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Wednesday 13 December 2017
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Glossary

Book - glossary

Throughout this website and within our Trust literature which is aimed at patients and carers, we aim to minimise the use of jargon, however on some occasions you may need some clarity on medical terms used. Below are some terms and acronyms that you may wish to learn more about, or where you can find out more about systems or processes. Click on the words to open up the information.

 

Click here for a printable version of the glossary

NHS Acronym buster explains common acronyms used. You can also download an NHS Acronym app from iTunes

See the social care jargon buster from SCIE (Social Care Institute for Excellence)

 

ADHD stands for Attention Deficit Hyperactivity Disorder

ADHD is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness. Attention deficit disorder (ADD) is a sub-type of ADHD. Common symptoms of ADHD include:

  • a short attention span
  • restlessness or constant fidgeting
  • being easily distracted

 

For more information see NHS Choices

See the Butterflies website for the Derbyshire ADHD support network

The term advance decision means a statement explaining what medical treatment the individual would not want in the future, should that individual 'lack capacity' as defined by the Mental Capacity Act 2005. It can relate to all future treatment, not just that which may be immediately life-saving. An advance decision is legally binding in England and Wales. Except in the case where the individual decides to refuse life-saving treatment, it does not have to be written down, although most are and a written document is less likely to be challenged For more information see: Patient.co.uk and DirectGov

Advocacy is about taking action to help people say what they want, secure their rights, represent their interests and obtain services they need.

An advocate is an independent person who encourages the empowerment of an individual or group. Advocacy comes in different forms and the type of advocacy being offered should be clearly identified to avoid confusion. For example self-advocacy is different to legal advocacy. There are also Independent Mental Capacity Advocates (IMCA’s) under the Mental Capacity Act 2005.

Advocates and advocacy schemes work in partnership with the people they support and take their side. Advocacy promotes social inclusion, equality and social justice. See Action for Advocacy

Autism is...

...a lifelong developmental disability that affects how a person communicates with, and relates to, other people. It also affects how they make sense of the world around them.

It is a spectrum condition, which means that, while all people with autism share certain difficulties, their condition will affect them in different ways. Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support. People with autism may also experience over- or under-sensitivity to sounds, touch, tastes, smells, light or colours.

Asperger syndrome is a form of autism. People with Asperger syndrome are often of average or above average intelligence. They have fewer problems with speech but may still have difficulties with understanding and processing language.

Click here for the Derbyshire Healthcare NHS Foundation Trust Sensory Processing Guide 

Find out more from the National Autistic Society, and in Easy Read.

Autism: recognition, referral, diagnosis and management of adults on the autism spectrum.

NICE have issued a guide which includes:

  1. General principles of care

  2. Identification and assessment

  3. Identifying the correct interventions and monitoring their use

  4. Interventions for autism

  5. Interventions for challenging behaviour

  6. Interventions for coexisting mental disorders

  7. Assessment and interventions for families, partners and carers

  8. Organisation and delivery of care

Autism: recognition, referral, diagnosis and management of adults on the autism spectrum. Issued: June 2012 NICE clinical guideline 142.This clinical guideline offers evidence-based advice on the diagnosis and management of autism in adults.

Autism: Summary and Implementation Tools from NICE

Autism: Summary and other links from The Mental Elf

Other links

The National Autistic Society UK Charity for people with autism (including Asperger Syndrome) and their families

Self-help books on autistic-spectrum disorders

Autism and Asperger's Syndrome: Information for Parents, Carers, and anyone who works with young people

Contact a Family guide for parents - Siblings - includes parent to parent tips and personal stories from brothers and sisters, as well as updated sources of support and useful resources for parents and professionals working with disabled children

Asperger's syndrome explained for children on YouTube

The Autism Act 2009 and Strategy

Autism Quality Standards from NICE (National Institute for Health and Care Excellence)

The Common Assessment Framework for children is a shared assessment and planning framework for use across all children's services and all local areas in England. It aims to help the early identification of children's additional needs and promote co-ordinated service provision to meet them. The CAF is a standardised approach to conducting an assessment of a child's additional needs and deciding how those needs should be met. For more information see: The Children’s Workforce Development Team and Derby and Derbyshire's Guides

A person lacks capacity in relation to a matter if at the time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain. It does not matter whether the impairment or disturbance is permanent or temporary.

