User and carer involvement in mental health training

National policy in the UK emphasises the importance of involving service users and caregivers in all types of mental health provision. The training of mental health care and social service professionals has always relied on seeing patients, but the patients’ role has usually been a passive one. This is now changing, and service users and carers are becoming active educators in professional training, benefiting both the teachers and those taught. Provision is still very variable and is dependent on local initiatives. Voluntary organisations are active in this field, and there are now two academic posts for service users in the UK. This article explores the current forms of service user training, its benefits and drawbacks, and makes recommendations for future work. Recent national policy has emphasised the importance of user and carer involvement in mental health services at a variety of levels (e.g. Department of Health, 2001). The National Service Framework for Mental Health states that ‘Service users and carers should be involved in planning, providing and evaluating training for all health care professionals’ (Department of Health, 1999). The Patients' Forum, INVOLVE (formerly Consumers in NHS Research) and the Commission for Patient and Public Involvement in Health all exist to ensure that patients and carers are involved with both the academic and the clinical side of health care. In this article we review the benefits and drawbacks of service users’ and carers’ involvement in health education in general. We go on to consider their role in mental health education at different levels, and present some of the views of service users. Finally, we consider the practical implications for mental health training. What to call ‘users’ and ‘carers’ When invited to contribute this article, we found the terms used in its title contentious. As doctors we are used to thinking of the people we see for assessment and management as ‘patients’. We know that colleagues in social work talk about ‘clients’ and that other colleagues and managers talk of ‘users’, ‘consumers’ and ‘stakeholders’. McGuireSnieckus et al (2003) found that when people consult general practitioners and psychiatrists they prefer to be referred to as patients (as opposed to clients or service users) and they are happy for other health and social service personnel to call them either patients or clients, but 10% or less like to be called service users. People acting outside the traditional role of receiving care describe themselves with a variety of terms. One group felt the term ‘consumer academic’ best reflected the range of responsibilities of a new academic user role, which included teaching and research (Happell et al, 2002). The Alzheimer’s Society talks about ‘carers’ and ‘family caregivers’. Mind (the National Association for Mental Health) talks about ‘service users’. The Distress Awareness Training Agency (DATA) refer to ‘resisters’, ‘survivors’, ‘users’ and ‘ex-users’. The mental health organisation SANE talks about ‘sufferers, families and friends’. Another term we found was ‘patient activist’. These different names reflect different views of the roles that we talk about in this article. When we use any of these terms here, we use either the word that the people concerned used for themselves, or one of the words listed above as being synonymous with ‘user’ or ‘carer’. Gill Livingston is a reader in the psychiatry of old age at Royal Free and University College Medical School (Holborn Union Building, Archway Campus, Highgate Hill, London N19 5NL, UK. Tel: 020 753