Title: DH/CSIP Independent Mental Health Advocacy Project (IMHA)
1DH/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
2Advocacy is not new
3Patients 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
4What 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.
5Advocacy is not new
- Advocacy with children
- Advocacy with people with dementia
- IMCA
- BME advocacy
6Learning 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.
7Learning 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
8Perceptions 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 -
9Making 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
10Advocacy 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.
11Introduction 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.
12IMHA 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
13IMHA 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.
14Patients 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.
15Other 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 -
16Support 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.
17Broader 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
18Rights 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.
19IMHAs access to patients records
-
- Normal rules on patient confidentiality apply to
conversations with IMHAs, even when the
conversation is at the patients request.
20IMHAs 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
21IMHAs 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 -
22IMHAs 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. -
23IMHAs 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. -
25IMHA 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
26Duty 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
27AMHPs 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. -
28AMHPs 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.
29Timing 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.
30Advocacy 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?
31Stories 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
32Your stories, questions and ideas
- Kay Steven
- Advocacy Lead
- Kay.Steven_at_csip.org.uk
- M07917 7185417
- www.goodadvocacypractice.org.uk