The following principles apply for the purposes of the Mental Capacity Act.

  1. A lack of capacity cannot be established merely by reference to:
    A. a person's age or appearance; or
    B. a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity.
  2. A person must be assumed to have capacity unless it is established that he lacks capacity.
  3. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
  4. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
  5. An act done, or decision made, under the Mental Capacity Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
  6. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

See: www.legislation.gov.uk/ukpga/2005/9/section/1 and the section under Involvement and Choice

The Choice and Partnership Approach is used by our CAMHS services. CAPA is a systemic approach to service organisation and to the relationship with the user / client / patient. It aims to put the user at the centre. To aid their choices we should use our expertise.

To be the most effective we need to smooth our processes and make every step add value. We must deliver our resources by planning as a whole system and layering skills whenever possible. For more information see the CAPA website on: www.capa.co.uk

The term Care Co-ordinator is now used in several ways:
  • CPA Care Co-ordinator: This is a mental health professional who co-ordinates care for someone who is using our mental health services who has serious and complex mental health needs, and needs the support of the Care Programme Approach. For more information see the entry on CPA below, and the Core Care Standard.
  • Primary Care Care Co-ordinator: This is someone working with or for one or more GP Practices to co-ordinate services for someone who has multiple health problems, and who meets the criteria for the service. They may or may not have a clinical background.
  • Local Area Co-ordinators work in defined areas in some parts of Derby City and Derbyshire to help connect people with complex health and social needs to local support. See the leaflet

 

A Carer is someone of any age who provides unpaidsupport to family or friends who could not manage without this help. This could be caring for a relative, partneror friend who is ill, frail, disabled or has mental health or substance misuse problems. 

Young Carers are ... children and young people wholook after someone in their family who has an illness, a disability, or is affected by mental ill-health or substance misuse.(Princess Royal Trust for Carers)

Calling all Carers - help us improve our services - fill in the Carers survey now

CCGs are Clinical Commissioning Groups. These replaced Primary Care Trusts in 2012, and are the new way in which health services are commissioned in England.

Derbyshire has 4 CCGs:

 

Find out more about how the NHS works: Understanding the New NHS.

The Care Programme Approach (CPA) is one of the care processes that formed the basis of the Core Care Standards. It applies to specialist mental health services, and has standards in a number of areas.

What is CPA about?

The Care Programme Approach came from the NHS and Community Care Act 1990. It was implemented in 1991 (Circular HC(90)23)/LASSL(90)11) to improve the way in which specialist services were provided to support people with mental health problems. It is used now to support people with complex and serious needs, and has standards about:

 

Who needs CPA?

The Trust uses the national guidelines to help decide who would benefit from the CPA (in addition to having a good service). These are based around risk and complexity, and any of the following factors or combination of factors can indicate the need for CPA:

Risk
  • Current or potential risks including suicide, self harm, harm to others, relapse history, self neglect, non-concordance, vulnerable adult, adult/child safeguarding;

  • Currently or a history of severe distress, instability or disengagement;

  • Currently/recently detained under the Mental Health Act 1983, or accepted by crisis/home treatment team

 

Complexity:
  • Severe mental disorder with high degree of clinical complexity
  • Non-physical co-morbidity e.g. substance/alcohol misuse, learning disability

  • Multiple service provision from different agencies

  • Significant reliance on carer/s, or has own caring responsibilities

  • Disadvantage or difficulty as a result of: parenting responsibilities; physical health problems/disability; unsettled accommodation; employment issues; significant impairment of function when mentally ill; or ethnicity, sexuality or gender issues

 
Key Groups:

In addition, the following key groups will usually be included in CPA, service users:

  • who have parenting responsibilities

  • who have significant caring responsibilities

  • with a dual diagnosis (substance misuse)

  • with a history of violence or self harm

  • who are in unsettled accommodation

If not, staff must record why they don't need it.

