Health

personal values and principles influence individual contributions to work in health and social care settings. Activity 1 This factsheet describes the standards of care that can be expected, what constitutes abuse or neglect, and what can be done if you think that you or someone else has been abused. Copyright note for Mind factsheets: You are welcome to print and photocopy this page of Mind's website. Organisations are free to distribute copies to service users and colleagues, but must ensure they always use the latest version, as available on the website, at the time of distribution. Introduction What are the health and social care professions' What standards can I expect of health and social care professions' Profession-based standards Duty of care Information about treatments Choice Dignity Who regulates the health and social care professions' Health and social services Statutory regulatory agencies Professional regulatory agencies Professional associations Criminal law What is professional abuse' Physical abuse Sexual abuse Financial abuse Psychological/emotional abuse Neglect How can I be sure that abuse has occurred' How can I take action if I believe abuse has occurred' Complaints about NHS and social services Complaints through professional regulators Police What if I don't want to report my experience' Recent and forthcoming developments 'Dignity in care' Safeguarding and dealing with abuse 'Making experiences count' Regulation of talking therapies Further reading Useful organisations References Introduction Health and social care professionals have a duty of care to ensure the wellbeing of service users. Most professions have set out good practice guidelines. Contravention of these guidelines may constitute abuse or neglect.  This factsheet has been written for people with mental distress who use or have used health and social care services. It may also be of interest to friends and carers of people with mental distress, people who work in health and social care services and other members of the public. What are the health and social care professions' The health professions focus on a person's medical or clinical condition. Health professionals who are likely to be involved in mental health care and treatment are: general practitioners (GPs), psychiatrists (medical doctors who have specialised in mental health), nurses (in hospital or community settings) and health care assistants. Allied health professions may also be involved in mental health care and treatment. These include psychologists, counsellors, psychotherapists and occupational therapists. Allied health professionals usually focus on social, emotional or practical issues that can impact on health and wellbeing. The social care professions focus on social, emotional and practical issues. Social care professionals who may be involved with mental health care and support include social workers, support workers, care assistants, day centre staff and housing support workers. More information on all of these professions can be found in Mind's factsheet, Who's who in mental health: a brief guide. What standards can I expect of health and social care professions' All health and social care professions have identified certain principles and ways of working as 'good practice'. Being aware of what 'good practice' means can help you to identify abuse or neglect. Some aspects of good practice have been made law through government legislation; others are standards set by professional associations. More detailed information on the legal issues surrounding professionals standards can be obtained from Mind's Legal advice service (see 'Useful organisations'). Profession-based standards Health and social care professionals cover a wide range of roles that focus on many different aspects of their service users' welfare. Each profession has its own rules and guidelines, covering both competence (the skills and knowledge required do their job to agreed standards) and ethics (the legal and moral issues relevant to their job). To find out the details of any profession's rules and guidelines, contact the relevant professional regulator (see 'Who regulates health and social care professions'' and 'Useful contacts'). Duty of care Health and social care professions have in common the concept of a 'duty of care' toward their users. This means that the wellbeing of the service user should be central to their work. All treatment given must have a therapeutic benefit to the user or must be essential for saving life. Information about treatment Service users should be given sufficient information about any treatment they are offered so that they can make an informed decision about whether or not to take it. [1] Information should include the benefits and possible risks of the treatment, the likely duration of treatment and any financial costs. The service user should also be given information on alternatives to the treatment being offered. Mental Health Act 1983 Generally, service users detained under the Mental Health Act 1983 must be told what the Act has to say about treatment for mental disorder. This includes the circumstances, if any, under which they can be treated without consent, the circumstances in which they have the right to refuse treatment, the role of second opinion appointed