Monday, 5 August 2013

What Do You Call a Person Who Receives Mental Health Services?

A description or a label?

There are people who have had bad experiences of mental health services – you only have to look in the comments sections of my posts on this blog to find people who have nothing good to say about mental health services  -- who would answer “victim”. (I just thought I’d get that in first).

But this is actually a serious question. When I started out as a social worker in the late 1970’s, social workers, and probation officers come to that, had “clients”. I didn’t then, and still don’t, think there is anything innately wrong with this term. After all, solicitors have clients. Architects have clients. Advertising companies have clients.

There is nothing pejorative or demeaning about the word “client”. It simply indicates that there is some form of consultative partnership going on. There is no hint there of any sort of power differential.

But “client” no longer appears to be a satisfactory term. Nurses and doctors have “patients”, but social workers clearly cannot have patients. The Oxford Dictionary definition of the word “patient” is: “a person receiving or registered to receive medical treatment”. Since social workers (or occupational therapists or clinical psychologists) do not actually give medical treatment, the term “patient” does not really apply.

However, I must say that, working in a multidisciplinary team with doctors and nurses, it is easy to refer to “patients”. I try to resist this, not always successfully. This is made a little more difficult by the Mental Health Act referring to people subject to the Act as being “patients”. So there are times when I have to use that term in a professional context when acting as an AMHP.

There has recently been what in my view is a wholly deplorable move, to use the term “customer”. “Customer” does not describe the relationship between a mental health service and someone who receives that service.

The Oxford Dictionary defines “customer” as: “a person who buys goods or services from a shop or business” while the Merriam-Webster Dictionary gives the definition: “one that purchases a commodity or service”. Since someone who sees a mental health professional, either voluntarily or because they have been detained in hospital or are subject to a Community Treatment Order is in no way “buying” or “purchasing” that service.

This is the problem I have with attempts to apply a business model to a public service. Under the new GP led NHS system, the “customer” is not the person in receipt of the service, the customers are actually the Clinical Commissioning Groups (CCG’s) who are in reality purchasing services from the Mental Health Trusts. It is therefore the CCG’s that the Trusts have to satisfy, not the people who actually receive their services.

If shops treated their customers in the way that mental health services treated the recipients of their services, it might go something like this.

Customer: Have you got this blouse in stripes and size 14, please?
Shop Assistant: We’ve got that in stock, but I’m not going to give it to you. You need a pair of leggings in size 16. Here they are. No need to try them on.

So, I think we’re all clear now that “customer” should never be used when referring to people who use mental health, or indeed and public service.

So what have we got left? The popular term currently appears to be “service user”. Even service users refer to themselves as “service users”.

It’s possibly the least worst, but I’m still not convinced that it accurately reflects the role. It still implies that the “service user” has a choice over whether or not to use the service. This is not always the case, especially where the Mental Health Act comes in. Is someone detained against their will under the Mental Health Act “using” that service? Is it indeed a “service” at all?

Is a prisoner serving a sentence in a prison a “service user”? Not if they have no choice over whether or not they want to receive that particular “service”.

The other problem is whether what a social worker, or a nurse, or a psychiatrist, or a psychiatric hospital can be described as a “service”.

A waiter is providing a service. They are quite literally your servant. The customer is always right. It is the job of the waiter to give you what you want, not what the waiter wants to give you. Contrast that with a psychiatrist, for example.

Patient: I’d like 10mg Olanzapine, as well 20mg Citalopram. Oh, and I think I’ll have some 5mg Diazepam prn, just in case I get a bit anxious.

Psychiatrist: No.

So do I have any alternative suggestion? My only alternative is “service recipient”. That is, someone who is in receipt of a service. Or  at a pinch, “client”.


  1. Service recipient is probably the best. Although I am sure some recipients would say that they are hardly receiving a service. It's a no win situation.

  2. Customer seems particularly inappropriate. Patients are taxpayers, and as such are the owners of the service.

    This is not something that is easy to forget in the midst of services where user involvement is so often tokenistic, or an afterthought.

    (*even if not paying income tax, all patients will be paying VAT)

  3. *oops, remove the not from that last sentence. It is, of course, easy to forget, or at least is often forgotten

  4. What about simply user/recipient? Although realise "user" could have other connotations! I agree trying to find an agreeable term for all is virtually impossible...want a name that is instantly understandable but not without being a troublesome label!

  5. As a patient, I prefer patient - whether I'm having a discussion with a nurse, psychiatrist, social worker, psychologist, or occupational therapist.

    I feel that the other terms imply soliciting services, rather than any element of care being provided. It's a very specific relationship. Then again, there is an issue of the passivity that "patient" sometimes comes with. Hopefully something that will go as medicine becomes less paternalistic.

    That's just from my point of veiw. Although I can see that describing the people you work with as a group may be difficult, I am usually asked how I prefer to be refered to in these circumstances. Is that ever unsuitable?

  6. Let's return to client! And please, please ditch all things buisness like!!

  7. I am a Nurse but one of the tutors I respected favoured the work of John Heron and 'client' just stuck. Fortunately noone has ever pulled me up over it. I had a manager for a while who worked in New Zealand where clients were 'Consumers of Services' which became consumers, a bit like users, quite a negative picture of someone using up resources...

    I think the move from 'service user' to 'customer' is signifiicant and political. With the advent of personal budgets clients are encouraged to see themselves as having choice in who provides their care as the NHS/Local Authority will be providing very little of it.

    Unfortunately I suspect a lot of them will also find themselves paying for it and jargon has a significant part to play in preparing us for it.

    Sad times.

  8. As someone with MH problems. I actually really couldn't care less what I am called. As long as it's not derogatory, I don't mind. I would imagine most people feel like this.

