People coming into the mental health system for the first time can find things bewildering. Speaking with professionals you may hear terms and abbreviations which are unfamiliar to you or which you don’t fully understand.

If someone is speaking to you and using abbreviations or phrases that you do not know, always ask them to explain what they mean. Don’t feel that you will look foolish:  people often forget that not everybody uses the same language on a daily basis.  Below is a list of some of the more common terms used.   Regarding services, not all terms will necessarily apply to your area as each health and social care trust may consist of different structures and systems.

Advocates Advocates for patients or service users help people obtain the information they need to make an informed decision in areas such as legal rights, treatments or services. An advocate can also support the patient/service user during a meeting with a doctor or another professional, and represent their views, if asked.  CAUSE provides carer advocacy and support for families, partners and friends caring for a loved who has experienced serious mental illness.

Approved Social Worker (ASW) Each local authority has a responsibility to provide sufficient numbers of social workers specifically trained and approved by the local authority under the Mental Health (NI) Order 1986.  Their role is to assess people for hospital admission and if they consider there is no alternative, to authorise admission and make the necessary arrangements.  This is an enhanced role and different from the usual remit of Social Workers.

Assertive Outreach Team This service aims to help people with a serious mental illness who may be difficult to engage with.  The service is available in the community 24 hours a day, usually visiting the person in their own home.   Team members have smaller caseloads than colleagues in Community Mental Health Teams (CMHT’s), which enables them to spend more time with their clients helping with practical tasks as well as encouraging the use of medical treatments. 

Atypical / Anti-psychotic Medication These are forms of medication used to treat psychosis.  Some of the more frequently prescribed are Amisulperide, Clozapine, Olanzapine and Risperidone.  Clozapine may be used when two or more of the above are ineffective. 

Capacity – Incapacity You have capacity when you can make your own decision about what’s best for you. A physical or mental illness may affect your thinking so that:

• you can't  make a decision for yourself

• you would make a decision that you would not make if you were well. In this case you would be seen to lack capacity to make that decision. Capacity can also change with time – because your state of mind can change with time. An illness that interferes with your judgement can get better – at least for a while.

Care Pathway A care pathway describes the types of steps involved in accessing care, different stages and interventions that may be offered. It outlines what you can expect in moving through professional services within a framework of care. There can be different care pathways for different services (e.g. the regional mental health care pathway for adult services) and specialist services (e.g. the regional care pathway for personality disorders).

Care Plan The outcome of an assessment.  A description of what an individual needs and how these needs will be met. An individual should receive a written copy of their Care Plan and their carer may request a copy if the individual approves.

Carer’s Assessment If you provide a regular and substantial amount of care for someone, you are entitled to a carer's assessment as a statutory right from your local Health and Social Care Trust.  There is no set definition of 'regular and substantial care'. A carer's assessment means social services will look at your situation and see if you are entitled to any services that could make caring easier for you.  The assessment is an opportunity for you to help the social worker understand the impact caring has on you, and talk about the services they may be able to provide to help you. The assessment can be carried out at your home. It is better if the person you care for is not present at the assessment. The assessment is about you. If there is more than one carer providing regular care in your household, you are both entitled to an assessment. 

CAMHS This stands for Child and Adolescent Mental Health Services. CAMHS aims to provide assessment and treatment to children/young people up to the age of 18 experiencing mental health, emotional or behavioural difficulties.  The service also aims to promote emotional well-being and deliver care preventative mental health services to children and young people.  Types of problems CAMHS can help with include mental illness, violent or angry behaviour, eating difficulties, low self-esteem, anxiety, obsessions or compulsions, sleep problems, self-harming and the effects of abuse or traumatic events.

Clinical Psychologist Someone who can use psychological knowledge and techniques to help in understanding and treating mental illness.  A wide range of psychological difficulties are dealt with, including anxiety, depression, relationship problems, learning disabilities, child and family problems and serious mental illness.  To assess a client, a clinical psychologist may undertake a clinical assessment using a variety of methods including psychological tests, interviews and direct observation of behaviour. Assessment may lead to therapy, counselling or advice.