doctors, and, where relevant, the rules on electroconvulsive therapy. Where a particular treatment is proposed during detention, the service user has a right to be given sufficient information to ensure that he or she understands the treatment in broad terms, including its nature, likely effects and significant possible adverse outcomes, the likelihood of its success and any alternatives to it. However, the Act allows service users to be given certain treatments in an emergency, for example in response to an immediate crisis; in this situation the health professionals are not legally obliged to ascertain whether a patient is capable of consenting to the treatment, or to discuss the treatment in full. As a matter of good practice, however, notes relating to an individual's mental capacity and attitude to receiving the treatment should be recorded on his or her medical file. Mind has produced an outline guide to the Mental Health Act 1983 (see 'Further reading'). Where health and social care professionals have reason to believe that the service user does not have the capacity to understand the information or make an informed decision, they must act in accordance with the Mental Capacity Act 2005. Mind has produced a series of briefing documents relating to the Mental Capacity Act (see 'Further reading'). Choice Over the past two decades the concept of choice has become important to the health and social care professions, and to the government departments that make policies affecting these sectors. It is now widely accepted that service users should be able to make informed choices about the most suitable treatments for themselves. However, a patient does not have a legal right to demand a particular treatment and complete choice does not always happen in practice (e.g. the preferred treatment may not be available within a service user's local area). Service users have the right to refuse treatment (unless they are sectioned under the Mental Health Act or have capacity issues covered under the Mental Capacity Act 2005). [2] Health and social care professionals should treat service users in ways that enhance their capacity to choose, and should not undermine their capacity (e.g. by withholding necessary information or presenting alternative options in a negatively biased manner). Dignity Health and social care professionals must treat service users with dignity. The concept of 'dignity' can be subjective, and each person has his or her own idea of what this means; nevertheless, the 'Dignity in care' campaign (described below) has shown that service users clearly consider dignity important. Issues such as gender, culture, religion and previous life experience will impact on an individual's idea of dignified treatment; finding out about these issues is a crucial part of treating a person with dignity. The Department of Health and the Social Care Institute for Excellence use the following definition of 'dignity' in health and social care: "Dignity in care ... means the kind of care, in any setting, which supports and promotes, and does not undermine, a person's self-respect regardless of any difference." [3] Professional associations often have their own definitions of what it means to treat service users with dignity; in many cases, this is linked to the profession's 'duty of care' (see 'Duty of care'). People sectioned under the Mental Health Act and people with capacity issues must also be treated with dignity: a 2007 amendment to the Mental Health Act has increased the penalty for professionals guilty of 'ill treatment or neglect' of people under section. [4] Service users covered by the Mental Capacity Act 2005 must always be treated 'in their best interests', including attention to the beliefs, values and wishes of the individual. [5] Who regulates the health and social care professions' Health and social services Health authorities (including primary care trusts and mental health trusts) and local authority social services are legally responsible for all the staff they employ. This includes ensuring that appointed staff have the necessary qualifications and competence to perform their roles and that there is no reason to believe that staff could pose a risk to service users (e.g. following up references and checking with the Criminal Records Bureau that prospective staff have no criminal conviction that could affect their work). Health authorities and social services departments should ensure that staff receive the ongoing supervision, training and support needed to carry out their work. A health authority or local authority is liable if a member of their staff is found guilty of professional misconduct.