Patient or client?

Sir: The use of terms for those who experience mental health difficulties is contentious and political. It is also above all dependent on context. I am not at all surprised that Ritchie et al (Psychiatric Bulletin, December 2000, 24, 447-450) found the term ‘patient’ was preferred by out-patient attendees, I regularly use the term patient without complaint for those who are currently receiving treatment.

However, there needs to be a term for those who have received such treatment in the past and who have a legitimate interest in the workings of the mental health services. ‘Patient’ is not an appropriate term to identify, for example, someone sitting on a planning committee who is there by virtue of having a personal experience of mental illness. We need a term for this and most people in this category accept the term ‘service user’.

Some people prefer to be called ‘survivors’ and when you listen to their experiences of mental health services this can seem quite appropriate. I would suggest asking people how they identify themselves and then showing them the courtesy of using their preferred term. The suggestion from Hodgkiss (Psychiatric Bulletin, December 2000, 24, 441) that user involvement and empowerment might be derailed by a name change is like expecting a juggernaut to be stopped by a pea. Service user involvement is here to stay. There is a lot of energy in the user/survivor movement (see, for example, http://www.madpride.net ).

We should be working with ‘service users’ in order to improve services for our ‘patients’; some of whom may be the same people in a different context.