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Service user, patient, client, user or survivor: describing recipients of mental health services

  • Peter Simmons (a1), Chris J. Hawley (a1) (a2), Tim M. Gale (a1) and Thanusha Sivakumaran (a1)
Abstract
Aims and method

To determine which terms receivers of mental health services wish to be known by (service user, patient, client, user, survivor) according to the professional consulted (psychiatrist, nurse, psychologist, social worker, occupational therapist). We conducted a questionnaire study to assess terms by like or dislike and by rank order. There were 336 participants from local catchment area secondary care community and in-patient settings in east Hertfordshire.

Results

Patient is the preferred term when consulted by psychiatrists and nurses, but it is equally preferable to client for social workers and occupational therapists. Service user is disliked more than liked overall, particularly by those who consulted a health professional, but not by those who consulted a social worker. A significant minority wish to be regarded as a survivor or user.

Clinical implications

National and local mental health services should adopt evidence-based terminology in referring to ‘patient’ or, in some groups, ‘patient or client’ in preference to ‘service user’.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Peter Simmons (peter.simmons@hertspartsft.nhs.uk)
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Declaration of interest

None.

Footnotes
References
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1 General Medical Council. Good Medical Practice. GMC, 2006 (http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp).
2 Nursing and Midwifery Council. The Code: Standards of Conduct, Performacne and Ethics for Nurses and Midwives. NMC, 2008 (http://www.nmc-uk.org/aDisplayDocument.aspx?documentID=5982).
3 British Association of Social Workers. The Code of Ethics for Social Work. BASW, 2002 (http://www.basw.co.uk/Portals/0/CODE%20OF%20ETHICS.pdf).
4 British Psychological Society. Code of Ethics and Conduct. BPS, 2006 (http://www.bps.org.uk/downloadfile.cfm?file_uuid=5084A882-1143-DFD0-7E6C-F1938A65C242&ext=pdf).
5 College of Occupational Therapists. Code of Ethics and Professional Conduct (Revised). College of Occupational Therapists, 2005 (http://www.cot.org.uk/MainWebSite/Resources/Document/Code-of-Ethics.pdf).
6 Neuberger, J. Do we need a new word for patients? Let's do away with ‘patients’. BMJ 1999; 318: 1756–8.
7 Department of Health. National Service Framework for Mental Health. Department of Health, 1999.
8 Royal College of Psychiatrists, Royal College of Physicians of London, British Medical Association. Mental Illness: Stigmatisation and Discrimination within the Medical Profession (CR91). Royal College of Psychiatrists, 2001.
9 Mind. Mind celebrates 60 years of speaking out. 27 April 2006 (http://www.mind.org.uk/news/1836_mind_celebrates_60_years_of_speaking_out).
10 Ritchie, CW, Hayes, D, Ames, DJ. Patient or client? The opinions of people attending a psychiatric clinic. Psychiatr Bull 2000; 24: 447–50.
11 McGuire-Snieckus, R, McCabe, R, Priebe, S. Patient, client or service user? A survey of patient preferences of dress and address of six mental health professions. Psychiatr Bull 2003; 27: 305–8.
12 Appleby, L. The National Service Framework for Mental Health – Five Years On. Department of Health, 2004.
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Service user, patient, client, user or survivor: describing recipients of mental health services

  • Peter Simmons (a1), Chris J. Hawley (a1) (a2), Tim M. Gale (a1) and Thanusha Sivakumaran (a1)
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eLetters

Ancient origins of the term patient

Dr Jawad Adil, Locum Consultant Psychiatrist
13 January 2010



The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the verb 'patior' meaning 'I am suffering'. The word 'patient' has been used for hundreds of years but it is only recently that non medical and non-nursing disciplines have started to advocate the use of words 'client' or 'service user'. At the heart of this lies the social model of care which intends to non-medicalize the management of illnesses so that patients may move away from the medical model which is percieved to include 'labels' and 'pharmacological treatments'. By calling people 'patients' I do not believe that we are making them sicker or denying them their rights, as has been popularised; on the contrary, we are helping to continue the unique doctor-patient relationship. This relationship has evolved over centuries and is built on mutual respect, knowledge, trust, shared values and openness. Patients themselves like to be called patients as evidenced in a few recent studies. Likewise, when I am ill, I would rather be called a 'patient' and not a 'client' which has some distasteful connotations to it. Also, I would like to be called a 'doctor' rather than a 'provider', 'teacher', 'clinician' or 'adviser', even though my role might vary from patient to patient. I find it hard to understand how by retaining the word 'patient', one cannot achieve a secure base, supportive relationships, hope, empowerment and aim to be a productive member of the community. ... More

Conflict of interest: None Declared

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Service user carries a stigma

AK Al-Sheikhli, Consultant Psychiatrist
13 January 2010

The term service user is one I employ reluctantly.In my opininon it carries a stigma and leads to denial of patients of their rights to have effective treatment. I think using the term is part of the movement to socialise psychiatry and we need to insist that psychiatric illnesses are similar to any other illnesses,and those who suffer from it are patients. Do cardiologists refer to patients with myocardial infarctions as service user? ... More

Conflict of interest: None Declared

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'Patients' - preferred and practical?

Shahzad M Alikhan, CT1 Psychiatry
13 January 2010

Simmons et al. (1) suggest that the majority of recipients of mental health services do appear on the whole to prefer the term ‘patient’, according at least to evidence from studies in London and Hertfordshire.

Although our guidelines prefer other terms, the American Psychiatric Association Practice Guidelines (2) exclusively use the collective patients, to refer to individuals receiving psychiatric care. Similarly the Canadian Psychiatric Association Clinical Practice guidelines (such as those for Treatment of Depressive Disorders(3)) refer solely to patients. Although other terminology is in use and under debate, patients is possibly also preferred by Canadian recipients (4). Cultural differences in attitudes to psychiatry and the organisation of healthcare services may account for the difference in terminology.

I also wonder to what extent individuals receiving mental health services who are or have been detained formally under the Mental Health Act in the UK would consider themselves clients or service users. It is possible that those that have been detained (currently or in the past) may prefer the term patient (because they were admitted to a hospital), whereas those individuals who receive or have received treatment primarily in the community may have a different perspective of mental health services and prefer terminology with fewer associations with perceived paternalism.

A final consideration might be to what extent the incorporation of the terms ‘client’ and ‘service user’ into psychiatric parlance, if fullyembraced, would be practical when taken to its logical conclusions – by this I mean, should we for example be referring to “in-clients”, and “out-clients” rather than “inpatients” and “outpatients”?

Declaration of Interest: none

1. Simmons P, Hawley CJ, Gale TM, Sivakumaran T. Service user, patient, client, user or survivor: describing recipients of mental health services. The Psychiatrist 2010 v. 34, p. 20-23

2. American Psychiatric Association Practice Guidelines: http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx

3. Canadian Psychiatric Association: Clinical Practice Guidelines : https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/depression/clinicalGuidelinesDepression.aspssion/clinicalGuidelinesDepression.asp

4. Preferred Terms for Users of Mental Health Services Among Service Providers and Recipients. Sharma V et al. Psychiatr Serv 51:203-209, February 2000
... More

Conflict of interest: None Declared

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