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
• 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

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Advocacy is not new
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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

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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.

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Advocacy is not new

• Advocacy with children
• Advocacy with people with dementia
• IMCA
• BME advocacy

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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.

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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

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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

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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

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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.

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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.

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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

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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.

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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.

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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

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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.

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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

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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.

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IMHAs access to patients records

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

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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

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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

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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.

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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.

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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.

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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

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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

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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.

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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.

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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.

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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?

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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

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Your stories, questions and ideas

• Kay Steven
• Advocacy Lead
• Kay.Steven_at_csip.org.uk
• M07917 7185417
• www.goodadvocacypractice.org.uk