For more information on national standards see the CPA Association

See individual services for more information about whether they use the CPA.

Refocusing the Care Programmme Approach: Policy and Positive Practice Guidance

Refocusing the CPA: A learning Resource for Care Co-ordinators Lincoln University


CPA Standards and Update Training Resources

Copy of presentation

CPA and Core Care Standards Quiz

CPA and Core Care Standards Quiz answers

Infolink Families and Carers

Carers Handbook

Your Care booklet

Sharing Information with Families and Carers Booklet

Carers Emergency Card Derbyshire

Triangle of Care Summary

Responsibilities of the Care Co-ordintor or lead professional

Derbyshire Appropriate Adult Service - currently operating for Juveniles, Mentally disordered people or Vulnerable adults in Derbyshire. www.derbyshireadvocacy.org.uk/aapages/daashome.htm

The Derbyshire Drug and Alcohol Action Team (DAAT) is a strong partnership of multi agencies across Derbyshire working together to tackle and reduce the harm caused by drug and alcohol misuse throughout the county (excluding Derby City). www.saferderbyshire.gov.uk/staying_safe/drugs_and_alcohol/default.asp

A dashboard is a way of showing information about performance. It can be shown like a car dashboard with dials showing how well or badly we're doing in different areas, but can be shown in different ways.

For an example of a performance dashboard, have a look at our Trust performance indicators, and see how we're doing now

Direct payments are local council payments for people who have been assessed as needing help from social services, and who would like to arrange and pay for their own care and support services instead of receiving them directly from the local council. www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Disabledpeople/DG_10018721

Mental Capacity Act 2005 Deprivation of Liberty Safeguards

They provide legal protection for vulnerable people who may be deprived of their liberty within the meaning of Article 5 of the European Convention on Human Rights (ECHR) in a hospital (other than under the Mental Health Act 1983) or care home, whether placed their under public or private arrangements.  See the CQC report on DOLS

For more information see the Derbyshire IMCA site

FACE stands for Functional Assessment of the Care Environment. The Trust uses FACE risk assessment tools in mental health, substance misuse, learning disability, and CAMHS. See the FACE website on: www.face.eu.com/our-products/assessment-tools/risk-assessment-toolset/

Clinical formulation is the process of making sense of the information that is gathered in an assessment, and using that information to create a productive way of helping the person.

For more information click here

The Health of the Nation Outcome scales (HoNOS) is an outcome measure. See: www.rcpsych.ac.uk/training/honos.aspx

The Health of the Nation Outcome Scales Payment by Results (PbR) tool is used to inform the decision about the appropriate PbR Cluster. This is used as part of the new process of mental health commissioning.

Independent Mental Capacity Advocate (see Advocacy)

From the 1st April 2007 the Mental Capacity Act established a new statutory scheme known as Independent Mental Capacity Advocacy (IMCA). Its aim is to provide additional safeguards for people who lack capacity to take decisions in certain specific, important situations and who are particularly vulnerable because they have no close relatives, friends or any other person to help to protect their interests.

Derbyshire Mind and Derbyshire Advocacy Service were commissioned to provide IMCA services across Derbyshire. The service is available to any adult in Derbyshire who fits the statutory criteria for an IMCA.

For information about the Derbyshire IMCA service see the IMCA website

Independent Mental Health Advocate (see advocacy)

This is a new type of advocacy introduced in April 2009 as a result of the Mental Health Act 2007. IMHAs can assist in helping a patient find out about their rights and how to exercise them.

The purpose of IMHAs is to help patients to fully participate in decisions about their care and treatment. To be eligible to receive the help of an IMHA, you have to be a ‘qualifying patient’.

Qualifying patients are those who are:

  • Detained in hospital under the Mental Health Act
  • Subject to a Guardianship Order under the Mental Health Act
  • Subject to a Community Treatment Order in the community
  • Discussing with their doctor the possibility of psychosurgery (any surgical operation on the brain tissue)
  • Discussing the possibility of serious treatments such as neurosurgery
  • Under 18 years old and are discussing with a doctor the possibility of ECT

 

To find out more see the Rethink Guide

These are an allocation of funding given to users after an assessment which should be sufficient to meet their assessed needs. Users can either take their personal budget as a direct payment, or – while still choosing how their care needs are met and by whom – leave councils with the responsibility to commission the services. Or they can take have some combination of the two. 