[6] Statutory regulatory agencies Health and social care services as a whole are regulated by national regulatory agencies, currently the Healthcare Commission and the Commission for Social Care Inspection (see 'Useful organisations'). These agencies inspect health and social care services to check that standards are being met. The Mental Health Act Commission performs this regulatory function for services used by people sectioned under the Mental Health Act. From April 2009, these three agencies will be replaced by a single agency, the Care Quality Commission (www.cqc.org.uk), which will regulate health and social care and monitor the welfare of patients detained under the Mental Health Act. Children's services are regulated by Ofsted. Professional regulatory agencies Most health and social care professions are also regulated by independent agencies relevant only to their own profession. Examples of this include the General Medical Council for doctors, and the Nursing and Midwifery Council for nurses. In order to be allowed to do their jobs, workers in these professions have to be registered with their regulatory agency. An individual who is found guilty of professional misconduct (whether through abuse or neglect) will be disciplined by their professional agency. Professional associations Psychotherapists and counsellors are not at present covered by a regulatory body that has legal powers, though this is likely to change over the next two or three years (see 'Recent and forthcoming developments'). What this means in practice is that anyone can call themselves a 'counsellor', even if they have not had the necessary training or gained a recognised qualification. It also means that members of professional associations cannot be prevented from practising, even if they have been removed from the register. To protect clients from therapists who may be unqualified or in any way unfit to practice, the two main associations that represent therapists also have a regulatory function. These are the British Association for Counselling and Psychotherapy (BACP) and the United Kingdom Council for Psychotherapy (UKCP) ('see 'Useful organisations'). Membership of these associations is voluntary, but in other ways they operate in a similar way to legally binding professional regulatory bodies in developing and enforcing professional standards for their members. For more information on finding talking therapists, see 'Further reading' and 'Useful organisations'. Criminal law Criminal law covers actions such as physical and sexual assault, theft and other financial crimes. Any crime committed by a health or social care worker against a service user is a matter of professional abuse. Regulation of the health and social care professions is in addition to the protection of service users conferred by criminal law. What is professional abuse' Professional abuse occurs when a health or care worker acts in a way that goes against their own professional standards and, in some cases, criminal law. Professional abuse undermines, and in many cases destroys, the therapeutic value of a health or social care service and is rooted in a violation of the service user's trust. WITNESS, the main organisation working to combat professional abuse and boundary violation (see 'Useful organisations'), has written: "... trust is vital because of our vulnerability when we seek help, the degree of intimacy involved in such relationships and the inherent power difference between a professional and the person seeking help. As a result these relationships are open to exploitation and abuse, sometimes unintentionally, with often devastating effects for the patient or client." [7] In many cases, abuse can be the result of a gradual erosion of boundaries between the client or service user and the professional involved. For example, the professional may disclose personal information, initiate contact outside agreed sessions or try to get involved in areas of the service user's life that are outside their professional remit. If boundaries are eroded in this way and the relationship is changed over time, it can be more difficult for the service user to identify unprofessional or abusive behaviour. Abuse can take many forms but can usually be defined as physical, sexual, financial or psychological/emotional. Physical abuse Physical abuse is non-accidental pain or injury inflicted on a service user by a health or care worker. This can include hitting, shaking, rough treatment or inappropriate use of restraint. The health and social care professions do not permit any physical contact that is not necessary for administering a treatment, or for which the service user has not given their consent. Sexual abuse Sexual abuse usually refers to any sexual activity that is unwanted and is inflicted by physical force or other methods of coercion such as threats or intimidation. Sexual contact between workers and service users is forbidden in the health and social care environment [8] because it could be harmful to the therapeutic value of the treatment being given and is likely to be based on the exploitation of a service user's vulnerability and the power imbalance inherent in the relationship. Financial abuse Financial abuse covers any way that a health or social care worker unlawfully uses his or her relationship with the service user for financial gain. This includes, but is not limited to: * charging a fee for services that should be free of charge * charging for services that are not in the service user's best interest * unnecessarily prolonging treatment for financial gain * increasing agreed fees after a treatment has begun * receiving financial inducements for recommending other products or services to the service user * theft from the service user (including items being 'borrowed' and not returned). Psychological/emotional abuse This refers to the psychological or emotional exploitation of the relationship between a health or social care worker