services may becommissioned from the NHS or the voluntary orprivate sector.

Community CareCommunity Care aims to provide health and social careservices in the community to enable people to live asindependently as possible in their own homes or inother accommodation in the community.

14

Controls assuranceThe way that an organisation checks that its policies arebeing carried out.This includes internal and externalaudit for financial matters, employment policies and allareas in which the organisation interacts with thepublic.

COREThe CORE Outcome Measure is one way to find out ifan intervention has been successful. It includes both theservice user’s and the clinician’s assessment of thetreatment.

CounsellingCounselling is a talking therapy that usually deals with arecent distressing event.The length of time thatcounselling is needed varies from person to person.

Court of ProtectionThe Court of Protection has several roles in lookingafter the financial affairs of people who cannot legallydo it themselves.These include making Enduring Powersof Attorney (see definition), making wills, and generallygiving directions and orders for the management of theproperty and financial affairs.

CPA(see Care Programme Approach)

CPN(see Community Psychiatric Nurse)

Crisis Resolution TeamA crisis resolution team aims to respond to people incrisis. It aims to provide an assessment and treatmentservice, 24 hours a day, wherever people are.

17

Compulsive eatingThis may occur when people experience loneliness ordistress and use food for comfort. Food may makethem happier on a temporary basis but as foodincreasingly dominates a person’s life, he or shebecomes more unhappy, finds it more difficult toexercise real control and, gaining more weight, puts hisor her own health at greater risk.

Conditional dischargeWhere a restricted patient under the Mental HealthAct is discharged subject to specific conditions andliable to be recalled by the Home Secretary.

Conduct DisorderThis is a persistent pattern of behaviour that involvesviolation of the rights of others. Verbal and physicalaggression are central features of conduct disorder.

Consent to treatmentIf you are an informal patient, you have the right torefuse any treatment you do not wish.You have a rightto receive full information about the treatment, itspurpose and possible side effects. If consent is notobtained the treatment cannot normally be given.

Consultant PsychiatristA Consultant Psychiatrist is a trained mental healthdoctor with additional specialist training in psychiatry.The consultant is medically responsible for the care ofpeople receiving mental health services and alsosupervises junior doctors.

ContraindicationA situation in which medication should not be used. Forexample because of a physical condition, othermedications, pregnancy.

16

DepressionDepression is one of the most common forms ofmental health problem and can occur to people of allages. Symptoms include feelings of despair, hopelessnessand worthlessness, an inability to cope, sleep problemsand sometimes thoughts of suicide. Often people withdepression will complain of physical problems (e.g forexample headaches, stomach problems) rather thandepression when consulting their GP. Varioustreatments are available for depression includingantidepressant medication, talking treatments such asCBT (see definition), or counselling (see definition).

DiagnosisIdentifying an illness or problem by its symptoms andsigns.

Diagnostic and Statistical Manual(DSM)

This is a manual that classifies mental health problemsand is used to diagnose people’s mental healthproblems.The American Psychiatric Associationpublishes it.

DirectorateServices in NHS organisations are usually grouped intodirectorates. Medical services (e.g. psychiatry) aregrouped into the Medical Directorate. Nursing staff andservices make up the Nursing Directorate.The way inwhich directorates are organised changes from Trust toTrust.

DischargeThe point at which a person formally leaves services.On discharge from hospital the multidisciplinary teamand the service user will develop a care plan. (see Careplan)

19

Deliberate self harmWhere a person injures or harms himself or herselfintentionally. Common forms are self-poisoning or cutting.

DeliriumA condition including severe confusion, disorganizedthinking, disorientation and restlessness. Delirium maybe caused by physical agents such as infections, toxicsubstances, metabolic disorders or strokes. DeliriumTremens, “the trembling delirium” is a type of deliriumthat affects people on alcohol withdrawal after a longperiod of heavy drinking. Its main symptoms areuncontrollable trembling along with the symptomsmentioned above.

DelusionA fixed, false belief.

