When looking for support you will find you have a lot of different questions. On this page we have tried to answer some of them.

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Where should I start?

There are many useful websites addressing mental health issues.  Some of these are particularly directed at accessing NHS care, and others are provided by voluntary sector/charitable organisations and may be more focused on the experiences of people using services or their families.

What are the potential pathways to mental health support?

Most people visit their GP to discuss concerns about mental health issues and they will assess your circumstances and offer appropriate advice or treatment. They can also refer you to a psychological therapy service or a specialist mental health service for further advice or treatment. However, nine out of ten adults with mental health problems are supported in primary care and relatively few are referred on to more specialist mental health care (secondary care services).

Mental health services may be provided by your GP surgery, a large local health centre, a specialist mental health clinic, or a hospital. The treatment may be provided on a one-to-one basis or in a group with others with similar difficulties, and therapy sometimes also involves partners and families.

How does the NHS mental health system work?

There are a very wide range of NHS mental health services.  These range from services provided in primary care (GP practices and health centres) for people with common and mild mental health problems right through to very specialist services provided in hospitals and inpatient units.  Most people contact their GP in the first instance and receive treatment in their local area.

If people have problems that are more serious and/or longstanding, they are referred to specialist services provided by NHS trusts.  There are 10 mental health trusts in London who are responsible for providing care and support for a local catchment area and they also provide more specialist services for a wider population.  These trusts provide a range of services from a variety of hospital and community bases.  They work closely with local authority social services departments and voluntary sector organisations specialising in mental health issues.

Mental health services deal with a wide range of issues, such as:

  • Depression
  • Anxiety disorders, including panic attacks and phobias
  • Psychosis conditions
  • Obsessive compulsive disorders
  • Eating disorders
  • Trauma-related conditions, such as post-traumatic stress disorder
  • Perinatal mental health conditions, including postpartum psychosis
  • Children’s mental health conditions
  • Drugs and alcohol services
  • ADHD and autism spectrum conditions
  • Dementia
  • Mental health conditions related to living with long-term (health) conditions

This means mental health services have to be able to cater for people from all walks of life and with very different needs. Mental health services are generally divided into the following categories: adult services, child and adolescent services, forensic services, learning disability services, older adult’s services and substance misuse services.

How these services are organised in each local area may differ.  Your GP can tell you what services are available in your area. Your local mental health care provider (trust) will have a website providing a range of useful information about accessing their services.

The NHS Choices website has a useful glossary of mental health services, teams and care pathways.

Who are all the people/roles involved and what do they do?

There are a number of different professions that provide services that focus on helping a person overcome a mental health problem. The largest difference between the types of professionals is usually what they focus or specialise in, and their educational background.

In order to treat individuals or groups in a clinical environment (such as a private practice, a community/health centre, or a hospital) all of the mental health professionals must be “accredited” or “licensed” in order to practice.

The major professions include:

  • Family doctors often prescribe medications for mental health concerns, but do not have specialised training or background in treatment mental disorders.
  • Psychiatrists who are medical doctors that specialise in mental health care and can prescribe medication; Psychologists who have a doctorate degree with training in diagnosis, psychological assessment, and a wide variety of psychotherapies
  • Social workers will have completed a master’s degree in social work and will often be an expert in the Mental Health Act.
  • Most psychiatric nurses have a degree with specialised training in psychiatry and some forms of psychotherapy.  Some have also completed general nursing training and some can prescribe the same kinds of medications that a psychiatrist can.
  • Other support workers (e.g. nursing assistants) and allied health professionals (e.g. occupational therapists)

The staff involved in mental health care will work as a multi-disciplinary team and they will appoint a care co-ordinator to be the main liaison person with the patient/service user and their family

When do I need a referral?

Mental health services are free on the NHS, but in most cases you will need a referral from your GP to access them.  You are entitled to ask for a referral for specialist treatment on the NHS. However, whether you will get the referral depends on what your GP feels is clinically necessary in your case.

There are some mental health services that will allow people to refer themselves.  This commonly includes services for drug problems and alcohol problems, as well as some psychological therapies (IAPT). The NHS Choices website enables you to type in your postcode or town and you will see service details and referral methods.

Another option is to seek help from a private counsellor or therapist.  The British Association of Counselling and Psychotherapy has a website which gives you details of the staff who work in your local area. There is very useful information about the different types of therapy, how to find the right therapist, the costs etc. 

What should I expect from the NHS?

Wherever you go for specialist help, you will get a detailed assessment. The purpose of an assessment is to build up an accurate picture of your needs. Different professionals and agencies provide a range of services, which means your initial assessment may involve one or more professionals. You may be seen by a nurse, social worker, psychologist, specialist pharmacist, psychiatrist or a combination of these and other professionals.