Comorbidity This describes most generally the co-occurrence of two or more mental health problems (e.g. personality disorder, mental illness and addiction), and where there is interplay between mental and physical illness.  It is well established that a significant proportion of physically ill patients will also have a mental illness.  An equally large number of patients with mental illness will have physical problems, either contributing to their illness or as a consequence of their mental illness.

Cognitive Behaviour Therapy (CBT) This is a way of helping people to cope with stress and emotional difficulties by making the connections between how we think, how we feel and how we behave.

Community Mental Health Team (CMHT) The providers of mental health services on a local basis.  These teams could include psychiatrists, clinical psychologists, community psychiatric nurses, social workers and occupational therapists, all of whom will work jointly in trying to develop a care plan to meet the needs of the person using the services.

Community Psychiatric Nurse (CPN) or Community Mental Health Nurse A qualified nurse who will provide outpatient and follow-up care when the individual is living at home/or in the community. 

Counsellors Counsellors offer counselling to those in need. Counselling aims to identify the problems a person is facing in any sphere of life and to help them discover effective ways of dealing with these. Simply talking through a problem with somebody neutral can often help a person to see a way forward. Counsellors work in various settings such as the private or voluntary sector, GPs' surgeries and hospitals.

Crisis Response and Home Treatment Service (also could be known as an ICTT – Intensive Community Treatment Team) This service can be an alternative to in-patient hospital admission. Its aim is to resolve crisis in the home.  It may be that this will provide a solution for some.  

Crisis House/Recovery House/Home Treatment House This is a mental health facility that is used as an alternative to hospital admission.   It provides holistic support and person centred care to aid recovery.  Usual stays are for a limited period of time.

Day Care Workers Day Care Workers provide a range of therapeutic activities which can include training, workshops and social opportunities for people with mental health problems.

Depot Injections Long acting medication often used where people are unable or unwilling to take tablets regularly.

Delusions A firm belief in something that is not true or implausible such as delusions of grandeur or of persecution.  Examples might include the person’s belief that they are invincible or possess some imaginary power, or that their mind is being controlled by another person.

Dialectical Behavioural Therapy (DBT) This a system of therapy, to treat people with borderline personality disorder (BPD). DBT combines standard cognitive-behavioural techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness.

Direct Payments Direct Payments is a scheme administered by Health and Social Care Trusts which gives people in need of care and support, freedom to manage their own care.  Payments are made directly to the person and they buy in services to meet their needs.  The level of payment is decided as a result of their assessment as part of their care plan. 

Dual-diagnosis This can be a combination of a mental illness with other conditions such as alcohol abuse, drug abuse, learning/physical disability.

Drug Therapies Any treatment that involves the taking of medication in any form, i.e. tablets, injections, etc.

Early Intervention Team This is a team who provide a clinical approach to those experiencing symptoms of psychosis for the first time. This approach centres on the early detection and treatment of early symptoms of psychosis during the formative years of the psychotic condition. The first three to five years are believed by some to be a critical period. The aim is to reduce the usual delays to treatment for those in their first episode of psychosis. The provision of optimal treatments in these early years is thought to prevent relapses and reduce the long term impact of the condition.

Electro-Convulsive Therapy (ECT) It is most commonly used for severe depression where medication has failed ECT is always administered under general anaesthetic and produces a mild shock to the brain similar to an epileptic fit.  

Emergency Psychiatric Service (EPS) The team provides a social work service outside of office hours at night, weekends and bank holidays.

Enduring Power of Attorney Is a legal function administered by a nominated person which enables people, while they are still mentally capable, to formally nominate someone to deal with their affairs for them, should they become mentally incapable.  The nominated person can either be a friend, relative or professional.