DementiaDementia is characterised by confusion, memory loss,poor problem-solving and poor concentration.Thereare many diseases that lead to dementia, the mostcommon being Alzheimer’s disease, Dementia usuallyoccurs in older people. Dementia in people under 65 isknown as early onset dementia.Dementia with Lewy bodies (DLB) is a rarer form ofdementia that shares characteristics with bothAlzheimer’s and Parkinson’s diseases.Vascular dementiaoccurs when cells in the brain are deprived of oxygen.Many symptoms are the same as other forms ofdementia, however there are some differences.

DependenceDependence refers to when a person is reliant on asubstance or person to help them function on a day-to-day level. It can also be used to refer to a personwho has become reliant on a medication to function insociety.

18

on food. Most people who suffer from eating disordersare women although men can also suffer from them.

ECT(see Electroconvulsive therapy)

EfficacyHow well something works.This term is used to referto treatments in particular.

Electroconvulsive therapy (ECT)

In ECT a small, carefully controlled amount of electricityis sent through the brain of a person who has beengiven an anaesthetic and muscle relaxant. This producesa mild seizure or convulsion. It is used for cases ofsevere mental illness, usually depression, where thepatient has not responded to other treatments ormedication.The Department of Health has issued strictguidelines on the use of this therapy.

Emergency powersThe powers to detain a person for an initial assessmentto determine whether the use of compulsory powers isappropriate. For example a Section 136 or a Section 5(2).

Enduring Power of Attorney (EPA)

An Enduring Power of Attorney (EPA) is a legaldocument that enables someone to appoint one ormore persons to manage their financial affairs andproperty, either now or in the future.

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

21

Dissociative disordersThis is a disorder in which normal consciousness oridentity is split or altered, often as a result of an intensepsychological trauma.

DoseA specific, set amount of medication administered.

Drama therapyDrama therapy aims to help a person use drama aspart of their recovery process. It can give a person anopportunity for reflection and to tell their story to helpsolve a problem and achieve a relief of strongsuppressed emotions.

Dual diagnosisDual diagnosis refers to two or more disordersaffecting one person. For example, mental illness andlearning disability. It is also used to indicate that aperson who has been diagnosed with a mental healthproblem also misuses substances, such as illegal drugs,legal drugs or alcohol.

Early intervention serviceEarly intervention services provide support andtreatment in the community for young people withpsychosis and their families.The aim is to reduce theperiod of untreated psychosis, which in turn, evidenceshows, is likely to lessen future problems and improvethe person’s health and well being in the long term.

Eating disordersExamples of eating disorders are anorexia nervosa,bulimia and compulsive eating.They are often anexpression of deep emotional difficulties and low self-esteem. Depression, disturbed sleep patterns,restlessness and disturbance of bodily functions aresome of the effects of eating disorders. People whohave an eating disorder find their lives become centred

20

Formal patientThis is a person who has been detained in hospitalunder the Mental Health Act (1983).

Guideline A recommendation of good practice usually based onresearch evidence.

General Practitioner (GP)

A family doctor, usually patients’ first point of contactwith the health service.

HallucinationsThey are disorders of perception or a perceptionwithout a stimulus.There are various different types ofhallucinations including; auditory (hearing sounds orvoices), olfactory (smells), tactile (sensation), visual(seeing things) or gustatory (taste).The most commonare hearing voices or seeing things that don’t reallyexist. Hallucinations are common psychotic disorders.Hallucinations may also occur after illegal drug use andsome 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 staffwho undertake assigned tasks involving direct care insupport of a registered/qualified nurse.There are twogrades of Health Care Assistants, A and B grade. Agrades would expect to be more closely supervised,while B grades may regularly work without supervisionfor 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 widelyused by English mental health services.The scales arecompleted after routine clinical assessments in anysetting and have a variety of uses for clinicians,

23

EvaluationJudging the value of something by making a comparison.

Evidence-based medicine/practiceThis can be known as evidence-based healthcare,evidence-based medicine or evidence-based practice. Itinvolves using available evidence, particularly research,to plan how to treat specific conditions.The processaims to find a comfortable compromise between theevidence, clinicians’ views and experiences and serviceusers’ views.

Evidence-based recommendationsA decision about management based primarily onevidence from scientific literature.