  9. Customer is terrible. The DWP now call people customers.

  10. Customer is AWFUL! :(

    Shocked and saddened to hear that.

    This is topical for me (a 'service user') as I am currently writing an assignment for my MA about an art exhibition created by individuals who happen to have mental health difficulties.

    No word seemed to fit... I wanted to settle with something I was comfortable with, and in the end I went with 'artists'.

    My CPN had a conversation with me about this several years ago, telling me that different individuals on her team had their own preferences of service user/ client. My Mum (CPN) uses 'patient'... maybe because she works in the Crisis Team and people tend to be more unwell?

  11. I quite liked client when I had my old mental health social worker (nicknamed Balamory). I felt like we were working together to try and solve problems. I've not had that feeling of partnership with any other social worker since though (mental health or physical disabilities) so it doesn't feel quite right.

    I lived in supported accommodation for a year and most of the others living there hated service user because it sounded too much like drug user and made them feel disempowered. They ended up using client in the end but they weren't social workers.

    It's complicated. Patient works fine for nurses and doctors. If the social worker/person they're working with work together as a partnership then client works, but if it's more top down (which seems more common though I'm not sure how it's meant to work) then it feels wrong. Service recipient doesn't feel much better than service user to me.

    It's not really that important but it's an interesting discussion.

  12. I refer to patients as a social worker working in a inpatient mental health hospital. There was discussion about changing this but the patients on the whole stated they wanted patient as they felt it reflected that they were unwell, just would be the term in a general hospital. At university 'service users' was also the preferred option.

    1. Thank you! I was looking for ideas about use at a university. Your comment helped.

  13. How about 'victim'. Abused, powerless, disenfranchised, silenced.

  14. Lucky ?Also, I'd like *not* to be addressed by my first name by someone I don't know on our first meeting, be that a nurse or a doctor. Seriously, I think it patronising and a bit strange to try and tiptoe round the fact that if you need mental health services, you are ill, and therefore a patient.

  15. Over here in Germany, we're all considered patients, we're all addressed with the formal you (Sie), and all patients are addressed as Mr/Mrs LastName. Non-doctor staff in MH settings is often firstname basis for security reasons and ease in remembering under stress for patients. But the formal you remains.

  16. In Australia the term used is "consumer". I dislike it as I feel it implies choice.

  17. As someone connected with Social Care, but not a Care Professional or a 'consumer' of MH Services, my opinion is that if someone is in a medical environment, then they are a 'patient'. If not, they are a 'Service User'; as whether it is voluntary, accepted or otherwise, they are using the 'service'.

    As an aside, what is the difference between 'service user' and 'service recipient', beyond the perceived negative connotations to the term 'user'?

  18. As the person who posted 'victim' as the term to be used I find it offensive that you could not even consider that someone may have been so traumatised by contact with services that this becomes the reality. Safeguarding issues will never be addressed when senior MH workers jump to conclusions. You just assumed I had a 'woe is me' attitude to life?

    I am not a victim of circumstance, my life approach was always more creative and positive than those professionals who provided a service. I did not ask them for help and did not want intervention most of the time but as an AMHP you will know that in MH you lose the rights others take for granted.

    I was a victim of serious sexual assault by a MH worker with all that this involves at the time and now. Up until then I trusted completely. So victim IS the correct term however uncomfortable it sounds to your ears.

  19. And following on from my previous post:
    Yes reported to police, yes criminal investigation, yes Trust and authorities informed, yes prosecution recommended by DPP.However risk to me considered too high to continue with case as level of distress unmanageable.

    Result to MH: completely isolated ,severely traumatised, no access to therapy as Trust controls this, multiple detentions under MHA as suicide becomes the only way the trauma goes away.

    And the perpetrator? Still employed after suspension. Nothing good to say about MH services? Difficult now for anyone involved in my case to see what is positive about my experiences . And I am not the only victim of this type of abuse. Police and Rape Crisis continue to try and support years after event.

    Options: civil action - strong case legally aided but takes years, report to NMC - ha bloody ha, private prosecution , summarary justice old school , forgiveness - hard when no remorse shown, do nothing, suicide.

    Only one option makes this go away and stops me being a victim.Trust would then call me an ex- service user I guess

    1. I am sorry you have had a bad experience of mental health services. In my first paragraph I do acknowledge that some service users will consider themselves "victims". There used to be a local service user group where I work which called itself "The survivors of mental health services". You should also acknowledge that most mental health professionals are actually trying to help people. I obviously cannot comment on your personal circumstances.

  20. I believe most people in the world have good intent and actions are often clumsy rather than malicious. I did trust MH workers -even tried to continue to after this. BUT the response was to either openly disbelieve me, withdraw services,not co-operate with police and the situation unravelled. I didnt know it at the time but the safeguarding policies were not fol;owed and CQC then carried out its own investigation. It transpired the worker had multiple similar complaints against him and yet the Trust and his colleagues scapegoated me for speaking up. It is these actions that have destroyed my trust, my dignity, my sense of place in the world.It feels at best like turning a blind eye and at worse criminal cover up. I have NEVER used the term victim as applied to myself before this.But to deny I am a victim lets the perpetrator AND all those who turned away off the hook. But they cant say they didnt know and they cant say they didnt know what the inevitable outcome is for me.

  21. I was sectioned last year and one of the Nurses informed me that I was a customer to which I asked her if they always locked up their "customers".

    This really does not fit at all.

  22. If I am a customer then maybe I get more protection under the Sales of Goods and services Act than I have ever got under the Mental Health Act! I could sue the hospital for not delivering goods or services that were fit for purpose and maybe the AMHP for misselling the contract of detention as the assessment and treatment were not delivered as promised. Breach of contract easier to enforce than negligence claims lol.