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DH/CSIP Independent Mental Health Advocacy Project (IMHA)

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DH/CSIP Independent Mental Health Advocacy Project (IMHA) Aim : to promote the provision of high quality advocacy for detained patients throughout England and Wales – PowerPoint PPT presentation

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Title: DH/CSIP Independent Mental Health Advocacy Project (IMHA)


1
DH/CSIP Independent Mental Health Advocacy
Project (IMHA)
  • Aim to promote the provision of high quality
    advocacy for detained patients throughout England
    and Wales
  • 3 workstreams
  • Research, develop and promote good advocacy
    practice for patients receiving compulsory care
    and treatment
  • Work with the IMCA team to develop a National
    Advocacy Qualification
  • Prepare guidance for commissioners

2
Advocacy is not new
3
Patients views
  • Advocates can make a
  • difference because
  • They are independent
  • They have time to listen
  • They tell us where we can find things out
  • They help us think through what to do
  • They support us at difficult meetings
  • They remind us of what we wanted to say

4
What a nurse thinks of independent advocacy
  • As a nurse I am subject to particular policies
    and procedures for example the Mental Health
    Act. Working on a secure unit, I think it is
    important to have access to an advocate who is
    essentially independent and outside the
    organisation. For the patients it is really
    important to see someone come onto the ward who
    isnt a member of the care team who isnt one
    of us. I realize it is not the most positive way
    to describe the relationship between staff and
    patients but it is difficult to describe it in
    any other way. I will try to develop a positive
    relationship with the patient but when someone is
    detained under the Mental Health Act there is no
    doubt that it does change the dynamics of the
    relationship I am part of a system that is
    restricting that persons liberty so the
    patient is not always going to engage with me in
    a positive way. An independent advocate doesnt
    come with that same baggage so has a different
    starting point when he meets with the detained
    patient.

5
Advocacy is not new
  • Advocacy with children
  • Advocacy with people with dementia
  • IMCA
  • BME advocacy

6
Learning from BME advocacy
  • BME advocacys rooted in
  • supporting access to fair and equal treatment
    in public services
  • providing a variety of types of advocacy and
    advocacy related services
  • Advocacy supports rights, leads to a retrieval of
    some power
  • Desire to protect this way of working.

7
Learning from BME advocacy consultation
  • Professionalisation of advocacy
  • Impacts on the scale of community based advocacy
    provided by BME service providers.
  • May lead to a two-tier advocacy system
    professional advocates regarded as more effective
    than community advocates

8
Perceptions and experiences
  • Mainstream mental health advocacy does not
  • understand BME advocacy
  • share practice, knowledge, and experience with
    BME advocacy service providers
  • Mainstream advocacy services have not skilled
    themselves up to understand the needs of service
    users from BME communities

9
Making the IMHA role accessible
  • Partnership working must exist
  • develop effective referral routes
  • statutory service identify gaps in service
    provision and
  • work with voluntary sector to fill gaps
  • BME advocates
  • supported to work within statutory services so
    that appropriate support can be given to their
    clients/service users.
  • BME advocacy services
  • recognised as a resource
  • valued by statutory sector staff

10
Advocacy is not new
  • Take Manuk, he has been on the ward for a few
    weeks now but he only asked me about advocacy
    after he had seen me on the ward a few times.
    Gona, on the other hand, she started speaking
    with me about her concerns after another patient
    told her how I had helped her. Sometimes patients
    just need time to settle on a ward and then they
    are able to take in what advocacy is about.

11
Introduction of IMHA
  • IMHA services provide an additional safeguard for
    patients who are subject to the Act.
  • IMHAs are specialist advocates who are trained to
    work within the framework of the Act
  • will be subject to regulations
  • should be independent of any person who is
    professionally concerned with the patients
    medical treatment.

12
IMHA is as safeguard
  • Promoting the guiding principles
  • Respect
  • Recognising and respecting diversity
  • Listening to patients wishes and feelings
  • Participation
  • Supporting patients to engage in decision-making
    about their care
  • Resource
  • Ensuring patients perspective can be heard

13
IMHA is for qualifying patients
  • The Act calls patients who are eligible for the
  • support of an IMHA qualifying patients.
  • Patients are eligible for support from an IMHA
  • if detained under the Act (even if they are
    currently on leave of absence from hospital)
  • conditionally discharged restricted patients
  • subject to guardianship or
  • supervised community treatment (SCT) patients.

14
Patients who dont qualify for an IMHA
  • Patients
  • being detained on the basis of an emergency
    application (section 4) until the second medical
    recommendation is received
  • under the holding powers in section 5
  • in a place of safety under section 135 or 136.

15
Other patients (informal patients) are eligible
if they are
  • being considered for a treatment to which section
    57 applies
  • neurosurgery for a mental disorder
  • surgical implantation of hormones to reduce
    male sex drive
  • under 18 and being considered for
    electro-convulsive therapy or any other treatment
    to which section 58A applies

16
Support IMHA must provide as described in law
  • Helping patients to obtain information about and
    understand
  • their rights under the Act
  • the rights which other people have in relation to
    them under the Act
  • the particular parts of the Act which apply to
    them (Why detained? What restrictions?)
  • any medical treatment that they are receiving or
    might receive
  • the reasons for that treatment
  • the legal authority for providing that
    treatment the safeguards and other requirements
    of the Act which would apply to that treatment.

