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”.