Extrapyramidal Side Effects A cluster of symptoms that resemble some features of Parkinson’s disease. For example, difficulty in initiating movement, slowness of movement, lack of facial expression and muscle stiffness.

Forensic Mental Health Services Forensic mental health services are for people with mental health problems who have been arrested, who are on remand or who have been to court and found guilty of a crime.  Forensic mental health units are an alternative to prison for people who have mental health problems and offer specialist treatment and care. They are ‘secure’ units: this means that people who are referred there are not free to come and go. Forensic psychiatric units have different levels of security ranging from low or medium to high secure hospitals. Most patients are detained under mental health legislation. People with mental health problems can be transferred to forensic mental health units at the time of arrest, during court proceedings, or when they are in prison. They may be referred while they are on remand and awaiting trial. A referral is usually made following an assessment of an individual’s needs, or a psychiatric report.  However, people with mental disorders, who have never been involved with the criminal justice system, might also be treated in forensic psychiatric services, if they cannot be safely managed elsewhere.

Hallucinations  Hallucinations are false perceptions or disturbances of perception. They can involve hearing voices that are not audible to others but can also involve seeing, feeling, tasting or smelling things that the person perceives as very real but which do not exist in reality.  Hallucinations can be very disturbing for the person who is experiencing them, especially if voices are, for example, abusive.

Health and Social Care Trusts These are the legally established bodies which provide and commission personal, medical and dental services in Northern Ireland. Currently they are known as Belfast Health and Social Care Trust, South Eastern Health and Social Care Trust, Northern Health and Social Care Trust, Western Health and Social Care Trust and Southern Health and Social Care Trust.

Holistic Approach This means considering the whole person in the treatment of the illness i.e. their physical, emotional, psychological, spiritual and social needs.

Key Worker Every patient referred to the mental health services is allocated a keyworker as a main point of contact.  The keyworker may be any member of the community mental health team (such as a psychiatrist, CPN, occupational therapist, psychologist or social worker). The role of the keyworker is to act as the co-ordinator of the mental health services needed by their patients. The keyworker has a responsibility to regularly review the progress of their patients and assess if all of their needs are being addressed. This involves gaining feedback from the patients about what they think about the help and support they are getting from the mental health team.

Liaison Psychiatry A liaison psychiatrist is a medically qualified doctor who has expertise in the diagnosis and management of:  • psychiatric illness in the medically ill • psychiatric illness and other psychological factors that interfere with recovery from medical illness • bodily symptoms that are not adequately explained by underlying physical illness Liaison psychiatry services are often based in general hospitals, but increasingly work with primary care in the management of comorbid medical and psychiatric illnesses.

Mental Health (NI) Order, 1986 You may have heard of ‘sections’.  This refers to a section of the Mental Health Order.  These allow certain mental health care professionals to make assessments and admit people compulsorily to hospital, when they are thought to be a risk to themselves or others, or in danger of serious deterioration if compulsory intervention is not undertaken.  This legislation sets out a framework for the care, treatment and protection of mentally disordered individuals.  

For more detailed information on the detention and assessment process and legislation, please refer to Understanding the detention or ‘sectioning’ process.

Mental Health Tribunal An official body made up of legal, medical and lay representatives to whom individuals may apply if they feel their detention in hospital is unnecessary or illegal.

Mentalisation Based Therapy (MBT) Mentalisation is the ability to make sense of our own and other people’s actions by thinking through what is going on in our own and other people's minds. It may be understood as an ability to empathise or put ourselves in others' shoes. MBT focuses on increasing self-reflection and an individual's ability to make sense of their own and others' thoughts, feelings, and motivations. In essence, this type of therapy helps an individual develop 'mentalising' skills in the same way that many people do during the course of growing up.

Occupational Therapist (OT) OTs are trained to work with people to help them to improve their ability to cope with daily living as independently as possible.  They not only help with practical tasks, but can improve coping strategies as well as helping to encourage participation in recreational, educational and vocational activities.

