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A guide to mental health services in England

Your assessment: getting the right treatment

Wherever you go for 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.

During an assessment, the following points will 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 and training 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.

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.   

Questions to ask

Whether it is your initial appointment with your GP or a specialist, there are a few things you can do to prepare in advance that will help find the right service or treatment for you.

Before your appointment, make some notes about what you want to discuss and then tick each point off during your appointment. Don't be afraid to ask questions about things you find unclear. Let the health professional explain it to you until you are sure you understand it  repeatedly if necessary.

If you like, take someone with you as support. For more tips, read our section on Questions to ask the doctor.

The Royal College of Psychiatrists has also produced tailored checklists, which you can download and take with you to your appointment:

I don't think it's working: can I change treatment or have a review?

If you feel that the treatment or mental health service isn't working for you, you should say something. Talk to the mental health professional you are seeing about your concerns. It may be that another approach or a new assessment is needed to find a more suitable service for you.

If you don't feel that your concerns are taken seriously, ask the manager of your mental health service to see someone different, including a different psychiatrist or care co-ordinator. Your GP may also be able to assist you.

Reviews

Your personal needs may change over time, so it is important your treatment is reviewed on a regular basis. You will always be allocated a named person as your care co-ordinator. This can be a nurse, social worker, occupational therapist, psychologist or psychiatrist, or an employment specialist.

Your care co-ordinator should ensure you have regular reviews, and should be your first point of contact if you have concerns. Your care co-ordinator will also help write your care plan and offer you support, including your family and friends if necessary.

How to prepare for your review

Your review should take place in a familiar place. Often it is the clinic, community mental health centre or GP surgery where you meet your care co-ordinator regularly. However, it may be possible for it to take place at your house or in a neutral place, such as a community centre.

During the review, you, your care co-ordinator and any other professionals involved in your care will discuss your progress and whether your care plan still meets your needs.

You can always arrange to bring a friend or relative to a review for support. Some people prefer to bring an advocate to their review. An advocate is someone who will represent your views and interests during the review process. Advocates can be volunteers, such as mental health charity workers, or professionals, such as lawyers. Your care co-ordinator should be able to tell you what advocacy services are available in your local area. Alternatively, check with your local council who your advocacy provider is. Rethink also offers an online directory for advocacy services in England on their website.  

Getting a second opinion

There is no legal right to a second opinion, but that doesn't mean you can't ask for one.

If you are not sure about a diagnosis or treatment suggested to you, you can ask for a second opinion. Most NHS trusts have arrangements in place for second opinion requests and, where possible, will work with you so you can see another mental health professional. Find contact details for your local NHS trust.

You can also ask the mental health professional, your GP or your care co-ordinator if they can arrange for a second opinion for you. Local voluntary groups and charities such as MIND or Rethink offer additional advice.

If your doctor refuses to pass on your request, or the mental health service refuses to offer a second opinion or a change of health professional, contact your local Patient Advice and Liaison Service (PALS). They will give you advice on what steps to take next.

Alternatively, you could ask an advocate to help you. Your council will be able to help you find a local advocacy service. Depending on who your local authority has contracted, advocacy services are supplied by different service providers. You should contact your local authority if you wish to know who your advocacy provider is. 

What if I want a specialist second opinion?

Sometimes you may feel that your local mental health service is not specialised enough to give a diagnosis or effective treatment for your condition, and you may want an expert to provide this instead.

You can ask for a specialist second opinion on the NHS. Some mental health trusts do offer specialist services, but others don't and a specialist would then have to be found elsewhere. Specialist services are usually focused on one condition or problem, particularly where that condition is complex or severe.

Conditions that may require a specialist service are:

If you want an independent opinion from outside your current mental health service – for example, from a specialist mood disorders or psychosis service – your psychiatrist may agree to this and take steps to arrange it.

Alternatively, your GP can arrange this, but they may have to contact your local clinical commissioning group (CCG), which will then decide whether or not they will pay for an independent opinion. Some specialist services are specially funded for such referrals – they usually have information on their websites about this.

Although getting a second opinion could be a difficult step that takes time, this shouldn't stop you asking for one if you feel strongly about it. If your GP disagrees or refuses to pass on your request, ask again. Explain why you feel you need a second opinion. Include examples such as:

  • I feel that standard treatments are not working for me. My mental health is not improving and I have been in and out of hospital, or have been in hospital for a long time. 
  • I am having side effects from the medication, which is seriously affecting my health. My doctor cannot find any answers or alternatives.

It is important to explain how your diagnosis or treatment is negatively affecting your life and why a second opinion might help.

What do you do if the CCG refuses funding?

Clinical commissioning groups (CCGs) are in charge of the funding for your local NHS and decide where the money should be spent. If your GP tells you that your request has been refused because the CCG is not funding it, you could contact the CCG directly.

Explain your reasons (maybe in writing or with an advocate) and ask them to reconsider. If you apply directly to the CCG, this is called an individual funding request (IFR). You can find the process explained on most CCG websites, as well as the application forms needed to make a claim.

If you are not happy with any aspect of your care, including circumstances where you are not in agreement with how your GP or current mental health team have responded to the recommendations of a second opinion, you can file an official complaint using the NHS complaints procedure.

Note: There are relatively infrequent circumstances when decisions are made about a person's care without their consent through the Mental Health Act. This is done to protect people who may not be able to make decisions about their care because of the effects of a mental illness. Read more about the Mental Health Act and find out who it applies to.

Page last reviewed: 26/04/2016

Next review due: 26/04/2019

Tips for your assessment

  • make notes about what you want to discuss
  • don't be afraid to speak up when things are unclear
  • ask again until you're sure you understand
  • take someone with you as support
  • ask for information you can take home with you 

 

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