Exposure therapyExposure therapy is a form of cognitive behaviouraltherapy used to help people who have experiencedtraumas. It uses careful, repeated and detailed experienceof the real or imagined trauma in a safe and supportiveenvironment to help the person face and gain control ofthe fear and distress that was overwhelming.

Eye Movement Desensitisation andReprocessing (EMDR)

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

Family therapyThis form of therapy involves all relevant members of afamily, placing importance on the family as a pathwaytoward helping to treat the patient.

22

HypomaniaThis is a less severe form of mania (see mania) thatmay or may not require hospital treatment. Hypomaniais usually a symptom of bipolar disorder (see definition).It may also result from illicit drug use.

HysteriaIt is a psychosomatic (see definition) disorder caused bya powerful psychological disturbance or need. Someonewith it is usually completely unaware of thepsychological basis of the problem. It is often impossibleto convince the person that there is no physical basisfor the upset, even after many investigations have ruledout the possibility of a physical cause.This is calleddenial.The strength of the denial in hysteria shows theenormous power of the subconscious mind. Hysteria isoften a defence mechanism of the mind to protect itagainst the effects of some traumatic and unpleasantexperience.

ICD-10 (International Classification of Disorders)

The ICD is a form of classifying mental health problemsand assists clinicians in diagnosing problems.Thenumber 10 represents the 10th edition of the book.

IM&T(see Information Management and Technology)

IncapacityIncapacity means that a patient does not have theability to understand and retain information about theirmedical condition and their need for treatment.

Informal patientAn informal patient is a person in hospital voluntarily.Most people admitted to hospital are informal patients.

25

researchers and administrators.They are designed to beused before and after interventions so that changesattributable to the interventions (outcomes) can bemeasured.

Home treatment teamA 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 earlierdischarge from hospital.

HONOS(see Health of the Nation Outcome Scales)

Human resourcesThis is a department found in most organisations thatworks to recruit staff, assist in their development (e.g.providing training) and ensure that staff work in goodconditions.

Huntingtons DiseaseHuntingtons Disease is a genetically inherited conditionthat causes both physical and mental problems. It alsofeatures alternating periods of aggression, anger,excitement and depression, and progressive loss ofmemory and personality (Dementia).These psychiatricdisturbances may appear before the movementdisorder or may develop later. Bizarre behaviour alonemay be the first sign of the disease.

HyperactivityHyperactivity is marked by high levels of activity andrestlessness. It can be treated by medication or diet.

24

LocumA temporary health or social care professional.Thisperson does not have a permanent contract with theTrust.

Learning disabilitiesThese are impairments in a specific mental process thataffects learning.The conditions can exist to varyingdegrees in different people.

Local Implementation Team (LIT)

Local Implementation Teams bring together a widegroup of stakeholders (see definition) in mental health,including service users and carers, to plan and overseethe development of mental health services in their localarea. In the future they will work closely with primarycare, which is responsible for commissioning mentalhealth services.

ManiaMania is characterised by a person feeling overexcited,elated, physically overactive and rapidly changing theirideas (scattered or tangential thoughts). It is a symptomof 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 thecompulsory detention of people in hospital forassessment and/or treatment for mental disorder.People who are detained under the mental health actmust show signs of mental disorder and needassessment and/or treatment because they are a risk tothemselves or a risk to others. People who aredetained have rights to appeal against their detention.

27

Information Management andTechnology (IM&T)

This refers to the use of information held by the Trust,in particular computerised information.

Information sharingThe responsibility of professionals across agencies toshare relevant information to ensure that everyoneinvolved in a person’s care is informed.

Integrated Care PathwayIntegrated Care Pathways are a multi-disciplinary andmulti-agency approach to mapping patients’ care fromadmission through to discharge and ongoing care.Theaim is pull together all the information into one file thatwill make it easier for the clinicians involved to give thebest care for the patient.

InterdisciplinaryThis refers to work or care that links acrossprofessional boundaries. For example, when doctorsand nurses work together to provide care.

Keyworker(see Named Nurse)

Korsakoff ’s syndromeThis is a problem that usually occurs in people whohave had severe, long-term alcohol abuse problems. It ischaracterised by marked short-term memory loss.

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

26

MonitoringObserving activity in relation to defined specifications,standards or targets, directly or through reports orindicators – did what was intended happen? Forexample, monitoring the effects of antidepressants totreat depression.