As a result, they provide a potentially good option for people who do not want to take on the responsibilities of a direct payment. Personal budgets have been rolled out in England since 2008, with a target of providing every service user with one by 2013. 

In Scotland, where they are known as individual budgets, there are also plans to roll them out, under the country's self-directed support strategy. See the Community Care guide: www.communitycare.co.uk/Articles/19/08/2011/102669/direct-payments-personal-budgets-and-individual-budgets.htm

Lead Professionals work with children with additional (including complex) needs who require an integrated package of support from more than one practitioner. 

The support comes from a multi-disciplinary team of practitioners called a team around the child (TAC). The TAC is often established on a case by case basis to support the child or their family who require support. The TAC model is also referred to as TAYP (team around the young person). 

The lead professional takes the lead to coordinate provision and act as a single point of contact for a child and their family when a TAC is required. For more information see www.cwdcouncil.org.uk/lead-professional.

The CPA lead professional is the professional who co-ordinated the care of people using specialist mental health services who don’t need the support of CPA. See: Co-ordination for their role.

Lesbian, Gay, Bi-sexual, Transexual

For more information see our Equality principle

Most children and young people in Derbyshire and Derby City enjoy happy and successful lives living within their own families. If, however, families experience particular problems or stress, they can call upon a wide variety of additional support, offered by a range of agencies, to help keep the family living and working together.

For some children and young people though, this might not be enough to ensure their safety and well-being so, either through agreement with their parents, or through court proceedings, these children might come to be cared for by the local authority. 

When this happens, we provide alternatives to their family care, for example foster care, residential care or adoption. 

Find out more from Derbyshire County Council

NICE guide QS31 Health and wellbeing of looked-after children and young people

The Multi-Agency Public Protection Arrangements (MAPPA) are managed by the Multi-Agency Public Protection Panel (MAPPP), made up of health and social care organisations in Derbyshire, as well as police and probation. They discuss people who are of concern in terms of risk of violence and held a common register of names. See the guide

Multi-Agency Risk Assessment Conferences (MARACs) are meetings where information about high risk domestic abuse victims (those at risk of murder or serious harm) is shared between local agencies. By bringing all agencies together at a MARAC, a risk focused, coordinated safety plan can be drawn up to support the victim. For more information see:

Multi-Disciplinary Meeting. See Review

Healthy Lifestyles

Making Every Contact Count (MECC) is about using every opportunity to talk to individuals about improving their health and well being.

The promotion of health and wellbeing should be at the core of an organisation's design and service culture, which is why MECC has become one of the five ambitions for NHS Midlands and East, and is being supported by the Trust through its 'It's OK to ask'  and 'Don't be surprised if we ask' campaign. You might see posters around, and Trust staff are being trained to have lifestyle conversations with the public and each other.

For more information about Keeping well see the new section on the website or go to:

  • Smoking

  • Drugs and Alcohol
  • Food and Drink
  • Keeping Active
  • Health Checks
  • Mental Wellbeing

  • Relationships
  • Conditions
  • Getting Older
  • Mens Health
  • Womens Health

     

For learning materials see NHS Midlands and East and NHS Local learning

A person lacks capacity in relation to a matter if at the time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain. It does not matter whether the impairment or disturbance is permanent or temporary.

The following principles apply for the purposes of the Mental Capacity Act.

  1. A lack of capacity cannot be established merely by reference to:
    A: a person's age or appearance, or
  2. B: a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity.
  3. A person must be assumed to have capacity unless it is established that he lacks capacity.
  4. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
  5. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
  6. An act done, or decision made, under the Mental Capacity Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
  7. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

See: www.legislation.gov.uk/ukpga/2005/9/section/1 and the section under Involvement and Choice

The main purpose of the Mental Health Act 1983 is to allow compulsory action to be taken, where necessary, to make sure that people with mental disorders get the care and treatment they need for their own health or safety, or for the protection of other people. It sets out the criteria that must be met before compulsory measures can be taken, along with protections and safeguards for patients. See the Department of Health or Mind.

