Glossary of terms

Advanced agreements

An advance agreement sets out a patient's instructions concerning his or her care or treatment. It will usually be made out when the patient has proper ability to make such decisions and is intended to be used to influence treatment when his or her judgment is impaired by their mental disorder. Health professionals are not bound to follow such instructions if they conflict with their professional judgment about the most appropriate form of care and treatment, but they should give them serious consideration.

Care and treatment order

The care and treatment order will authorise the care and treatment specified in a care plan recommended by the clinical team. The order will be made by the Mental Health Tribunal.

Care plan

A comprehensive care plan is prepared by a patient's clinical team following a detailed assessment of the patient's needs carried out in accordance with the Care Programme Approach and the corresponding guidance in Wales. The written care plan will address the patient's identified health and social needs.

Care Programme Approach (CPA)

The CPA provides a framework for care co-ordination of service users under specialist mental health services. The main elements are a care co-ordinator, a written care plan, and at the higher level, regular reviews by the multi-disciplinary health team and integration with the social services care management.

Carers

Professional carers, relatives or friends who look after individuals who are mentally disordered. This will normally be the main carer or carers.

Civil powers

Legal powers of compulsory care and treatment authorised by the Mental Health Tribunal in civil proceedings.

Clinical supervisor

The consultant with lead responsibility for the care of a patient with a mental disorder. Normally a consultant psychiatrist, but may also include a consultant psychologist. The clinical supervisor replaces the current "Responsible Medical Officer".

Clinical team

A multi-disciplinary team, under the leadership of the clinical supervisor, which is responsible for the assessment, care and treatment and supervision of patients.

Code of Practice

A statutory Code of Practice will provide guidance on the operation of the new legislation, and will cover the key areas of good practice. It will be an important source of information for practitioners, patients and their advisers.

Cognitive Behavioural Therapy (CBT)

A form of psychological treatment based on learning theory principles used mostly in depression but increasingly shown to be a useful component of treatment in schizophrenia and some personality disorder. CBT involves improving thinking and social skills by teaching strategies to apply to deal with problems and people more effectively.

Commission for Health Improvement

CHI was set up under the Health Act 1999 to inspect all NHS organisations in a rolling programme to help drive up standards and the quality of care, and began work in April 2000. CHI is the first ever independent, external body to scrutinise standards in the NHS. CHI also has a developmental role in helping the NHS to address weaknesses through providing advice and spreading good practice more quickly and effectively than before.

Commission for Mental Health

The Mental Health Act Commission will be replaced by a new Commission for Mental Health which will look after the interests of people who are subject to the provisions of the new legislation.

Compulsory powers

The legal powers of compulsion which empower the clinical supervisor to provide care and treatment for a mental disorder in the absence of a patient's consent.

Conditional discharge

When a restricted patient is discharged from hospital subject to specified conditions and liability to be recalled to hospital by the Home Secretary.

Criminal justice disposal

A period of imprisonment or a community punishment imposed by a Court.

Criminal justice system

All the agencies responsible for the detection and prosecution of breaches of the criminal law and for the execution of the sentences of Courts. These include the police, the Crown Prosecution Service, the Courts and the probation and prison services.

Dialectical behavioural therapy

A specific type of cognitive behavioural therapy which includes skills training and exposure to emotional cues, found to be particularly effective in treating those with self-harming behaviour. It is delivered according to a manual to ensure adherence to effective interventions.

Discharge

A patient will be discharged from compulsory care and treatment under the new legislation when the conditions for continued use of compulsory powers are no longer met. Discharge from compulsory care and treatment does not mean that a patient will not need continuing care but in many cases care and treatment will continue without the use of compulsory powers.

Emergency powers

Powers to detain a patient pending a preliminary examination to determine whether the use of compulsory powers is appropriate.

Expert panel

Local panels of experts from a wide variety of disciplines including general, old age, child and learning disability psychiatry and psychology. The panel will also include those with social care and mental health nursing backgrounds. Members of the panel will be of consultant grade, or, in the case of social workers or nurses, will have appropriate seniority and experience. Appointments will be made by the Commission for Mental Health.

Formal assessment

All patients coming within the provisions of the new legislation will undergo a formal assessment in accordance with the Care Programme Approach or the corresponding guidance in Wales.

"Hare" score

The score of an individual on the Psychopathy Checklist (Revised) (PCL-R). The PCL-R is a construct designed by Hare, based on Clerkey's concept of the psychopath as observed in his book "The Mask of Sanity". It is a 20 item checklist. A cut off of a score of 30 (each item can score a maximum of 2 points), the subject will be designated a psychopath for research purposes.