Person-centred Planning Person-centred planning (PCP) is a set of approaches designed to assist someone to plan their life and supports.  The person is at the heart of the process which also will factor the involvement of family/partners/friends in wider the context of the person’s community life.  In PCP, the plan should reflect what is what is important to a person now and for the future and what support they need and aim to put this into action.  The plan should keep ‘listening’ to what the person wants for their life and reflect changing needs or wishes of the person to remain live.

Personalisation of Care Personalisation means recognising people as individuals who have strengths and preferences and putting them at the centre of their own care and support. Services should aim to meet the needs of individuals, with care personalised in terms of their specific requirements.  It involves enabling people to identify their own needs, make choices about their own care and how and when they are supported to live their lives. People need access to information, advocacy and advice so they can make informed decisions.

Pharmacists Pharmacists are experts on medicines; they are trained to promote high quality patient care through safe and effective administration of drug treatments. They will give comprehensive information and advice on request.

Primary Mental Health Care Primary Mental Health Care is provided by GPs who are the first point of contact for individuals and their families when mental health problems arise. CPNs and Social workers also work with GPs to provide primary mental health care.

Psychiatrist A psychiatrist is a medically qualified doctor who has trained and specialises in mental illness, as well as the interaction between physical and mental illness.  Psychiatry is the branch of medicine concerned with mental health, diagnosis, treatment and care.  

Psychotherapists Psychotherapists offer therapy to those who are referred to them. They are mostly patients who have been referred by psychiatrists, GPs, social workers and psychologists. The exact nature of the help they provide depends on the type of psychotherapy they specialise in.

Schema This term describes an organized pattern of thought or behaviour. It can also be described as a mental structure of pre-conceived ideas, or a system of organising and perceiving new information. Schemata have a tendency to remain unchanged, even in the face of contradictory information.

Secondary Mental Health Care A GP may refer a patient for secondary mental health care; this usually involves referral to a psychiatrist, who works with other professionals, such as CPNs and social workers in mental health services.

Senior House Officer This is a doctor who is in the first three years of their training as a specialist. As well as gaining experience, they are studying to pass their membership exams for the Royal College of Psychiatrists. They will work for, and be supervised by, a consultant.

Social Workers Social workers are trained to assess mental health problems and understand how social circumstances can influence them.  Their special skills enable them to be involved in planning and implementation of care plans and they can, on request, attend Mental Health Review Tribunal Hearings.  The Social Worker who may be involved as part of the care team is able to make a valuable contribution in advising on suitable housing, appropriate benefit claims and generally giving support in the community. See also definition of Approved Social Worker above.

Step-up/Step-down Care Step up /step down care provides an early intervention or early discharge option for people as an alternative to hospitalisation or after discharge from hospital. Step up / step down is part of intermediate care facilities that are outside acute hospitals, enabling people to receive more support than is currently available at home (step-up) and to leave acute hospital and get ready to  return home (step-down). These residential facilities will provide mental health care to accommodate those experiencing acute mental health symptoms.  It is important to note that step-up/step-down care is not available or vary in availability across areas.

Support Worker Support workers provide a practical support service to people with mental illness.  This support can take place in a number of different locations, such as a day centre, residential facility or individual’s own home.

Therapeutic Community A place where someone can attend (or sometimes stay) for several weeks or months, Most of the work is done in groups. You learn from being with other people in a unit. It differs from 'real life' in that any disagreements or upsets happen in a safe place. The staff and other patients can help someone get through such problems and learn from them.

Voluntary / community organisations; non-profit or third sector organisations These are usually the collective term used to refer to charities.  It could include organisations which are not wholly commercial or statutory agencies.  Voluntary sector organisations are largely non-profit.  Charities are explicitly set up to run services / projects for a charitable purpose linked to public benefit.  Voluntary sector organisations deliver a wide range of services in Northern Ireland to support service users and carers