Expectations from health services

Getting good health care can be tough, especially if you're feeling down. Luckily, guidelines exist to keep you safe and ensure your confidentiality is protected.

If you're worried about talking about self-harm, start by knowing what you should expect.

You may have come across a wide variety of mental health services when seeking help and support, yet the level of care you’ve received won’t necessarily match up with how you’re supposed to be treated. When asked about experiences of health services and professionals, young people at 42^nd Street, an organisation which supports young people under stress, expressed a wide range of views.

From the negative:

• “They didn’t help me at all.”
• “Discriminating.”
• “Irritating and patronising.”
• “Judgemental and dismissive.”
• “Lack of choice.”
• “Rubbish, I did their job for them.”

To the more positive:

• “Some are really good, others just don’t care.”
• “Good to talk to – the health professional I had was kind are caring.”
• “Supportive.”
• “Good for advice and sharing experience.”
• “Very helpful.”

The guidelines

There are a variety of government initiatives and suggestions to improve young peoples’ health services, from the 2003 Royal College of Paediatrics and Child Health Guidelines for Primary Care Organisations to the 2004 National Service Framework (NSF) for Children and the work of the Children and Young People’s Unit. They all want more or less the same things for you, such as:

• The right to be treated with respect
• Access to information relating to prevention and treatment of health problems
• Access to high quality mental health services to ensure effective assessment, treatment and support, for you and your family, by informed, appropriately trained staff
• The ability to make informed decisions about your treatments
• The choice to refuse treatment, to see a different health professional, or gain a second opinion

NSF

The most notable changes introduced by the NSF states that all services should be inclusive and that mental health services need to be expanded for all under 18s; previously some 16 and 17 year-olds have been treated by adult services.

NICE

More recently, the National Institute for Clinical Excellence (NICE) has produced guidelines for the diagnosis and treatment of self-harm for the NHS in England and Wales. As well as echoing and complimenting the main points of the NSF guidelines above, NICE also states that:

• All healthcare professionals should listen sensitively to you and support you during and after the period of extreme distress you may be feeling.
• If you have harmed yourself before, healthcare professionals should not make assumptions about your reasons for doing so; they should treat each episode of self-harm in its own right.
• Staff should always make sure that you are mentally capable (able to understand) of making a decision about your treatment. The fact that you’ve harmed yourself is not evidence alone that you are not capable.

Are these guidelines enforceable by law?

Unfortunately not, but they should be taken seriously by health professionals. While the Government has put these National Service Framework standards in place, and NICE has suggested its clinical guidelines as recommendations for good practise, both have left it to your local NHS services to decide how best to approach it. However, several inspection bodies (including OFSTED, which inspects schools) are looking to make sure that progress is being made towards meeting these standards.

Levels of care

When you visit your doctor (GP) or nurse about any issues to do with mental health or self-harming, you may be referred to a local mental health team or to Child and Adolescent Mental Health Services (CAMHS). Here you’ll be able to see professionals who can help in different ways and help make sense of all of the jargon being thrown at you, as well as the services available, such as mental health trusts.

Your medical records

• You have a legal right under the Data Protection Act 1998 to see all of your health records. You may have to pay a fee of £10 to see computerised records or £50 for paper records.

• You can have a copy of your records, but you may be charged for the cost of copying. If you believe something written in your records is incorrect, you can have an amendment attached, although you cannot insist that the record itself is changed.

• Despite the above, parts of your records may be withheld without you being told on the grounds that seeing them would damage your physical or mental health.

The Mental Health Act 2007

The Mental Health Act offers safeguards and procedures that must be followed by mental health professionals. If health practitioners feel that you are a danger to yourself or others they can detain you against your will, known as ‘being sectioned’, and treat you without your consent. If you find yourself in situations where people deem you unfit to make decisions about your own health and wellbeing, it’s wise to nominate an advocate who can act on your behalf and in your best interests.

For more information about your rights and how to complain, read our trouble getting help with mental health article.