A mental health advocate is someone who can listen to you and support you in times of need. Advocates should be independent from any person or organisation involved in delivering your care. An advocate should support you to:
- express your views and concerns
- access information and services
- defend and promote your rights and responsibilities
- explore your choices and options
There are many forms of advocacy in mental health – see the entries for different types of advocate below. (See Advocacy for more information.)
A citizen advocate is a volunteer, who works as part of a citizen advocacy scheme. A citizen advocate would usually work with you on a long term and one to one basis. Unlike a peer advocate, a citizen advocate does not have to have personal experience of a mental health problem. (See Peer advocate below)
Independent mental capacity advocate (IMCA)
An independent mental capacity advocate (IMCA) can support and represent you if it has been decided that you lack capacity to make decisions under the Mental Capacity Act. An IMCA provides information to work out what is in your best interests and, if necessary, will challenge decisions that they do not believe are helpful for you.
Independent mental health advocate (IMHA)
An independent mental health advocate (IMHA) helps you understand and use your legal rights if you are being treated under the Mental Health Act. For example, if you have been detained under the Mental Health Act (sectioned) or are being treated on a community treatment order (CTO).
An inpatient advocate works with people who have been admitted to hospital. Inpatient advocates can be helpful in several ways, including helping you to claim benefits, challenging detention and supporting you to express your preferences and concerns to doctors during ward rounds. Most advocacy services will have inpatient advocacy as part of their service.
A peer advocate is someone with experience of using mental health services who can support you to understand and defend your rights. Because a peer advocate has experience of using mental health services, they can often use their own experiences to help you understand your situation and give you practical advice.
Self advocacy is about you expressing your own needs and rights as a mental health service user. Some examples of tools for self advocacy are:
- assertiveness training
- using crisis cards or advance statements which set out your wishes in the event of crisis
Self advocates often form self advocacy groups – a group of mental health service users and ex users who work together. A self advocacy group might:
- act collectively to influence service provision and treatment
- support an individual to advocate for themselves.
If you are held by the police and they realise, or are told, that you have a mental health problem, you must be accompanied by an appropriate adult. An appropriate adult should be an adult who is independent of the police, such as a member of your family or a mental health worker, but it cannot be your solicitor. You can not choose who your appropriate adult is, but you may be asked you about your preferences. An appropriate adult should make sure that you get a solicitor, request that you are seen by a doctor and help you to communicate with the police. They should also be present if you are questioned about an offence. (See Mental health and the police.)
Approved mental health professional (AMHP)
An approved mental health professional (AMHP) is responsible for organising and coordinating assessments under the Mental Health Act. An AMHP can recommend that you are detained in hospital under the Mental Health Act (sectioned) or that you receive a community treatment order (CTO). The role is often held by specially trained social workers, but can also be carried out by occupational therapists, community mental health nurses and psychologists. This role has replaced the role of approved social worker (ASW). (See The Mental Health Act 1983.)
Assertive outreach team (AOT)
An assertive outreach team (AOT) may work with you in the community (i.e. outside of hospital) if you have found working with other community based mental health services difficult or unhelpful. If you have experienced severe mental health symptoms along with other problems such as violence or homelessness, it is more likely that you will work with an AOT. The care coordinator within an AOT will generally be responsible for a smaller number of service users than in a community mental health team (CMHT), which means they can devote more time to each individual they see. (See Community mental health team (CMHT) below). An AOT contains a range of different mental health workers, such as social workers, support workers, community mental health nurses (CMHNs) and psychologists.
A care coordinator is the main point of contact and support if you need ongoing mental health care. They keep in close contact with you while you receive mental health care and monitor how that care is delivered – particularly when you are outside of hospital. They are also responsible for carrying out an assessment to work out your health and social care needs under the care programme approach (CPA). A care coordinator usually works as part of the community mental health team (See Community mental health team (CMHT) below). A care coordinator could be any mental health professional; for example, a nurse, social worker or other mental health worker. This is decided according to what is most appropriate for your situation.