MultidisciplinaryMultidisciplinary denotes an approach to care thatinvolves more than one discipline.Typically this willmean that doctors, nurses, psychologists andoccupational therapists are involved.

Music therapyThis form of therapy uses music and therapeuticapproaches to help people attain goals.These goals canbe mental, physical, emotional, social and/or spiritual.

Named NurseThis is a ward nurse who will have a specialresponsibility for a patient while they are in hospital.

National guidelineA broad statement of principle about what constitutesappropriate care.

National Institute for Clinical Excellence(NICE)

It provides clinical staff and the public in England andWales with guidance on current treatments. It co-ordinates the National Collaborating Centres fromwhom it commissions the development of clinicalpractice guidelines.

29

Mental Health Act Commission(MHAC)

The Mental Health Commission (MHAC) has a legalresponsibility under the Mental Health Act (MHA) toprotect the interests of all patients detained under theMHA in England and Wales.

Mental Health Act Hospital ManagersFor the purposes of the Mental Health Act (seedefinition) Trusts are defined as Mental Health ActHospital Managers. In practice, these are usually non-executive directors and/or lay people appointed by theTrust to carry out the Trust’s responsibilities under theMental Health Act.

Mental Health Review TribunalThis is an independent panel of people. A detainedperson can appeal against their detention to this panel.The panel can discharge the detained person or makeother recommendations. It is possible to appeal to HighCourts against Mental Health Review Tribunal decisions.

Mental Health Minimum Data SetThis has been developed to collect person-centredinformation and record packages of care received by anindividual.This is collected by the Trust and submittedto the Department of Health.The data reported isnumbers not names.

MINDMind is a leading mental health charity in England andWales. It works to create a better life for everyonewith experience of mental distress.

MRCPsychMRCPsych is the entrance exam to the Royal Collegeof Psychiatrists and must be passed before a doctor canbecome a Consultant Psychiatrist.

28

have lived together for six months. A same-sex partnercould only become the nearest relative if they had livedtogether for five years.

NICE(see National Institute for Clinical Excellence)

Nominated personA person who is appointed to represent a patient indiscussions in matters related to their care.

Non-executive DirectorA Non-executive Director is a member of the TrustBoard.They act as a two way representative.They bringthe experiences, views and wishes of the communityand patients to the Trust Board.They also represent theinterests of the NHS organisation to the Community

NSF(see National Service Frameworks)

Obsessive-compulsive disorder (OCD)

OCD is a problem characterised by obsessive thoughtsand compulsive behaviour.The behaviour can takevarious forms such as cleaning or checking rituals inwhich the person will repeatedly clean themselves ortheir house or check, for example, that doors arelocked and/or electrical sockets are turned off.Dermatological problems are common in people whorepeatedly wash their hands. People with OCD can betreated using cognitive behavioural treatment and/orantidepressants.

Occupational TherapistOccupational therapists use purposeful activities to treatpeople with physical and/or mental health problems.They work as part of a team to identify problems causedby people’s conditions and find ways of coping with theseto encourage independence and a better quality of life.

31

National Service Frameworks (NSF)

National Service Frameworks are issued by thegovernment and provide guidance and standards forhealth services to be to working towards.There is anNSF dedicated to mental health that set standardsaround mental health promotion, treatment and serviceuser involvement.There is also an NSF for OlderPeople that has a section on mental health for olderpeople.This term should not to be confused with theNational Schizophrenia Fellowship, which is now calledRethink.

Nearest Relative(see Next of Kin)

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

NeurosisNeurosis is used to describe anxiety disorders such asanxiety and phobias.

Next of KinThe term next of kin is widely used, but there is nostatutory definition. In practice the general rule hasbeen to recognise spouses and blood relatives as nextof kin.The Mental Health Act 1983 defines a list ofcertain people who can be treated as the ‘nearestrelative’ of a patient.A ‘nearest relative’ has a number of important powersand functions, including the right to discharge a patientwho has been formally detained in hospital, make anapplication for a person to be admitted for assessment,treatment or guardianship and also to object toapplications for treatment or guardianship being madeby a social worker. Only certain categories of peoplecan become a ‘nearest relative’. First in the list arespouses, and then unmarried heterosexual couples who

30

Parkinson’s diseaseParkinson’s Disease is more common in older people.The disease affects the connections in the brain causingthem to malfunction.This results in movementdisorders such as tremor and stiffness.The diseaseprogresses steadily over years eventually causing severephysical and mental disability. Symptoms can be treatedwith medication.