and a service user. It is the most difficult form of abuse to define because it relies heavily on individuals' feelings and perceptions rather than on physical or tangible evidence. The following principles can be useful in identifying psychological or emotional abuse. * Is the health or social care worker disclosing sensitive, personal information to the service user' * Is the worker making psychological or emotional demands on the service user that do not appear to contribute to a therapeutic process' * Is the worker trying to make contact with the service user outside the agreed working environment' * Does the worker appear to be trying to humiliate or belittle the service user' If the answer to any of these questions is 'yes', the worker may be guilty of psychological or emotional abuse. Neglect Neglect cuts across all the areas described in this section. Abuse is usually defined as harmful action; neglect can be understood as a form of abuse by failing to act. If a health or social care worker has failed to do something within their professional remit that is in the service user's best interest, this is neglect. Examples of neglect include, but are not limited to: * failing to act on a service user's concerns about their physical or mental health * failing to act on a service user's complaints about the care or treatment they are receiving from others, or on the signs of ill-treatment or neglect * failing to act on indications that a service user's health, or ability to care for him or herself, is deteriorating * failing to act on a service user's expressions of extreme mental distress, such as suicidal feelings. How can I be sure that abuse has occurred' Service users may feel uncertain as to whether they have experienced abuse by a health or social care worker. This can reflect a range of factors, including past experiences of using mental health services. Here are just a few scenarios in which uncertainty could arise. * An experience such as being detained or having a drug administered against one's will, although distressing, may be lawful in some situations (if a person is sectioned under the Mental Health Act). * Services, and particular members of staff, may not meet a service user's needs but this is not always professional misconduct or unlawful abuse or neglect. Examples of this would be long waiting times for non-urgent treatment (such as talking therapies) or health and social care workers' lack of empathy for the service user. * An abusive worker may claim that whatever has taken place is in the service user's best interests, or that what happened didn't happen, or didn't happen in the way the service user remembers. The power imbalance in the relationship may mean that the abusive worker is able to convince the service user that this is so. * The service user may lack confidence in their own judgement and may not trust their own perceptions, perhaps because they have been convinced by other people (including health and social care workers) that their judgements and perceptions are flawed. This lack of self-belief could be worsened by the power imbalance in the relationship between service user and service provider. You can be sure that abuse or neglect has occurred if the health or social care worker has broken the law. You can also be sure that professional misconduct has occurred if the worker has acted in a way that is forbidden by the professional association whose membership they hold. If you are not aware of a particular law or rule being broken but are nevertheless concerned by the behaviour of a worker, or by an aspect of your relationship with that worker, it is important to trust your perceptions. Sources of information and support to help you understand what has occurred and to take any necessary action are described in the following section. How can I take action if I believe abuse has occurred' All health and social care providers (e.g. health authorities and social services departments) and all associations that regulate health and social care professions should have a complaints procedure. It is good practice to provide service users with information on how to complain; this information should be readily accessible on health and social care premises. All service users have the right to complain if they feel that their care has been substandard or that they have experienced abuse. People who are sectioned under the Mental Health Act should have access to an advocate who can communicate the service user's complaints, and to the relevant authority. Those who have capacity issues covered by the Mental Capacity Act 2005 may have complaints made on their behalf by third parties operating in their best interests. More information on advocacy can be found in the Mind guide to advocacy or by contacting the Mind Legal Line or the Advocacy Research Exchange (see 'Useful organisations'). Complaints about NHS and social services If you have experienced abuse or neglect while using NHS or social services, the usual way to make a complaint is through their complaints procedures. All NHS and social services are legally obliged to have a complaints procedure in place and to inform service users of how to use it (which includes providing any support needed to enable the service user to make a complaint). If you receive no response