A carer is anyone who supports someone experiencing mental health problems. This could be a parent, partner, son or daughter, neighbour or friend. A carer can be an adult or a child carers are often unpaid, but some receive benefits to provide full time care. A lot of carers live with the person they care for, but many do not. The term carer may also refer to someone who is employed as a professional carer, but it is used less frequently in this sense. (See How to cope as a carer for more information.)
A CBT practitioner provides cognitive behavioural therapy (CBT) – a short term talking treatment (usually six weeks to six months) designed to change patterns of behaviour and thoughts. CBT is recommended as the initial treatment for many mental health problems. CBT practitioners may offer individual or group therapy as well as other kinds of talking treatment. A CBT practitioner could be a psychiatrist, psychologist or another mental health professional who has had specialist CBT training. CBT practitioners may work for the NHS, as private practitioners or for a voluntary organisation, such as a local Mind. All CBT practitioners should be registered with an appropriate professional accreditation body. There are a number of such bodies. (See Useful contacts).
Citizens Advice Bureau (CAB)
The Citizens Advice Bureau (CAB) is an independent organisation providing the public with information across many social and legal issues. Specialist advisors working at CAB can answer queries on a broad range of topics, including employment, housing rights and benefits.
Community mental health nurse (CMHN)
A community mental health nurse (CMHN) is a registered nurse with specialist training who works with you if you receive community based mental health care (i.e. care outside of hospital). The role of a CMHN is very wide and can include:
- counselling or anxiety management
- exploring coping strategies
- helping you with day to day life
- administering psychiatric drugs such as injections
CMHNs may also have a particular specialism, such as children, elderly people, or drug or alcohol problems.
Some CMHNs are attached to GP surgeries or community mental health centres, and others work in psychiatric units. Most work as part of a community mental health team (CMHT). (See Community mental health team (CMHT) below).
Community mental health team (CMHT)
A community mental health team (CMHT) organises and coordinates your care if you receive community based mental health care (i.e. care outside of hospital). This includes carrying out mental health assessments, treatment and care.
You are normally referred to a CMHT if you have complex mental health problems and need more specialist help than a GP can offer.
A CMHT contains a range of different mental health workers, such as psychiatrists, psychiatric nurses, social workers and occupational therapists.
Community psychiatric nurse (CPN)
A community psychiatric nurse (CPN) is another term for community mental health nurse (CMHN). (See Community mental health nurse (CMHN) above)
A counsellor offers counselling – a talking treatment that aims to help you find ways of coping with problems that you are experiencing. The overall aim of counselling is to provide an opportunity for you to work towards living in a more satisfying way where you feel able to cope with life’s challenges. (See Talking treatments.)
A counsellor may offer individual or group therapy, and may deal with specific problems, such as grief, anxiety, violence or shyness.
A counsellor may be a professional counsellor, a psychologist or another mental health professional. Counsellors may work for the NHS, for private practitioners or for a voluntary organisation, such as a local Mind group.
All non NHS practitioners should be registered with a professional self regulating body. The body they register with will depend on their exact role and qualifications. (See Useful contacts.)
Crisis resolution and home treatment team (CRHTT)
A crisis resolution and home treatment team (CRHTT) offers you intensive support and advice if you are experiencing a mental health crisis.
The aim of the CRHTT is to provide the support you need to recover at home and avoid you being admitted to hospital if possible. They may also work with your care coordinator and your carer(s) to develop and review your care plan.
During a crisis, they will visit you at home, often on a daily basis. Once you start to feel better, their involvement in your care will decrease and you will either be referred to another team for ongoing care or you will be discharged.
If a crisis gets worse, or continues for longer than expected, your CRHTT may work in partnership with a hospital, possibly including arranging for your admission.
A CRHTT contains different mental health workers, such as psychiatrists, community mental health nurses (CMHNs), social workers and community support workers.
Early intervention team (EIT)
An early intervention team (EIT) works with anyone aged 14–35 who is experiencing a first episode of psychosis or is at significant risk of doing so.
An EIT aims to help you understand the symptoms that occur just before a psychotic episode, in order to help you seek appropriate treatment as early as possible. This is intended to reduce the length of your psychotic episodes and help you recover from them more quickly.
