Service Description
Mental Health Care Professionals
Mental health conditions can be complicated to treat as they can impact on a wide range of issues, such as housing, employment, relationships and physical well being.
Due to this, there a number of different mental health care professionals, each with their own specialised expertise; some of which are outlined below.
GPs
Your GP will often be your first point of contact with the mental health services. It is estimated that people with emotional or psychological conditions make up between a quarter and a third of a GP's workload.
GPs can make an initial assessment of a mental health condition, prescribe medications such as anti-depressants, and arrange referrals to other services and treatments, such as counselling if necessary.
Community Mental Health Nurse (CMHN)
A community mental health nurse (CMHN) (sometimes known as a community psychiatric nurse) is a registered nurse with specialist training in mental health. Some are attached to GP's surgeries or community mental health centres while others work in psychiatric units.
CMHNs have a wide range of expertise. They can provide counselling, offer advice and support to people with long-term mental health conditions and administer medication.
Some CMHN's specialise in treating certain people, such as children, older people, or people with a drug or alcohol addiction.
Clinical psychologists
Clinical psychologists are health professionals who specialise in the assessment and treatment of mental health conditions. They often work in combination with other mental health care professionals in multi- disciplinary teams.
Psychiatrists
Psychiatrists are qualified medical doctors who have done further training in treating mental health conditions. Psychiatrists are not just based in hospitals, but can have close links with GP's surgeries and community mental health centres.
Counsellors
Counsellors are individuals who have been trained to provide talking therapies that aim to help people cope better with both their life and their mental health condition. Most counsellors specialise in a specific type of therapy, such as cognitive behavioural therapy (CBT).
Psychotherapists
Psychotherapists have a similar role to counsellors, but they usually have more extensive training, and are also often qualified psychologists or psychiatrists. Psychotherapy tends to be a longer and more intense process than counselling.
Occupational therapists
Occupational Therapists in mental health provide training, support and advice to help someone to reach their maximum level of function and independence for day- to day living, including: personal independence, communication skills, self confidence, employment, social and leisure activities and interpersonal relationships.
Social workers
Social workers are often used to bridge the gap between mental health services and the wider social service provision. They can provide advice on practical issues such as benefits, housing, day care and training.
Approved Mental Health Professional (AMHP)
An approved mental health professional (AMPH) is a Social Worker, Mental Health Nurse, Occupational Therapist or Psychologist who has completed additional comprehensive and specialist training in order to be approved by the Local Authority and to fulfil designated functions under the Mental Health Act(MHA) (1983). Their functions can include helping to assess whether a person needs to be compulsorily detained as part of their treatment (sectioned).
An AMPH is also responsible for ensuring that the human and civil rights of a person being detained under the Mental Health Act are respected and upheld. For more information on the Mental Health Act see the section below about hospital care.
Mental Health Care Services
In the past there was often a clear distinction between 'frontline' primary care for mental health conditions, such as GPs and CMHNs, and more specialised services such as psychiatrists or clinical psychologists, who often only worked out of psychiatric units.
Due to the recommendations made in the National Service Framework report, there has now been a shift to providing some of these specialised services in a community setting, such as a day centre or at a person's home. As hospitalisation for a mental health condition can be both traumatic and stigmatising, it is only used when it is thought absolutely necessary.
Mental health services are now delivered by using a multi-disciplinary approach whenever possible.
Mental Health Trusts
In many parts of the country, mental health services are organised by specialist Mental Health Trusts. Mental Health Trusts provide inpatient care, community and rehabilitation services, residential care centres, day clinics and drop-in centres.
There are currently over 40 Mental Health Trusts in England and Wales.
Community Mental Health Teams (CMHTs)
Community mental health teams (CMHTs) work to help people with complex mental health conditions, such as schizophrenia or bipolar disorder (manic depression).
They aim to provide the day-to-day support needed that will allow a person to remain in a community setting.
Crisis Resolution Teams (CRTs)
Crisis resolution teams (CRTs) treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis, which without the involvement of the CRT, would require hospitalisation. Examples of an acute psychiatric crisis includes a psychotic episode or a suicide attempt.
Due to the nature of their work, CRTs offer a 24 hour service, and cases are often referred to them via A&E Departments or the police service.
The CRT will aim to treat a person in the least restrictive environment possible, ideally near that person's home. This can be in a person's own home, in dedicated crisis residential homes or a hostel, or in a day centre.
CRTs are also responsible for planning after-care once the crisis has passed in order to prevent a further crisis from occurring.
Assertive Outreach Teams (AOTs)
Assertive outreach teams aim to help people who have had a previous history of serious mental health problems yet are no longer in regular contact with mental health services.
The concern is that these people may still require regular treatment, but for a number of possible reasons, are no longer seeking it and so might become a risk to themselves or others.
AOTs will work in co-operation with other agencies in trying to locate people thought at risk, then try to persuade them to resume their contact with mental health services, while uncovering the reasons why they lost contact in the first place.
Once these issues have been resolved, the person's treatment can then usually be transferred over to a community mental health team.
If a person still refuses treatment, and it is though they pose a significant risk to themselves or others, the AOT may have to liase with the social services in order to get the person sectioned under the Mental Health Act.
Early Intervention in Psychosis Teams (EIPT)
Psychosis is a term that is used to describe a mental condition where someone is unable to distinguish between reality and their imagination. An episode of psychosis is usually caused by an underlying serious mental health condition such as schizophrenia or bi-polar disorder, or as a result of drug or alcohol abuse.