to your complaint within the timescale specified in the complaints procedure, or if the reply you receive is not helpful, you can complain through other channels. If your complaint is with an NHS service, it is usual to begin with the health authority's Patient Advice and Liaison Service (PALS); any member of staff will be able to provide you with details of your local PALS. If you would prefer an independent advocacy service, you can contact the Independent Complaints and Advocacy Service (ICAS), which was set up to support patients and carers in their complaints against NHS services. You can find contact details of your region's ICAS from a member of staff or via the Department of Health website (www.dh.gov.uk). The Parliamentary and Health Service Ombudsman and the Local Government Ombudsman (see 'Useful organisations') investigate individual complaints about health and social services that have not been resolved by local complaints procedures. These services were set up to ensure that standards are met in NHS and social services. You can also complain to the regulatory bodies for health and social care - the Healthcare Commission, Commission for Social Care Inspection or the Mental Health Act Commission (see 'Useful organisations'). (From April 2009 all these bodies will be merged into a single new agency, the Care Quality Commission). You may wish to take legal advice or contact a local advocacy service (such as services provided by many local Mind associations). If you are in any doubt about the best course of action, contact Mind's Legal advice service or WITNESS's helpline (see 'Useful organisations') to discuss your situation. Complaints through professional regulators Professional associations have rules on what constitutes 'good practice' by their members. If a health or social care professional breaks any of these rules, their professional association is obliged to investigate the situation and take any action needed. In extreme cases the health or social care professional may be expelled from the association and forbidden to practise their profession ('struck off'). If you are using private or voluntary sector services outside the NHS (e.g. a private counsellor), you would usually make your complaint through the complaints procedure of the relevant professional association (e.g. the British Association of Counsellors and Psychotherapists). You would need to check which professional association (if any) the practitioner belongs to, and then check with that professional association. All professional associations must have a complaints procedure. Police If you have experienced abuse of a physical or sexual nature, or financial misconduct such as theft, the health or social care worker has committed a criminal offence. This means that you have the right to report such an offence to the police and have the abuser tried through the criminal justice system. People sometimes choose not to report crimes to the police for a variety of reasons, such as not wanting to relive a traumatic event by telling it to someone else, fears of not being believed or previous negative experiences of the police. However, in recent years many police forces have made big improvements in the way they treat victims of physical and sexual violence. Some have also implemented new processes for reporting these crimes. One of these is the introduction of 'third party reporting' in which an organisation can report a crime on behalf of a victim who wishes to remain anonymous. You can find out if third party reporting operates in your area by contacting your local police force. If you feel that an advocate would be helpful to ensure that you are treated fairly and can communicate your experience clearly to the police, you can make contact with a local advocacy service. To find out what is available in your area, use your local directory or contact Mindinfoline (see 'Useful organisations'). Mind has produced a guide to advocacy (see 'Further reading'). You can also find support to help you through the process of reporting a crime through local organisations, such as some local Mind associations and Victim Support (see 'Useful organisations'). What if I don't want to report my experience' You always have the choice of whether or not to make a formal complaint about an experience of abuse or neglect. All the organisations that offer support to survivors of abuse by health and social care workers (such as WITNESS) or of crime (such as Victim Support) will offer you their services whether or not you choose to make a formal complaint. A range of local support services is available for the victims of abuse; you can find out about these by contacting Mindinfoline. Recent and forthcoming developments Reforms of health and social care services help to protect people from professional abuse and neglect. This section briefly describes the main reforms in this area. 