Patient Administration System (PAS)

A computer system used to record information aboutthe care provided to service users.The data can onlybe accessed by authorised users. PAS will soon bereplaced by a newer system.

PCT(see Primary Care Trust)

Personality DisordersIt is common for someone with a personality disorder tobe 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 abroad range of personal and social situations.” (see alsoBorderline Personality Disorder).

PharmacistA healthcare professional who ensures that medicationthat service users receives are safe, effective andappropriate.

PharmacyThe department that supplies medicines.

33

Occupational TherapyOccupational therapy uses goal-directed activities,appropriate to a person’s age and social role, torestore, develop or maintain the ability for independentliving.

OCD(see Obsessive Compulsive Disorder)

OutcomeIn health services this refers to any change in a person’swellbeing following a period of treatment.The expectedoutcome will usually be an improvement in symptomsor the resolution of a problem.

Outcome scale/measureOutcome scales and measures are standard ways ofassessing or evaluating the difference made to aperson’s wellbeing by a course of treatment. A personwill usually rate himself or herself, or be rated by ahealth professional, against a set of questions orstandards about their symptoms, feelings and wellbeing.This is usually done at the beginning of, and after aperiod of, treatment. Any improvement or decline willbe shown by changes in the outcome scale ratings. Anexample of an outcome scale is HONOS (seedefinition).

Patient Advice and Liaison Service(PALS)

All NHS trusts are required to have a Patient Adviceand Liaison Service.The service offers patientsinformation, advice, quick solution of problems oraccess to the complaints procedure.

Patient Environment Action Team(PEAT)

A team that visits hospitals to check on cleanliness.

32

Power of attorney(see Enduring Power of Attorney)

Primary Care Primary care is the care that you will receive when youfirst come into contact with health services about aproblem.These include family health services providedby GPs, dentists, pharmacists, opticians, and others suchas community nurses, physiotherapists and some socialworkers

Primary care liaison teamA service working closely with GPs for clients whocannot be effectively managed in an ordinary primarycare setting.The team takes a key role in theorganisation and delivery of service working closelywith statutory and non-statutory agencies andtransferring patients between services as required.Theteam offers risk assessment of clients, advice and shortto medium term psychological therapies.

Primary Care Trust (PCT)

This is the organisation that looks after primary care(see definition). PCTs are commissioners (seedefinition)

ProcedureA procedure is a series of actions taken in a definiteand established order.This can refer to a treatment planor to general activities.

ProtocolA local policy or strategy that defines appropriateaction. (see Policy)

35

PhobiasThis is an extremely common problem in the generalpopulation. Phobias are irrational and uncontrollablefears of an object or situation that most people canface without anxiety.The object or situation will triggerfeelings of intense panic and the sufferer will go togreat lengths to avoid them. Common phobias are fearof flying, spiders and enclosed spaces.

PICU(see Psychiatric Intensive Care Unit)

PolicyPolicies are produced by organisations to clearly outlinewhat staff must do, and not do, in certain situations.

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

Postnatal depressionPostnatal depression can occur any time in the first yearafter having a baby and most commonly occurs withinthe first six months. Symptoms include feeling low andunhappy most of the time, acute anxiety, irritability,sleeplessness, tiredness and a loss of enjoyment ordesire to do anything.These can be made worse byfeelings of guilt about not being able to cope or lookafter the baby. Not to be confused with baby blues (seedefinition).

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is an anxietydisorder that develops following an unusuallythreatening event. Symptoms include flashbacks,nightmares and intense distress when exposed to anobject or situation that is related to the traumaticevent.

34

PsychosisPsychosis, or psychotic disorders, involves distortedperceptions of reality and irrational behaviour, oftenaccompanied by hallucinations and delusions.