What should I expect from the GP?

Many GPs are very familiar with common mental health problems (e.g. depression and anxiety) and are confident in treating patients and referring on to more specialist services when appropriate. There has been a significant expansion in access to psychological therapies, following the introduction of the national Improving Access to Psychological Therapies (IAPT) programme. Many of the services are delivered in GP practices or other community health centres.

What do I need to articulate to my GP? What will I be asked?

During an assessment, the following points may be considered (where relevant):

  • your mental health symptoms and experiences
  • your feelings, thoughts and actions
  • your physical health and wellbeing
  • your housing and financial circumstances
  • your employment status and needs
  • your social and family relationships
  • your culture and ethnic background
  • your gender and sexuality
  • your use of drugs or alcohol
  • past experiences, especially of similar problems
  • issues relevant to your or others’ safety
  • whether there is anyone who depends on you, such as a child or elderly relative
  • your strengths and skills and what helps you best
  • your hopes and aspirations for the future

You only have to talk about what you want to talk about. It helps to be frank and open, but if you are not ready to discuss some issues, you don’t have to. You can always bring a friend or family member to an appointment to support you.

How does it work if alcohol and/or drugs is also a problem?

The advice relating to metal health and substance misuse would highlight that use of substances to manage emotional distress, whilst understandable, is not a recommended strategy and can exacerbate the mental health problem as well as create additional problems which could include addiction. For example, alcohol will increase feelings of anxiety, low mood and sleep problems. The general advice would be to cut down and attend to the impact on mood and seek advice accordingly.

The general (do no harm) advice is that before stopping themselves, people should seek medical advice if they are drinking every day and the same advice for prescription medications (either prescribed or illicitly obtained via the internet etc) and GBL(gamma-butyrolactone).  Stimulant and opiates are less of a concern in this respect.

Some people find it helpful to have a period away from their ordinary living/working environment to deal with the immediate problem of dependence before then entering into a period of therapy/counselling.  There are facilities available in the private sector that specialise in these sorts of services.  The facilities available in the NHS are usually only available for people with very complex and long-standing problems.

Then what happens after the assessment?

The advice relating to metal health and substance misuse would highlight that use of substances to manage emotional distress, whilst understandable, is not a recommended strategy and can exacerbate the mental health problem as well as create additional problems which could include addiction. For example, alcohol will increase feelings of anxiety, low mood and sleep problems. The general advice would be to cut down and attend to the impact on mood and seek advice accordingly.

The general (do no harm) advice is that before stopping themselves, people should seek medical advice if they are drinking every day and the same advice for prescription medications (either prescribed or illicitly obtained via the internet etc) and GBL(gamma-butyrolactone).  Stimulant and opiates are less of a concern in this respect.

The outcome of the assessment should be discussed with you. You should have the opportunity to ask any questions about your condition, the diagnosis, possible causes, any treatments on offer, and how those may impact on your life. You should also be involved in the decision making about what treatments are best for you, and you should also be given information you can take home, as well as tips for additional research.

Can I get services outside of my borough?

Since April 2013, health services are commissioned by clinical commissioning groups (CCGs) Commissioning responsibilities include planning services based on assessing the needs of their local population; securing services that meet those needs; and monitoring the quality of care provided.

CCG’s are funded on the basis of the population of a geographic area (e.g. a borough in London) and this is largely determined by who is registered with local GPs.  CCGs are responsible for meeting the cost of the services commissioned for their local population and if a patient accesses services in another area, then they will have to meet the costs of those services.

So in general, it is expected that patients use services commissioned for their local population (in a London Borough for example) but there are mechanisms to fund services in another area with the agreement of commissioners.  The first step would be discuss this with a health professional in local services e.g. GP, Care Co-Ordinator etc.

You have the legal right to choose which provider and clinical team you are referred to by your GP for your first outpatient appointment. In most cases you have a right to choose which mental health service provider you go to in England.

You do not have a legal right to choice if you need urgent or emergency treatment and if you are detained under the Mental Health Act 1983.  Also, if you already receive care and treatment for the condition you are being referred for or the organisation or clinical team does not provide clinically appropriate care for your condition.

What will my company know?

Patient information is generally held under legal and ethical obligations of confidentiality. Information provided in confidence should not be used or disclosed in a form that might identify a patient without his or her consent. There are a number of important exceptions to this rule but it applies in most circumstances.

Professionals can share information without your consent if there is a risk of serious harm to you or to others, or there is a risk of a serious crime. For example, if someone tells their doctor that they are planning to hurt themselves or other people, the doctor could decide to share this information with someone, or contact the police.

