Glossary of Mental Health Terms (A-E)

Mental Health Terms (F_J)
Mental Health Terms (K_O)
Mental Health Terms (P_T)
Mental Health Terms (U_X)


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

ADHD (see Attention deficit hyperactivity disorder)

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.

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.

A typical 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 very high (mania) to very 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 patient-identifiable 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 Commissioning Groups (CCG)
Clinical Commissioning Groups are part of the UK National Health Service, or NHS of the UK

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) is 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.

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. Commission for Audit and

Inspection in Healthcare (CHAI)
The Commission for Healthcare Audit and Inspection (CHAI) is a new body that will exist from April 2004. It is being set up to help to 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 will be replaced by the Commission for Audit and Inspection in Healthcare (CHAI see definition) from 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.

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).

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.

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.

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. 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.

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)

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. People who have an eating disorder find their lives become centred on food. Most people who suffer from eating disorders are women although men can also suffer from them.

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.