Psychosomatic disorderIn some illnesses, psychological factors seem to play aparticularly important part.They can influence not onlythe cause of the illness, but can also worsen thesymptoms and affect the course of the disorder.Theseillnesses are termed psychosomatic disorders. Becausepsychological factors are important in every illness,there is lack of agreement as to what should beconsidered a psychosomatic disorder.

PsychotherapistPsychotherapists help people to be in more control oftheir own lives by exploring emotional difficulties andhelping them understand themselves and theirrelationships with others.They provide consultation andintervention on a one to one basis and in groups.

PsychotherapyThe treatment of mental health, emotional andpersonality problems through talking with a therapist.There are many different types of psychotherapy.

Quality improvementThis is a general term for various methods of improvingthe quality of services that are provided to service users.

Randomised controlled trial (RCT)

A type of research or experiment used to compare theeffectiveness of different treatments. Patients arerandomly assigned to groups.The groups either receivethe treatment being assessed or are a control group.The control group receive dummy (placebo)medication. RCTs offer the most reliable form ofevidence for effectiveness.

37

Psychiatric Intensive Care Unit (PICU)

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

PsychiatristA doctor who specialises in the diagnosis andtreatment of people who are mentally ill. Psychiatristshave undergone specialist training and may diagnoseillness, prescribe medication and other forms ofappropriate treatment.They also decide whether toadmit people to and discharge from hospital.

PsychoanalysisThis is a type of therapy that focuses on unconsciousmotives and conflicts.The use of dream recall and freeassociations can be used in psychoanalysis.

Psychodynamic therapyThis is a form of psychotherapy in which the patienttalks and the therapist makes interpretations about thepatient’s words and behaviour.

Psychodrama(see Drama Therapy)

PsychologistPsychologists have skills in the assessment andtreatment of mental illness and psychological problems.Unlike psychiatrists they are not medical doctors, theirskills include assessing cognitive functions (for example,speech and thought) and providing talking interventionsincluding psychotherapy and counselling.

PsychopharmacologyThe management of psychiatric illness using medicationsuch as antidepressants or antipsychotics.

36

Royal College of NursingThis is a professional body that represents the interestsof nurses, and provides support in professional matters.

Royal College of Psychiatrists (RCPsych)

This is the professional body for psychiatrists as well asthe body that sets exams for those wishing to becomepsychiatrists.

Royal Pharmaceutical SocietyThe Society provides guidance for pharmacists (seedefinition) and pharmacy staff.

Schizoaffective DisorderThis condition displays symptoms of both schizophreniaand bipolar disorder.

SchizophreniaThis is a psychotic disorder marked by delusions,hallucinations, disordered thinking and speechinappropriate emotions and/or lack of emotions. It ischaracterised by serious disturbances of thought andperception 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 careSecondary care is specialist care, usually provided inhospital, after a referral from a GP or healthprofessional. Mental Health Services are included insecondary care (see also tertiary care).

SectionThis is used to refer to one of the sections of any Actof Parliament. A person who is detained in hospitalunder the Mental Health Act (1983) is commonlyreferred to as ‘sectioned’.

39

Rapid cyclingWhen a person with bipolar disorder experiences fouror more mood episodes (mania, hypomania ordepression) within a year.

ReflexologyThis is a type of alternative or complementary therapythat uses pressure points on the feet to promotehealth and well-being.

RehabilitationImproving a person’s skills through treatment and/ortraining to enable them to live a more fulfilling life inthe community.

ReliabilityThe ability of a data gathering tool to obtain consistentresults.

Responsible Medical Officer (RMO)

The consultant psychiatrist with medical responsibilityfor a service user.

Restriction orderRestriction orders can be added to some sections.Theperson must have been convicted of an offence forwhich imprisonment is a possible penalty.This ordermeans that only the Home Secretary can allowdischarge or time away from the hospital.

Risk assessmentIdentifying aspects of a service which could lead toinjury to a patient or staff member and/or to financialloss for an individual or Trust.

Risk managementChanging aspects of a service that could lead to injuryto a patient or staff member and/or to financial loss foran individual or Trust.

