Expert answers from
Terms beginning with O P and R
- Patient Advice and Liaison Service (PALS)
- Patient and public involvement (PPI)
- Peer support worker/peer professional
- Personal budget
- Personal health budgets
- Primary care
- Primary care trusts (PCTs)
- Positive symptoms
- Prodromal symptoms
- Psychological treatment
- Psychotic like experiences (PLEs)
- Randomised controlled trial
- Recovery College
- Responsible Clinician
An ‘outcome’ is a result. Mental health professionals and researchers talk about outcomes when they describe what happens to people’s health and quality or life after treatment or therapy, for example, or what happens to people’s health and quality of life if they do not have a particular treatment. A ‘long-term’ outcome is what happens to people’s health and quality of life over a number of years. Researchers measure outcomes to see if a particular treatment or package of support is effective. One outcome they might measure would be the number of relapses people have, for example. Another might be the number of times people are admitted to hospital. The government is introducing very specific outcomes as a way of measuring the success of social care and mental health services.
All NHS trusts have a Patient Advice and Liaison Service (PALS). The role of PALS workers is to provide support, advice and information to patients and their families. They can also tell you how to complain about a service, and will explain the trust’s complaints procedures.
PPI is a term used in research to describe the involvement of people who use services and their family members as advisors, consultants or collaborators rather than as participants in trials and studies.
Some mental health trusts train and employ peer support workers (also called peer professionals, peer support specialists or peer workers). These are people who have personal experience of mental health problems and using mental health services. The peer support worker is a new sort of worker, introduced as part of the move to make mental health services more orientated towards supporting personal recovery. They are working in various roles in different services, both on wards and in community-based teams.
A personal budget is a sum of money allocated by a local authority to an individual who is eligible for long-term social care support. The idea is that people can then plan and decide how to spend the money themselves to best suit their needs and the way they want to live. People can receive the money contained in a personal budget in a number of different ways. A direct payment means the agreed sum is paid into an individual's bank account on a regular basis (weekly or monthly, for example). The individual is then able to access and spend the money themselves. Alternatively, the local authority may manage the money on behalf of an individual. This is sometimes called a 'managed account.'
A personal health budget is an amount of NHS money given to a patient after an assessment of their health needs. The individual then personally controls that sum of money and uses it to buy services to meet those needs. Each person gets a care plan that includes the amount of money in the budget and details how it is going to be spent. After April 2013, individual personal health budgets will have to be agreed by the new clinical commissioning groups responsible for planning and commissioning health services in different areas. The government has been piloting and evaluating personal health budgets and people with mental health problems have been involved in the pilot schemes. The government is committed to making personal health budgets more widely available in the future.
Personalisation describes a way of making sure people who need care and support in the community have the opportunity to plan and choose for themselves services to help them live in a way they want to – rather than being told what is best for them by professionals. It is government policy for health and social care services to be organised in a way that promotes personalisation. For local authorities, a key element of personalisation is the introduction of 'personal budgets' for people who need long-term social care. This sometimes includes people who have a serious mental illness like schizophrenia. Instead of organising and commissioning services on behalf of people who need social care, a local authority is instead allocating a sum of money to eligible individuals. Each person can then use those funds to organise services that meet their particular needs and enhance their life. The government wants all local authorities to provide personal budgets to everyone eligible for support from social services by April 2013. As a result of this policy, local authorities have been redesigning their systems for delivering social care services.
The NHS has ‘primary care’ and ‘secondary care’ services. Primary care services are the first point of contact with the NHS: a GP, a dentist, an optician, for example. NHS walk-in centres, and the NHS Direct phone service are also primary care services. Secondary care services are specialist services like mental health services that are run within a specific area. Mostly you need to be referred to a secondary care service by your GP. Sometimes, very specialist services take referrals from across the country: these may be referred to as tertiary care services.
Primary care trusts are the organisations that previously planned and ‘purchased’ health services for a particular area. In April 2013, they are replaced by clinical commissioning groups, led by GPs and other health professionals. This is part of the latest NHS re-organisation described in the Health and Social Care Act 2012.
The 'positive symptoms’ of schizophrenia are the more obvious signs of psychosis – delusions, hallucinations and disordered thinking.
Before people experience a first episode of psychosis, they may experience what health professionals call ‘prodromal symptoms’. Someone may become depressed or anxious, find it difficult to concentrate or have problems remembering things, stop seeing their friends, act in a strange and uncharacteristic way, be less interested in study, work or hobbies and care less about how they look. They may become socially withdrawn and spend much more time alone. They also sometimes have experiences resembling the symptoms of psychosis – hearing voices every now and then, being occasionally suspicious and paranoid for example.
A ‘provider’ is any organisation that provides health or social care and support. It may be an NHS organisation, a voluntary organisation, a charity or a private organisation.
Psychological treatments (also called psychological interventions) are ‘talking therapies’. Some psychological treatments, like cognitive behaviour therapy, focus on the links between feelings, thoughts and behaviour. Some, such as family therapy (also called family intervention), focus on how families negotiate to solve problems together and cope with problems. Others, such as cognitive remediation therapy, focus on working to improve memory and attention. Psychologists work with individuals, groups and families.
An estimated five to eight per cent of people who do not have a diagnosis of a mental illness experience 'psychotic like experiences' – they may hear voices, have paranoid thoughts and delusional beliefs, for example. These sort of experiences are more common among adolescents, and younger children can also have them. Research studies have shown that for most people, these experiences are temporary and disappear over time. A very small proportion of people who have these experiences go on to develop a mental health problem such as schizophrenia or bipolar disorder.
A randomised controlled trial (or RCT) is a type of research project used mostly to test how effective treatments or services are. People who agree to take part in a RCT are randomly chosen to have different treatments or services so researchers can compare the effectiveness of each one. The random selection means the results are not biased or 'fixed'. Many researchers think that the evidence from a properly conducted and randomised controlled trial provides the clearest answer about which treatments work best. Guidance from the National Institute for Health and Clinical Excellence (NICE) is based on evidence from randomised controlled trials for this reason.
There are two meanings to the word ‘recovery’. The first is the traditional meaning – when the symptoms of an illness are gone, people are said to have ‘recovered’. Health professionals call this a ‘clinical recovery’. The second meaning is about recovering a life worth living, without necessarily having a clinical recovery. This occurs when someone builds a life that is satisfying, fulfilling and enjoyable, whether or not he or she continues to experience the symptoms of an illness. There is a lot of work going on to make mental health services more supportive of this second type of recovery and the government included this kind of recovery as a priority in its strategy about mental health, published in February 2011.
A Recovery College is a new type of service that gives people with mental health problems the opportunity to access education and training programmes designed to help them on their road to recovery. The courses are devised and delivered by people with personal experience of mental illness working together with mental health professionals. The idea is that Recovery Colleges help people become experts in self-care and give them the skills and confidence they need for work and get on with their lives.
The term 'refractory schizophrenia' is used when antipsychotic medication makes little difference to the symptoms of the illness. 'Treatment-resistant' is a more commonly used term.
The Responsible Clinician is is the name given to the senior professional in charge of someone’s care when they are detained in hospital for assessment or treatment under the Mental Health Act.