In certain circumstances, a professional can share personal information if this is for the public good.  Personal information can also be shared if this is required by law. For example, a court could order a doctor to give it to them.

There may be times when you cannot give consent for a professional to share information because you are unconscious or very unwell. This is called ‘lacking capacity’.  In this situation, a doctor may be able to share information if this is in your best interests.

How does receiving mental health services link to work i.e. what are my rights and the legal impact?

If you need to take time off work, your employer should manage the situation in the same way as any other health related absence (and according to their organisational policy and procedures).

Your employer may have personal information about you, and will need to keep this information confidential. In rare situations, your employer may have to break confidentiality if they feel you are a risk to yourself or others. They may contact your GP or other health professionals to discuss the risks. Your employer should have a policy on this and you can ask your Human Resources department for a copy of it.

How does an EAP work and will they report back to my company on my concerns?

All health professionals are bound by rules of confidentiality and will need to meet professional, ethical and legal obligations.

If it is an emergency, who do I call?

A mental health emergency should be taken as seriously as a medical emergency.  If you or someone you know experiences an acute life-threatening medical or mental health emergency you can visit A&E or call 999.

You can go to A&E directly if you need immediate help and are worried about your safety. You may be close to acting on suicidal thoughts or have seriously harmed yourself.  Once at A&E the team will tend to your immediate physical and mental health needs.

Many hospitals now have a liaison psychiatry team (or psychological medicine service) which is designed to bridge the gap between physical and mental healthcare. If this service is not available, the A&E team will contact the local on-call mental health services, such as the crisis resolution and home treatment teams (CRHTs). The team in charge of your care will assess you, decide on the best course of care, and whether you can go home or need to be admitted to hospital

If you or someone you know requires urgent care, but it is not life-threatening e.g. if you have an existing mental health problem and your symptoms get worse, you experience a mental health problem for the first time or if someone has self-harmed but it does not appear to be life-threatening, or is talking about wanting to self-harm.

In this case you can call NHS 111.  You could consider contacting your GP practice and asking for an emergency appointment. Your practice should be able to offer you an appointment in a crisis with the first available doctor. If you’ve already been given a crisis line number from a health professional, call it.

What does ‘being sectioned mean’ and what is the impact?

In most cases, when people are treated in hospital or another mental health facility, they have agreed or volunteered to be there. You may be referred to as a “voluntary patient”.

However, there are cases when a person can be detained (also known as sectioned) under the Mental Health Act (1983) and treated without their agreement. The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment and rights of people with a mental health disorder.

The Mental Health Act is structured in many sections. If someone says, “You are being sectioned under the Mental Health Act”, they mean you are detained according to a particular section of the Mental Health Act.  In most cases, you will be told which section of the Mental Health Act applied in your case – for example, “You are detained under Section 2 of the Mental Health Act”.

People detained under the Mental Health Act need urgent treatment for a mental health disorder and are at risk of harm to themselves or others.  Professionals are then bound by the legal obligations of the Act in relation to the mechanisms and timeframes for decision-making about care.

Can I be transferred from one hospital to another/can I request that?

The usual expectation is that you are admitted to the local hospital for treatment and care.  However, if there are pressures on beds, sometimes, patients are admitted to another hospital and transferred back to the local facility when a bed becomes available.

The staff in the inpatient setting (ward) work with colleagues in community services to plan for discharge and any ongoing support that is required so mental health services are keen to have people admitted to their local hospital.

However, sometimes there are good reasons to try to find an alternative service e.g. where an NHS employee working in local services would be better served in another service.

What happens if I’m hospitalised for a suicide attempt

A doctor might recommend that you be admitted to hospital if:

  • You need to be admitted for a short period for further assessment
  • There’s a risk to your safety, for example if you are severely self-harming or at risk of acting on suicidal thoughts
  • There’s a risk of harm to other people
  • There isn’t a safe way to treat you at home
  • You need more intensive support than can be given to you at home

The MIND website has a helpful section on admission to hospital (including the advantages and disadvantages of inpatient care)

What should I expect within 24 hours? 3-5 days?

The care team will include doctors and nurses and other support staff.  The care team should begin your care by creating a care plan for you – a written record that outlines your care and treatment. You have a right to be involved in creating your care plan, so the team should consult you about what goes in it.

Your care plan will name one person who will act as your care coordinator – this will be one of the mental health professionals involved in your care. Your care coordinator should then work with you to create a care plan for when you leave hospital.  The duration of hospital stay varies with an average length of stay of about 28 days.  However, it is common for teams to aim for 7 days or less if possible.  Most people prefer to get home as soon as possible.

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