Friday, 22 January 2010

'Patients' - preferred and practical?

[This is a copy of an e-letter I wrote whilst reading journals and killing time on nights to The Psychiatrist (formerly Psychiatric Bulletin), published online Jan 2010. Scheduled for publication in print March 2010. It is a response to an article presenting findings that mental health service users in Hertfordshire, in keeping with findings from elsewhere, tend on the whole to prefer to be referred to as "patients" rather than other terms which seem to be preferred in the language of mental health trusts and national guidelines such as "clients" or "service users".]

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 fully embraced, 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”?

Dr Shahzad Alikhan
CT1 Psychiatry

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:

3. Canadian Psychiatric Association: Clinical Practice Guidelines :

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