AN ADVOCACY PROJECT
DIFFERENT KINDS OF ADVOCACY!
(Patient choice and different advocacy complement each other).
Compiled by Manchester Users’ Network.
What kind of advocacy do Mental Health Service Users Need?
Commissioners need to fund different kinds of advocates (An Advocacy Project). Some patients may need more than one type of advocacy.
We have seen the amount of abuse and unfair treatment of patients in psychiatric hospitals and Care Homes which tends not be reported and only comes to light many years later. I am sure a proper effective advocacy project would greatly reduce this at Mental Health Trusts and other organisations.
An advocate respects the views and wishes of the person they advocate for, without judgement, and believes in their right to access information, representation, services and opportunities.
Although some advocates may be legally or medically qualified, in general, advocates are volunteers or paid workers who have been trained by the project or group they are part of. You can expect an advocate to have been given training in listening and negotiating skills. They should also have knowledge of the basic legal framework and provision of mental health and community care services.
Self-advocacy is about speaking up for you and making your views and wishes clear. This can be very difficult to do at times, and there are skills and tools that can support self-advocacy, such as assertiveness training, crisis cards or as ‘advance directives’ which set out your wishes in case of any crisis. Self-advocacy groups are groups of people who support each other in developing and using self-advocacy skills. Many people see self-advocacy as the ultimate aim of other forms of advocacy work. Most local user and survivor groups promote and include self-advocacy.
Group advocacy (also known as collective advocacy) is where a group of people with similar experiences meet together to put forward shared views. Local mental health service-user groups, support groups and patient councils are all examples of group advocacy. There are also larger national groups, such as those that appear under which campaign and advocate about issues raised by their membership.
Peer advocacy is support from someone with experience of using mental health services. Peer advocates can draw on their own experiences to understand and empathise with the person they are working with. Working with a peer advocate makes it easier for advocate and user to have an equal relationship. Some peer advocates and advocacy schemes work on an entirely voluntary basis, but the majority are now funded user- and survivor-run schemes with paid workers.
Formal, professional, or paid advocacy
Many voluntary organisations have developed advocacy services, which train and pay some or all of the advocates to work with anyone who wants to use their service. Although not always the case, this kind of advocacy is usually focused on short-term or ‘crisis’ work, rather than providing long-term support. Many of the advocates working for formal advocacy services are also users and survivors.
Citizen advocacy matches people with partners who are members of their local community. Citizen advocacy partnerships tend to be long-term, supportive relationships. Most citizen advocacy schemes have paid coordinators, who train and support unpaid volunteer partners. As well as helping with specific situations, citizen advocacy partnerships are intended to support vulnerable people so that they can take a greater part in the life of their community.
People with specialist knowledge and training, such as lawyers and advice workers, are sometimes called ‘legal advocates’. Legal advocates differ from other mental health advocates in that they represent people in formal settings, such as courts, tribunals or complaints processes. A legal advocate will often give advice and express their opinion about the best course of action.
‘Best interests’ (non-instructed) advocacy
‘Best interests’ advocacy is where an advocate represents what he or she feels a person’s wishes would be, if they were able to express them.‘ Best interests’ work is not generally appropriate in mental health advocacy where people are well able to express their needs and opinions directly. Some mental health advocates working with older adults are trained to do ‘best interests’ work with those clients with dementia who are no longer able to communicate clearly. A specific example of ‘best interests’ advocacy is provided by Independent Mental Capacity Advocates (IMCAs) under the Mental Capacity Act 2005.
Advocacy under the Mental Health Act 1983 (MHA)
Certain people – called ‘qualifying patients’ – are entitled to help and support from Independent Mental Health Advocates (IMHAs). This includes people who have been detained under the MHA for longer than 72 hours, such as those under sections 2 and 3, and people living in the community under Mental Health Act guardianship, conditional discharge and supervised community treatment. Others who are not ‘qualifying patients’ but who are receiving treatment in hospital for mental health problems may also be entitled to IMHA support if they are considering certain treatments under the MHA, such as neurosurgery and electro convulsive therapy.
Note: a person is not obliged to accept help from IMHAs if they don’t want to. The role of an IMHA is to provide information or help obtain advice on any rights that a person or others, such as their nearest relative, may have under the MHA, on any MHA powers being used by professionals who affect them, and any medical treatment offered to them, or being considered, in connection with their care under the MHA. It may be possible for IMHAs to assist with complaints about a person’s care and treatment under the MHA or to resolve problems with the services received under the MHA while in hospital or in the community.
An IMHA cannot apply to a mental health tribunal on a person’s behalf, but can obtain information needed for a tribunal or assist in other ways. IMHAs are entitled to interview professionals and inspect medical records in connection with their role in assisting a person, as long as that person agrees.
When a person is discharged from a section or supervised community treatment and they are no longer receiving care and services under the MHA, their entitlement to IMHA assistance will end.
Advocacy under the Mental Capacity Act 2005
The Mental Capacity Act 2005 applies to people who lack the mental capacity to make a particular decision. The Act states that in certain situations, an Independent Mental Capacity Advocate (IMCA) must be appointed to help people who lack capacity to make a decision and have no one else to speak on their behalf. This could happen when an NHS body wants to provide ‘serious medical treatment’ or there are plans to provide the person with long-term accommodation in hospital or a care home. Noting, if the person is detained under the Mental Health Act 1983 then the Mental Capacity Act does not apply and there is no duty to provide an IMCA.
Advocacy in hospitals
The experience of an inpatient admission, whether voluntary or under a section of the Mental Health Act (MHA), can be confusing and disempowering. Exercising your right to be informed and involved in your own care and treatment is difficult when you are distressed or when your views may be discounted as part of your ‘illnesses.
In hospital, an advocate will help you get information about your legal rights, your medication or discharge plans. Advocates can be helpful in preparing for Mental Health Review Tribunals and other meetings, and can often attend meetings with you. If you want support on day-to-day issues in hospital, such as getting food that is appropriate to your religious or cultural background, or making sure your belongings are safe, an advocate will support you in making your concerns known to the staff. An advocate can assist you in finding out about the services that might be available when you leave hospital. Where you are unhappy with the service you are receiving, an advocate can support you through the complaints process.
Advocacy in the community
In the community, an advocate might assist you with a benefit claim, finding the right housing, or getting the community care services you want. An advocate can provide support if you want to complain about services you are not happy with. They might also help you find out about work, education or leisure opportunities in your area.