17
Broader IMHA role
  • IMHA can help patients to exercise their rights,
  • representing them and speaking on their behalf
  • So, IMHAs may also support patients in a range of
    other
  • ways to ensure they can participate in the
    decisions that are
  • made about their care and treatment
  • Engage with the care planning process
  • Access Mental Health Review Tribunals, prepare
    for them and understand the decisions made
  • Negotiate appropriate aftercare
  • Access other support and services
  • Raise concerns about their experience/care
  • Promote self advocacy

18
Rights given to IMHA for the purpose of providing
help to a patient
  • Visit and interview a patient in private
  • Visit and interview any person who is
    professionally concerned with a patients medical
    treatment
  • Where the patient consents, IMHAs have a right to
    see any
  • clinical or other records relating to the
    patients detention and services provided to the
    patient.
  • any records relating to the patient held by a
    local social services authority.

19
IMHAs access to patients records
  • Normal rules on patient confidentiality apply to
    conversations with IMHAs, even when the
    conversation is at the patients request.

20
IMHAs access to patients records
  • Where the patient does not have the capacity (or
    in the case of a child, the competence) to
    consent to an IMHA having access to their records
  • Holder of the records
  • Must allow the IMHA access if they think that it
    is appropriate and that the records in question
    are relevant to the help to be provided by the
    IMHA

21
IMHAs access to patients records
  • Holder of the records
  • should start from a general presumption
  • that it is likely to be in-patients interests
    to be represented by an IMHA who is knowledgeable
    about their case
  • consider what is best for the patient and not
    what would be most convenient for the
    organisation which holds the records

22
IMHAs access to patients records
  • The holder of the records decision to disclose
    information in the patients best interest
  • Should be taken in accordance with the Mental
    Capacity Act 2005 (MCA) or, for children under
    16, the common law
  • Each decision must be taken on its merits
  • Must take into account what they know about the
    patients wishes and feelings, including any
    written statements made in advance.

23
IMHAs access to patients records
  • Records must not be disclosed if that would
    conflict with a decision made on the patients
    behalf by the patients attorney or deputy, or by
    the Court of Protection.
  • If the record holder thinks that disclosing the
    confidential patient information in the records
    to the IMHA would be in the patients best
    interests, it is likely to be appropriate to
    allow the IMHA access to those records in all but
    the most exceptional cases.

24
A qualifying patient
  • may request the support of an IMHA at any time
    after they become a qualifying patient
  • may choose to end the support they are receiving
    from an IMHA at any time
  • does not have to accept help from an IMHA if they
    do not want it.

25
IMHA duty to respond
  • Referrals to IMHA can come from anyone
  • IMHA have a duty to respond to requests to visit
    a patient received from
  • Patients
  • Nearest relatives
  • Responsible clinicians
  • Approved mental health professionals
  • IMHA must comply if the request is reasonable
  • Patients can turn down the IMHA support

26
Duty to explain IMHA
  • Depending on the patients circumstances,
    responsibility for informing patients about
  • the help available from an IMHA
  • how the IMHA service can be accessed
  • is placed on
  • Hospital Managers
  • Responsible clinicians
  • Responsible social services authorities
  • Registered medical practitioners

27
AMHPs and responsible clinician
  • Should consider requesting an IMHA to visit a
    qualifying patient
  • if the patient might benefit from an IMHAs visit
    but is unable or unlikely for whatever reason to
    request an IMHAs help themselves.
  • Before requesting an IMHA
  • wherever practicable discuss the idea with the
    patient
  • give the patient the opportunity to decide for
    themselves whether to request an IMHAs help.

28
AMHPs and responsible clinician
  • Should not request an IMHA
  • where they know, or strongly suspect, that the
    patient does not want an IMHAs help, or the help
    of the particular IMHA in question.

29
Timing and form of information
  • Patients have to be told about the IMHA service
    as soon as practicable after they qualify for the
    service
  • The information has to be given orally and in
    writing
  • Copies of the information about the IMHA service
    should be given to nearest relatives unless the
    patient specifically requests otherwise.

30
Advocacy changes the story
  • The psychiatrist said to me that I have
    borderline personality disorder
  • I told my advocate what the psychiatrist said
  • My advocate said what do you say?

31
Stories take us beyond them and us
  • Talk! Listen and tell your local and regional
    stories
  • Develop a collaborative approach
  • Ask the difficult (and easy) questions
  • Have the difficult (and easy) conversations
  • Use the intelligence to develop service provision
    with key stakeholders
  • Encourage a strategic approach to planning for
    advocacy that looks beyond IMHA and IMCA

32
Your stories, questions and ideas
  • Kay Steven
  • Advocacy Lead
  • Kay.Steven_at_csip.org.uk
  • M07917 7185417
  • www.goodadvocacypractice.org.uk
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