A nurse designated as being responsible for a patient's nursing care during a hospital stay and who is identified by name as such to the patient. The concept of the named nurse stresses the importance of continuity of care.

Nearest relative is a legal term defined in section 26 of the Mental Health Act 1983 (MHA), and should not be confused with next of kin. The MHA gives a patient’s nearest relative rights and powers in relation to detention, discharge and also being informed (or consulted) about actions that have been taken or are proposed under the Act. For more information see the Mind Website on:

Not to be confused with the nearest relative, this is usually the personyou are most closely related to. There is asuggested ladder of relationships to help determine closeness. See Findlaw UK for information about being next of kin

PALS (Patient Advice Liaison Service)

PALS offers confidential advice, information and support. We are committed to supporting service users, carers or staff about the care we provide. We will guide you through the different services available in a fair and honest way, and advise you of all the options available. If you do not know where to turn to or do not know who to ask, PALS is here to help.

As a carer, you may feel you need someone to talk to about any concerns or problems you may be experiencing. We liaise with staff, managers and, where appropriate, other relevant organisations, to negotiate speedy solutions and to help bring about changes to the way in which services are delivered.

PALS' commitment - we can offer:

  • A confidential service: any discussion between you and PALS will not be passed on without your permission. Information and support: we can find information from an NHS professional, and also from independent, statutory or non-statutory organisations, such as independent advocates. A listening ear to feedback: PALS would value this. We will report back to the Mental Health Trust any good or bad experience you had of its services.
  • Interpreting service/hearing support: If your first language is not English, we can provide you with an interpreter. We will also arrange for hearing support staff to be available for you.

Tel: 08000 272128

Email: DMHT_PALS@derbyshcft.nhs.uk

(see individual budgets)
PPT's are Patient Pathway Teams. They are groups of services, patients and their families who are working on transformational change in the Trust.

Psychosis is a medical word used to describe mental health problems that stop the person from thinking clearly, telling the difference between reality and their imagination, and acting in a normal way.

The two main symptoms of psychosis are:

  • hallucinations – where a person hears, sees (and in some cases smells) things that are not really there; a common hallucination is when people hear voices in their head
  • delusions – where a person believes things that, when examined rationally, are obviously untrue; such as believing that your next door neighbour is secretly planning to kill you

 

To find out more, see NHS Choices

(Quality Alcohol Drug Standards) The QuADS Organisational Quality Standards Manual for alcohol and drug treatment services was developed by the QuADS Project, a joint Alcohol Concern/ Standing Conference on Drug Abuse (SCODA) project funded by the Department of Health, and actively supported by the United Kingdom Anti-Drugs Co-ordination Unit. See: www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/quads.pdf

This covers groups that may experience disadvantage that we take special account of. It stands for:

  • Race and culture
  • Economic disadvantage
  • Gender
  • Age
  • Religion and spirituality
  • Disability
  • Sexuality

For more information, see Equality

RightCare is a scheme which was designed by Derbyshire Health United (DHU) clinicians to ensure that seamless patient care takes place out of hours, when General Practitioner (GP) practices are closed. RightCare is designed for patients with long term conditions and complex healthcare needs, including end of life patients. The scheme helps to prevent unnecessary admissions to hospital and attendance at Accident and Emergency (A&E), lower patient anxiety, provides reassurance and allows patients to access the most appropriate healthcare and advice quickly.

Who would benefit from RightCare?

The service is suitable for people with complex health problems and long term conditions such as Chronic Obstructive Pulmonary Disease (COPD), those requiring palliative care, frequent users of Accident and Emergency (A&E) and 999, also some people with Mental Health Conditions and Learning Difficulties.

How does RightCare work?

The scheme is devised around use of the RightCare Plan which is devised with the patient by their own GP or other health care professional e.g. District Nurse, Community Matron, etc. and then shared with DHU, by secure e-mail. The plan is valid for up to 6 months and is kept on a database at DHU which is the Out of Hours GP service in Derbyshire. DHU currently share the information with NHS Direct, East Midlands Ambulance Service, Royal Derby Hospitals and Chesterfield Royal Hospital.