'Dignity in care' 'Dignity in care' is a campaign set up to eliminate the tolerance of indignity in social care services. The overall aim of the campaign is to stimulate national debate about dignity in care, and to create a care system that respects people and has zero tolerance of abuse. Although originally focused on services for older people, the campaign has now been expanded to include mental health services. More details and information on the latest developments can be obtained from (www.dh.gov.uk/en/SocialCare/Socialcarereform/Dignityincare/index.htm), or by contacting Mind's Policy and Campaigns Unit. Safeguarding and dealing with abuse 'No Secrets', published jointly by the Department of Health and the Home Office, set out a framework for safeguarding - keeping people safe from abuse and neglect. The Safeguarding Vulnerable Groups Act 2006 was passed to strengthen safeguarding arrangements for individuals in the workplace. One of its main points is to improve vetting procedures so that people who may present a danger to service users are identified and prevented from working in social care professions. The new Independent Safeguarding Authority (ISA; see 'Useful organisations') is in charge of enforcing these new procedures. More details and information on the latest developments can be obtained from (www.dh.gov.uk/en/SocialCare/Socialcarereform/Safeguardinganddealingwithabuse/index.htm) or Mind's Policy and Campaigns Unit (see 'Useful organisations'). 'Making experiences count' 'Making experiences count' is a programme of work aimed at improving the complaints procedures in health and social care, to make the process easier, quicker and more effective for service users. More details and information on the latest developments can be obtained from (www.dh.gov.uk/en/Managingyourorganisation/Legalandcontractual/Complaintspolicy/MakingExperiencesCount/index.htm) or by contacting Mind's Policy and Campaigns Unit. Regulation of talking therapies Talking therapists include psychologists, psychotherapists and counsellors. As described above, talking therapies are not currently regulated by any agency that has legal power. However, work is well underway to develop national occupational standards for these professions and to ensure that all talking therapists are subject to statutory regulation. It is intended that these professions will be regulated by the Health Professions Council (HPC), which already regulates such professions as art therapists and occupational therapists. More details and information on the latest developments can be obtained from the HPC website or Mind's Policy and Campaigns Unit. Further reading Mind factsheets  Who's who in mental health: a brief guide Legal briefing: How to complain about Health and Social Care Booklets and other publications To order any of these, call Mind Publications on 020 8221 9666 or emailpublications@mind.org.uk Mind guide to advocacy Making sense of counselling Making sense of psychotherapy and psychoanalysis The Mental Health Act 1983 an outline guide Understanding talking treatments Another assault Mind's campaign for equal access to justice for people with mental health problems. Mind report, 2007 Other publications Department of Health and Home Office, No secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse, DH, 2000. National Assembly for Wales and Home Office. In safe hands: implementing adult protection procedures in Wales, National Assembly for Wales, 2000. Useful organisations Advocacy Resource Exchange (ARX) Portman House 53 Millbrook Road East Southampton SO15 1HN tel: 0151 734 3047 advocacy finder helpline: 08451 228 633 (Mon-Fri 2-5pm) email: joe@advocacyresource.net website: www.advocacyresource.net  An organisation that provides information and advice about advocacy, including how to find an advocate. British Association for Counselling and Psychotherapy (BACP) BACP House 15 St John's Business Park Lutterworth LE17 4BH tel: 01455 883 330 (general enquiries) client information helpdesk: 01455 883 316 email: bacp@bacp.co.uk  web: www.bacp.co.uk  The biggest UK membership organisation for counsellors and psychotherapists. The website also includes a 'find a therapist' section. Care Quality Commission 7th Floor, New Kings Beam House 22 Upper Ground London SE1 9BW tel: 03000 61 61 61 web: www.cqc.org.uk  From April 2009 will regulate the quality of health and social care and look after the interests of people detained under the Mental Health Act. Commission for Social Care Inspection (CSCI) Head office 33 Greycoat Street London SW1P 2QF tel: 0845 015 0120 or 0191 233 3323 (helpline) email: enquiries@csci.gsi.gov.uk  web: www.csci.org.uk An independent agency that inspects and reports on care services and local authorities/councils. The website includes directories of care services and inspection reports. Children's services are regulated by Ofsted (see below). In 2009 the CSCI will be incorporated into the new Care Quality Commission (www.cqc.org.uk). General Medical Council (GMC) London office Regent's Place 350 Euston Road London NW1 3JN tel: 0845 357 8001 (London); 029 2050 4060 (Cardiff) email: gmc@gmc-uk.org  web: www.gmc-uk.org  The GMC is a statutory agency that registers and regulates doctors practising in the UK. General Social Care Council London Office Goldings House 2 Hay's Lane London SE1 2HB tel: 020 7397 5100 email: info@gscc.org.uk  web: www.gscc.org.uk  Statutory agency for that registers social care workers and regulates their conduct and training. Also has an office in Rugby, Warwickshire. Healthcare Commission Head Office Finsbury Tower 103-105 Bunhill Row London EC1Y 8TG tel: 020 7448 9200 helpline: 0845 601 3012 email: feedback@healthcarecommission.org.uk  web: www.healthcarecommission.org.uk  The Healthcare Commission is the independent watchdog for health care in England. It inspects and reports on the quality and safety of services provided by the NHS and the independent healthcare sector. In 2009 the Healthcare Commission will be incorporated into the new Care Quality Commission (www.cqc.org.uk). Health Professions Council (HPC) Park House 184 Kennington Park Road London SE11 4BU tel: 020 7582 0866 web: www.hpc-uk.org  Statutory agency that regulates a range of health professionals. The website provides a register of health professionals who meet the HPC's standards and also gives advice on how to make a complaint and about 'fitness to practice'. Independent Safeguarding Authority (ISA) information line: 0300 123 1111 email: scheme.info@homeoffice.gsi.gov.uk web: www.isa-gov.org.uk  The ISA was created to help prevent unsuitable people from working with children and vulnerable adults. The CSI works with the Criminal Records Bureau to gather relevant information on every person who wants to work or volunteer with vulnerable people. Local Government Ombudsman PO Box 4771 Coventry CV4 0EH tel: 0854 602 1983 web: www.lgo.org.uk  Carries out independent investigations of complaints about local authorities/councils that cannot be resolved at local level, including social services. Mental Health Act Commission (MHAC) Maid Marian House 56 Hounds Gate Nottingham NG1 6BG tel. 0115 9437100 web: www.mhac.org.uk  The MHAC safeguards the interests of people detained under the Mental Health Act It visits mental health service providers regularly in order to check the legality of detention and provides safeguards to patients who lack capacity or refuse consent to treatment, through the Second Opinion Appointed Doctor Service. In 2009 the MHAC will be incorporated into the new Care Quality Commission (www.cqc.org.uk). Mind infoline PO Box 277 Manchester M60 3XN tel: 0300 123 3393 email: info@mind.org.uk  For information on mental health and related issues. Mind Legal advice service PO Box 277 Manchester M60 3XN tel: 0300 466 6463 email: legal@mind.org.uk For information and advice on mental health law and other legal issues relating to mental health. Mind's Policy and Campaigns Unit 15-19 Broadway London E15 4BQ tel: 020 8215 2282 email: puadministrator@mind.org.uk  For information on Mind's policy work and other policy and campaigns relating to mental health issues. Nursing and Midwifery Council 23 Portland Place London W1B 1PZ tel: 020 7637 7181 web: www.nmc-uk.org  Statutory agency that registers and regulates nurses and midwives practising in the UK. The Council sets standards for education, training, conduct and performance and ensures that the standards are met, in order to safeguard the health and wellbeing of the public. Ofsted Ofsted National Business Unit Royal Exchange Buildings St Ann's Square Manchester M2 7LA tel: 08456 014 772 (for complaints about a service) email: enquiries@ofsted.gov.uk web: www.ofsted.gov.uk Ofsted inspects and regulates the educational, economic and social wellbeing of children, young people and adult learners. This includes the care and local services. Parliamentary and Health Service Ombudsman Millbank Tower Millbank London SW1P 4QP complaints helpline: 0345 015 4033 email: phso.enquiries@ombudsman.org.uk  web: www.ombudsman.org.uk  Carries out independent investigations into complaints about unfair or improper actions or poor service by the NHS and UK government departments that cannot be resolved at local level. United Kingdom Council for Psychotherapy (UKCP) 2nd Floor, Edward House 2 Wakley Street London EC1V 7LT tel: 020 7014 9955 email: via website web: www.ukcp.org.uk  The main membership organisation solely for psychotherapists. The aim of the UKCP is to promote and maintain the profession of psychotherapy and high standards in the practice of psychotherapy in the UK, for the benefit of the public. Although registration is currently voluntary, the UKCP is working towards statutory registration. Victim Support National Centre Hallam House 50-60 Hallam Street London W1W 6JL tel: 020 7268 0200 helpline: 0845 3030 900 email: supportline@victimsupport.org.uk  web: www.victimsupport.org.uk  Victim Support is a charity that gives free advice and support to people affected by crime. The website provides a list of local offices. WITNESS 32-36 Loman St London SE1 0EH tel: 020 7922 7799 helpline: 08454 500 300 email: info@professionalboundaries.org.uk  web: www.popan.org.uk  WITNESS is a charity that aims to promote safe boundaries between professionals and the public to prevent abuse. References [1] Mind 2008, Mind rights guide 3: Consent to treatment, Mind. [2] Mind 2008, Mind rights guide 3: Consent to treatment , Mind. [3] SCIE 2008, Practice guide 09: Dignity in care, Social Care Institute for Excellence. [4] Mind 2008, Legal briefing 1: Amendments made to the Mental Health Act 1983 by the Mental Health Act 2007, Mind. [5] Mind 2008, Legal briefing 4: Healthcare and Welfare/Personal Care Decisions under the Mental Capacity Act 2005, Mind. [6] Mind 2008, Legal briefing: Clinical negligence, Mind. [7] Witness 2008, 'FAQ: What is professional abuse''www.safeboundaries.org.uk/contact_sent.htm (accessed September 2008). [8] Home Office 2003, Working within the Sexual Offences Act 2