38

Serious Untoward Incidents (SUIs)

This is a term used by many health organisations todescribe a serious incident or event which led, or mayhave led, to the harm of patients or staff. Members ofstaff who were not involved in the incident investigatethese and the lessons learned from each incident areused to improve care in the future.

Service userThis is someone who uses health services. Othercommon 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 peoplewas introduced in the National Service Framework forOlder People.The purpose of the single assessmentprocess is to ensure that older people receiveappropriate, effective and timely responses to theirhealth and social care needs, and that professionalresources are used effectively.

Specialist Registrar (SpR)

SpR grade is a recognised training grade in theprogression of medical staff to Consultant status. It wasformally known as Senior Registrar. On completion ofthe Senior House Officer (SHO) rotation, and passingthe MRCPysch, the Specialist Registrar continuestraining in their chosen area of psychiatry.

SSRI(see Selective Serotonin Reuptake Inhibitor)

41

Section 12 ApprovedDoctors who are approved by the secretary of State,having special knowledge of mental health and who arerequired to be involved in assessments under theMental Health Act 1983.

Section 17Section 17 of the Mental Health Act (1983) makesprovision for patients who are liable to be detainedunder various sections of the act to be granted leave ofabsence.

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

Selective Serotonin Reuptake Inhibitor(SSRI)

This is a type of antidepressant medication. An exampleis prozac (fluoxetine)

Senior House Officer (SHO)

This is the position gained by doctors after they areregistered as a doctor by the General Medical Council.It is the second tier of trainee doctor (afterpreregistration house officer) in a hospital.

SEPIASEPIA is a computer package that is used to keepinformation about CPA (see definition).

Serious mental illness/Severe mentalillness

These are mental health problems that are seriousenough to warrant contact with mental health services.

40

Talking treatmentsThese are psychological treatments in whichimprovement in a person’s symptoms or wellbeing isachieved by talking with a therapist or counsellor ratherthan, or as well as, taking medication.

Tertiary CareWhen a hospital consultant decides that more specialistcare is needed. Mental Health Services are included inthis. (see also Secondary care).

TitrationThis is a method of determining what substances are ina person’s system by testing bodily fluids. It can detectsubstances such as prescribed medication and alsoillegal substances such as drugs or alcohol. Dosetitration means to slowly increase the dose of a drug toa level that can be maintained.

ToleranceTolerance refers the body’s capacity to endure levels ofmedication over periods of time. It can also be used torefer to an addict’s capacity to consume levels of eitheralcohol or illegal drugs due to repeated use orexposure

To-take-aways (TTAs)

TTAs are medicines supplied by pharmacy for serviceusers going on leave from the hospital.

TTAs(see To-take-aways)

43

StakeholdersA range of people and organisations that are affectedby, or have an interest in, the services offered by anorganisation. In the case of hospital trusts, it includespatients, carers, staff, unions, voluntary organisations,social services, health authority, GPs, primary caregroups and trusts in England, local health groups inWales.

StandardA measure, specification or object to which objectsshould conform or against which others are judged. Arequired degree of excellence.

Substance AbuseThis refers to the abuse or misuse of non-medical or‘recreational’ drugs and/or alcohol. As well as physicalproblems, some substance abuse can lead topsychological problems, such as depression, anxiety and,in some cases, psychosis.

SuicideTaking one’s own life.

Support WorkersSupport workers provide support for clients and theircarers under the supervision of a care coordinatorwhich has been negotiated under the care programmeapproach.They can help people regain lost skills anddevelop new interests to help regain confidence andself esteem.

SUI(see Serious Untoward Incidents)

42

Notes

45

User involvementUser involvement refers to a variety of ways in whichpeople who use health services can be involved in thedevelopment, maintenance and improvement ofservices.This includes patient satisfaction questionnaires,focus groups, representation on committees,involvement in training and user-led presentations andprojects.

ValidityA data collection instrument’s ability to actuallymeasure or test what it is intended to measure or test.

Vascular Dementia(see Dementia)

WhistleblowingThis is the act of informing a relevant person in anorganisation of instances or services in which patientsare at risk.

44

Notes

47

Notes

46

Notes

48

NELMHT Communications

January 2004

Tel: 020 8970 5758 www.nelmht.nhs.uk