The early intervention by the psychosis team (EIPT) is designed to work with people aged 18-35 who have experienced their first episode of psychosis. In the past, it could take up to two years after the onset of psychotic symptoms before someone started receiving treatment and help.
Now, the EIPT focuses on the early detection and assessment of psychotic symptoms and then provides support and counselling in order to treat the underlying causes.
Early intervention can often be crucial because it is during the first few years that people with psychotic symptoms are at greatest risk of harm; both to themselves and to others. Also, the earlier a serious mental condition is treated, the better the long-term outcomes tend to be.
For more information about psychosis see the 'related articles' section.
Mental health facilities
Outpatient clinics
Most people with mental health condition can be treated on an outpatient basis, meaning they will not have to stay in a hospital or psychiatric unit.
Treatment can take place at a dedicated community mental health centre, a day clinic that operates out of the local hospital, or in some larger GP surgeries.
Hospital care
People can admit themselves voluntarily to hospital if their psychiatrist agrees that this is the best course of action.
People can also be compulsorily detained at a hospital under the Mental Health Act. Somebody can only be compulsory detained at a hospital if they are suffering from a severe mental disorder, such as schizophrenia, and detention is necessary:
- in the interests of their own health,
- in the interests of their own safety, and/or,
- for the protection of other people.
People compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will only stay as long as is thought absolutely necessary for treatment.
Regional secure units
Regional secure units are medium-security psychiatric units. They are used to treat:
- people who have been admitted by the courts under the Mental Health Act,
- people who have been transferred from prison under the Mental Health Act, and
- people transferred from an ordinary hospital ward because it is felt they need to be treated in a more secure setting.
Secure hospitals
Secure hospitals are high-security hospital used to treat people held under the Mental Health Act who are thought to pose a significant danger to the public. There are three secure hospitals in England and Wales; Ashworth, Rampton, and Broadmoor.
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How to use it
GPs and counselling
If you are concerned about your mental health you should first visit your GP. GPs, in combination with counsellors, can successfully treat some less complex mental health conditions such as mild to moderate depression, anxiety, and some eating disorders.
Your GP will be able to prescribe any medicines that are needed to help with your symptoms and also to refer to a counsellor.
An increasing popular type of therapy for a wide range of mental heath conditions is cognitive behavioural therapy (CBT).
CBT is based on the assumption that most unwanted thinking patterns, and emotional, and behavioural, reactions are learned over a long period of time. The aim is to identify the unhelpful thinking that is causing the unwanted feelings and behaviours and then to learn to replace this thinking with more realistic and balanced thoughts.
A course of CBT therapy can last between 5 to 20 weekly sessions, with each session lasting between 30 and 60 minutes.
A number of interactive software programmes are now available that replicate some of the functions of a CBT therapists. One example is the 'Beating the blues' programme, which has been approved by the National Institute for Clinical Excellence for the treatment of depression, anxiety, phobias.
Care Programme Approach (CPA)
If you have a more serious mental health condition that requires access to specialised mental health services you will be entered into a treatment process known as a Care Programme Approach (CPA). A CPA is essentially a way of ensuring that you receive the right tailored treatment for your needs.
There are four stages to a CPA:
- assessment - where your health and social needs are assessed,
- care programme - a care programme is created in order to meet your health and social needs,
- a care coordinator is appointed - a care coordinator (sometimes known as a keyworker) will be your first point of contact and will monitor your care, and
- review - your treatment will be regularly reviewed, and if needed, changes to the care plan can be agreed.
Assessment
The purpose of an assessment is to build up an accurate picture of your needs. As different professionals and agencies provide a range of services, your assessment will probably be carried out by more than one person. For example, a social worker, a psychologist and your GP may all be involved in your assessment.
During an assessment the following points will be considered:
- your psychiatric symptoms and experiences,
- your psychological thoughts and behaviour,
- your physical health and well-being,
- your housing and financial circumstances,
- your employment and training needs,
- whether you have a history of drug or alcohol use,
- whether you pose a risk to yourself or others,
- your culture and ethnic background,
- your gender and sexuality,
- whether you have anyone who depends on you, such as a child or elderly relative, and
- your hopes and aspirations for the future.
Care Plan
In its most basic form a care plan is what different people or agencies agree to do, in response to your assessed need. It also provides a record of your progress.
The care plan is drawn up for your benefit, not for the mental health service, so you will be encouraged to contribute your own wishes and desired outcome to the plan.
As part of the plan you may wish to consider what steps you would like taken, in the event of a future psychiatric crisis, such as who needs to be contacted, where you would like to be treated and what help people currently in your care, such as your child, would require.
Care coordinator
Your care coordinator will provide your first point of contact between yourself and the various health professionals involved in your treatment. They are also able to explain how the different services are responding to your different needs, while relaying any concerns or questions you may have to the appropriate person
Ideally, your care coordinator should be somebody you feel comfortable talking to and being with, and can be a social worker, occupational therapist, or community mental health nurse.
While you may have some choice about who becomes your care coordinator, it may not be possible in all cases.
Reviews
As your personal needs may change over time it is important that your treatment is reviewed on a regular basis.
During a review, yourself, your care coordinator, and other professionals involved in your care will meet to discuss your progress and to discuss whether your care plan needs to be changed to better meet your needs.
It may be possible to hold a review at your house, or in a neutral place, such as a community centre.
You can bring a friend or relative to a review for support if you wish.
Some people prefer to bring an advocate to their review. An advocate is somebody who will represent your views and interests during the review process.
Advocates can be voluntary, such as mental health charity workers, or professional, such as lawyers. Your care coordinator should be able to tell you what advocacy services are available in your local area.
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