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argued that decisions should be based on someone’s ability to make decisions (‘capacity’) rather than on whether he or she has a psychiatric diagnosis (BPS, 1999). This is the case under Scottish law: however, unfortunately in our view, the recently revised mental health legislation in England and Wales is still based on whether someone’s difficulties fit the criteria for a ‘disorder’. A positive experience of services [In hospital] I was listened to seriously and attentively; my requests ... were all complied with quickly and treated with respect. Doctors did not look straight over or through me, they treated me like a substantial human being and were very sympathetic, especially concerning the terrible feelings of humiliation I had about my delusions. Nurses did not generally adopt a controlling, domineering attitude but were usually sensitive, responsive and human. Even ward domestics played a significant role in my recovery. Peter Chadwick (Chadwick, 1997) 14.4 How services need to change 14.4.1 Learning from users and ex-users of services Professionals must listen to what service users and ex-users have to say about services and treatments; it is only by listening that professionals can learn what really is helpful to those they are treating. It should be standard practice for service users to be involved at all levels, from planning the service as a whole to providing feedback to individual teams and, essentially, in planning their own care. Because service users and ex-users are experts by experience, a number of services have begun not only to involve service users in decision making at high levels, but also to employ them as members of their clinical teams. 14.4.2 Employing ‘experts by experience’ as workers One example of such a service is the South West London and St George’s Mental Health Trust, which identifies personal experience of mental health problems as ‘desirable’ in its selection criteria for staff, including senior clinicians (http://www.swlstg-tr.nhs.uk/work/ index.asp). 14.4.3 Service users as trainers Service users, ex-users and relatives are experts by experience, and so they should also be involved in the process of training mental health workers. Clear guidelines and auditing structures should be established to enable this inclusion of valuable insights for professional training courses and for training within services for mental health teams (e.g. ward or Community Mental Health Team ‘away days’; Donaldson, 2006). 14.4.4 Specialist bipolar services Major population centres within the UK would benefit from specialist services for bipolar disorder similar to those that are available in some cities in the US. Services for young people experiencing mood instability are also needed: Early Intervention with Psychosis services (EIS or EIP) are being developed round the country but tend to focus on young people experiencing paranoid thoughts or unusual sensory experiences rather than on those experiencing mood instability. It is vital that services address this gap in provision, especially as some young people may not initially see elevated mood as a problem and so may not seek help.

Part 5: Wider implications

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Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...