Hospital and limitation direction

Where the Court imposes a prison sentence at the same time as a direction of immediate admission to hospital (a hospital direction) together with a limitation direction (which has the same effect as a restriction order). When the offender is discharged from detention in hospital, he will be transferred to prison to serve the remainder of his sentence.

Information sharing

New legislation will place a duty on professionals and agencies that have responsibilities for patients who are subject to compulsory powers to share relevant information to ensure that all those involved in a patient's care and treatment are properly informed. This is often important to ensuring the patient's best interests are met, it may sometimes be necessary in the public interest.

Mental disorder

Under new legislation this will be defined to cover any disability or disorder of the mind or brain, whether permanent or temporary, which results in an impairment or disturbance of mental functioning.

Mental Health Tribunal

A new independent Tribunal will authorise the use of formal powers beyond 28 days. The Tribunal will be required to seek advice from independent experts (from the expert panel) as well as taking advice from the clinical team and hearing the views of patients or their representatives.

Mental Health National Service Framework (NSF)

Published in September 1999, the NSF has established national standards for the care and treatment of mental illness in England. An NSF for Wales is being developed in conjunction with the new All Wales Strategy for adult mental health services.

Multi Agency Risk Panels/Public Protection Panels

Local panels led by the police and probation services, and involving other agencies such as health, social services and housing, which agree local arrangements for managing the risk posed by potentially dangerous offenders in the community.

National Care Standards Commission

Provisions for the Commission were made in the Care Standards Act 2000 and it is expected to take on its regulatory responsibilities from April 2002. The Commission is an independent inspection and regulatory system for independent health and social care services.

National Oversight Group

A national group involving representatives from Regional Specialised Commissioning Groups, chaired by the NHS Executive Director of Operations, which oversees the development and operation of regional commissioning of high security psychiatric services.

Personality disorder

A disorder of the development of personality. It includes a range of mood, feeling and behavioural disorders including anti-social behaviour.

Place of safety

Any suitable place to which a person is taken under the new legislation for the purpose of carrying out a preliminary examination.

Primary Care Trusts (PCTs)

PCTs are free-standing bodies, accountable to their Health Authority for commissioning care and responsible for the provision of community services.

Psychiatric supervisor

A psychiatrist who is responsible for supervising an offender on conditional discharge from compulsory care and treatment in hospital. The psychiatric supervisor is currently known as the supervising psychiatrist.

Restriction order

When, in the case of an offender, a compulsory care and treatment order in hospital is made, the Court will be able to impose a restriction order where it appears necessary for the protection of the public from serious harm. The principal effect of the restriction order will be that the patient cannot be discharged from hospital without the consent of the Home Secretary or that of the Mental Health Tribunal in accordance with certain statutory criteria. It also means that the Home Secretary's consent is needed for the patient to be allowed out of hospital either for short periods or to move to another hospital.

Restriction direction

When transferring a prisoner from prison to hospital for compulsory care and treatment, the Home Secretary may, and in most cases will, also impose a restriction direction, so that the patient cannot be transferred to another hospital, sent on leave or discharged without his consent.

Restricted patient

A patient subject to a restriction order or restriction direction.

Second opinion approved doctor

A psychiatrist appointed by the Commission for Mental Health to provide a second opinion, as required by legislation, on the continued use of medication in the face of a patient's persistent objection or, providing the special safeguards in respect of patients with long term mental incapability who do not resist treatment. He or she also provides a second opinion on the use of treatments requiring special safeguards such as psychosurgery or the use of electro-convulsive therapy.

Social supervisor

A social worker (or in some cases, a probation officer) who is responsible for the supervision of an offender on conditional discharge from compulsory care and treatment in hospital.

Specialist mental health service

Care and treatment for a mental disorder which is provided under the management of a clinical supervisor.

Tariff

The period of a life sentence to be served to meet the requirements of retribution and deterrence before a prisoner is eligible for release on life licence.

Therapeutic benefit

The concept of therapeutic benefit will cover improvements in the symptoms of mental disorder or slowing down deterioration and the management of behaviours arising from the mental disorder.

Therapeutic community

A therapeutic community is a consciously designed social environment within a residential or day unit in which the social and group process is used for therapeutic intent. The community is the primary therapeutic instrument and provides a context for other therapies.

Transfer direction

A warrant issued by the Home Secretary, following medical recommendations, directing that a prisoner be transferred to a named psychiatric hospital for compulsory care and treatment.

'Treatability'

In the 1983 Act 'treatability' is a narrow concept that only applies to certain categories of mental disorder. In new legislation this will be framed to enable those who pose a significant risk of serious harm to others as a result of thier mental disorder to be detained in a therapeutic environment where they can be offered care and treatment.

Urgent treatment

Any treatment that needs to be provided immediately, in the best interests of the patient and which cannot await the development of a care plan.