An EIT contains different mental health workers, such as psychiatrists, psychologists, community mental health nurses (CMHNs) and social workers.
A gateway worker offers one to one support to people who are experiencing low level mental health problems, such as mild depression, anxiety or stress.
A gateway worker aims to help you stay independent and supports you to manage your own mental health. A gateway worker can:
- give you information and advice
- tell you about services and groups in your area
- carry out mental health assessments
- support you to attend health or social care appointments.
A gateway worker is usually a nurse, social worker or occupational therapist. They may work in a GP surgery or visit you at your home.
General practitioner (GP)
A general practitioner (GP) is a doctor who provides a complete spectrum of health care in the community (i.e. outside of hospital). GPs are the first point of contact with the NHS for most people, including if you are experiencing emotional and psychological difficulties.
GPs can talk through problems, prescribe medication or make referrals to other services, such as counselling or cognitive behavioural therapy (CBT). Many GP practices have counsellors, social workers or community mental health nurses (CMHNs) attached to their surgeries.
GPs may provide treatment themselves, or work with other mental health professionals to provide your care. They may also refer you to a more specialist mental health team, such as a community mental health team (CMHT). (See Community mental health team (CMHT) above.)
A health visitor is a qualified nurse or midwife, with special training and experience in child health. Health visitors work with you if you are pregnant, have recently given birth, or have a child under the age of five.
They can offer practical support, information and advice about the health and development of your child, as well as about mental health issues such as postnatal depression. They can also point the way to more specialist help if it is needed.
A hospital manager coordinates hospital resources, facilities and services. They are responsible for administering all non medical areas of the hospital and ensuring that medical staff have the resources do their jobs. Hospital managers may work for NHS or private healthcare providers.
Mental Health Tribunal
If you disagree with a decision that has been made about you under the Mental Health Act, you can apply to the Mental Health Tribunal. The Mental Health Tribunal listens to evidence from doctors and social workers and reviews the decisions that have been made. The tribunal have the power to overturn or change decisions if they feel they are not appropriate.
The Mental Health Tribunal deals with decisions about:
- detaining (sectioning) someone in hospital
- community treatment orders (CTO)
- conditions placed on discharge from hospital.
The Mental Health Tribunal is made up of three tribunal members, who are legal and medical professionals. Tribunal hearings are usually held in hospitals. (See GOV.UK for more information.)
Nearest relative (NR)
If you are admitted to hospital under a section of the Mental Health Act or subject to a community treatment order (CTO), your nearest relative (NR) is given rights and powers under the Mental Health Act.
The nearest relative is selected from your closest relatives, including your partner if applicable, by the approved mental health professional (AMHP) responsible for your care. It is a specific legal role, separate from a person’s next of kin.
The nearest relative may request that you are detained in hospital under the Mental Health Act (sectioned), or that you are discharged from hospital if you have been detained. They have the right to be given information about your care, and to be consulted in any decisions that are made about you. (See our legal information Nearest relatives under the Mental Health Act for more detailed information.)
National Institute for Health and Care Excellence (NICE)
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice on health and social care in the UK. NICE has a range of responsibilities, including:
- issuing guidelines that describe how best to manage and treat mental health problems
- setting quality standards for treatment
- providing access to information for NHS professionals, such as information about medication.
NICE’s guidelines and advice are used by the NHS, as well as by some voluntary and private organisations. NICE works in collaboration with relevant professional bodies such as the Royal College of Psychiatrists.
Occupational therapist (OT)
An occupational therapist (OT) aims to help you overcome any practical difficulties you have as a result of your mental health problem.
They can help you build up the confidence and skills needed for personal, social, domestic, leisure or work activities. They often focus on the learning of specific skills or techniques, including arts, crafts, drama, dance, writing, group work (such as anxiety management and assertion training), individual counselling and practical day to day living skills.
Occupational therapists work in a range of places, such as GP surgeries, psychiatric units or residential units. They may also visit you at home. They may work for the NHS, a social services department or a voluntary organisation.
Occupational therapists are usually registered with the British Association of Occupational Therapists and College of Occupational Therapists.