When should patients contact RightCare?

Patients should contact RightCare when their own GP surgery is closed and they feel unwell. Patients will have their own copy of the RightCare Plan, which will help them decide when further medical help is needed.

How do patients contact RightCare?

Patients will have the dedicated RightCare Number which is shown on the RightCare Plan which will put them in contact with DHU directly.

The patient will speak to a call handler from DHU in the first instance, usually within 60 seconds. The medical team at DHU will be able to access the current and relevant medical details on the RightCare Plan, which will enable the Clinician to organise the most appropriate medical care. This could be telephone advice, Primary Care Centre appointment, home visit by a health professional or referral to hospital if appropriate etc.

If you think yourself or someone you know may benefit from the scheme please contact your GP surgery or Community Matron/District Nurse to ask about RightCare.

For further information please contact the RightCare Team on 0300 1000 404 or Healthcare professionals can see forther guidance

Safeguarding children is defined as “the process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully”

Safeguarding Vulnerable adults is defined as protecting a person aged 18 or over, "who is or may be in need of community care services by reason of mental or other disability, age or illness and who is, or maybe unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation".

For more information see: Safeguarding

This section of the Mental Health Act 1983 gives patients who are subject to s.3, 37, 45a, 47 or 48 the right to attend a s.117 meeting before they are discharged, and to have an aftercare plan which is agreed by health and social care, giving them free aftercare as long as they are receiving specialist mental health services. For more information see the Rethink Guide and Factsheet. The Trust has a policy on s.117.

This is a part of the Mental Health Act 1983 which details removing a mentally ill person from a public place to a place of safety. It details police powers and the rights of someone in this position. 

The police, health authority and social services authority should agree a local policy for putting into practice section 136 of the Act. For example, police officers should know who to contact at the local hospital and social services department. A place of safety could be a hospital or a police station. A police station should only be used in exceptional circumstances, such as a serious threat of violence or danger to people providing care or support. A person may be transferred from one place of safety to another before assessment. 

Taking someone to a place of safety will allow that person to be assessed by a doctor and interviewed by an approved mental health professional. Approved mental health professionals are specially trained in both mental health and the law relating to it. They are appointed by local authorities to interview people and assess their well-being. See the DirectGov website:

www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/Police/DG_4018603

Standing Conference on Drug Abuse developed assessment standards

This is also known as 'personalisation' or 'personal budgets'. There are different ways to describe it, but whatever name's given to it - it's about giving people real power and control over their lives

For more information see Derby City or Derbyshire social care websites

A statement of wishes and preferences is very important because you can use it to describe the kinds of things that are important to you now. 

This can be used at a time in the future when, through lack of capacity, you may be unable to communicate our wishes. Wishes and preferences cover different things. For example, you might have strong feelings about the way you want to be cared for in later life, or the things that would influence your choice about medical treatment. 

It is also possible to say who we do and do not want consulted when decisions are made. For more information see the SCIE e-learning: www.scie.org.uk/assets/elearning/mentalcapacityact/Web/module7/html/object7_2.htm

VARM (Vulnerable Adult Risk Management) is a multi-agency risk management process to enable professionals to come together to develop creative and assertive plans to support Adults at Risk who have mental capacity and who are at risk of serious harm or death through self-neglect, risk taking behaviour or by refusing previous offers of support from services. For more information see: Derby Safeguarding Adults Board

This is a person aged 18 or over, "who is or may be in need of community care services by reason of mental or other disability, age or illness and who is, or maybe unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation "

A visit paid by a doctor to patients on a ward. It may include a small number of other professionals.

Wellness Recovery Action Planning is a system that you devise for yourself that helps you work through mental health challenges or life issues. See the website on: www.mentalhealthrecovery.com

These are ... children or young people who look after someone in their family who has an illness, disability, or is affected by mental ill-health orsubstance misuse (Princess Royal Trust for Carers)