‘When you haven't got much of a voice’: an evaluation of the quality of Independent Mental Health Advocate (IMHA) services in England

Abstract

• Inadequate understanding of entitlement to advocacy by professionals, who have a duty to promote access, has been implicated in limited uptake of IMHA.• Gaps in mental health advocacy provision for those with specific needs reflect inadequate commissioning and models of advocacy provision. What this paper adds• A rigorous in-depth evaluation of multiple perspectives on the provision and experience of statutory mental health advocacy.• Identification of three factors influencing the quality of IMHA services: effectiveness of commissioning, provision of IMHA services, and understanding and disposition of mental health services to advocacy.• IMHAs can enhance personal agency in situations where freedoms and control are constrained. AbstractAdvocacy serves to promote the voice of service users, represent their interests and enable participation in decision-making. Given the context of increasing numbers of people detained under the Mental Health Act and heightened awareness of the potential for neglect and abuse in human services, statutory advocacy is an important safeguard supporting human rights and democratising the social relationships of care. This article reports findings from a national review of Independent Mental Health Advocate (IMHA) provision in England. A qualitative study used a two-stage design to define quality and assess the experience and impact of IMHA provision in eight study sites. A sample of 289 participants -75 focus group participants and 214 individuals interviewed -including 90 people eligible for IMHA services, as well as advocates, a range of hospital and community-based mental health professionals, and commissioners. The research team included people with experience of compulsion. Findings indicate that the experience of compulsion can be profoundly disempowering, confirming the need for IMHA. However, access was highly variable and more problematic for people with specific needs relating to ethnicity, age and disability. Uptake of IMHA services was influenced by available resources, attitude and understanding of mental health professionals, as well as the organisation of IMHA provision. Access could be improved through a system of opt-out as opposed to opt-in. Service user satisfaction was most frequently reported in terms of positive experiences of the process of advocacy rather than tangible impacts on care and treatment under the Mental Health Act. IMHA services have the potential to significantly shift the dynamic so that service users have more of a voice in their care and treatment. However, a shift is needed from a narrow conception of statutory advocacy as safeguarding rights to one emphasising self-determination and participation in decisions about care and treatment.

Independent advocacy in adult support and protection work

“…Questions about the evolution of advocacy as it becomes increasingly closely allied with statutory processes are also echoed in this literature (Newbigging et al, 2015;Redley et al, 2011). Whilst the IMHA and IMCA services introduce differently nuanced considerations in the English and Welsh contexts (Newbigging et al, 2015;Redley et al, 2011;Townsley & Laing, 2011), some drawing together of cross-cutting themes might extend this discussion in ways of interest to the independent advocacy and broader voluntary and community sectors across the UK and elsewhere.…”

“…The barriers created by limited resources and variable understanding and acceptance of advocacy amongst other professionals, for instance, have resonance with other UK empirical research (Newbigging et al, 2015;Forbat & Atkinson, 2005;Carver & Morrison, 2005; Older People's Advocacy Alliance UK, 2009). Questions about the evolution of advocacy as it becomes increasingly closely allied with statutory processes are also echoed in this literature (Newbigging et al, 2015;Redley et al, 2011). Whilst the IMHA and IMCA services introduce differently nuanced considerations in the English and Welsh contexts (Newbigging et al, 2015;Redley et al, 2011;Townsley & Laing, 2011), some drawing together of cross-cutting themes might extend this discussion in ways of interest to the independent advocacy and broader voluntary and community sectors across the UK and elsewhere.…”

“…There is no equivalent in Scotland of the Independent Mental Health Advocates (IMHAs) and Independent Mental Capacity Advocates (IMCAs), the functions of whom are more fully detailed in English and Welsh statute (Redley et al, 2011, Newbigging et al, 2015.…”

Are mental health tribunals operating in accordance with international human rights standards? A systematic review of the international literature

“…Advocacy can be an important means of supporting decision‐making. Individuals in a large scale multiple case study conducted in England were found to be generally satisfied with advocacy support when they received it (Newbigging, Ridley, McKeown, Machin, & Poursanidou, ). However, in order to be effective, advocacy must be accessible and over two‐thirds of participants who were eligible for advocacy but did not use it were unaware of its purpose (Newbigging et al, ).…”

Third sector organisations: unique or simply other qualified providers?

“…TSOs are more dominant players in relation to employment and advocacy (Schneider 2005, Newbigging et al 2012. In addition to direct service delivery TSOs have played a range of other roles in mental health including campaigning, developing new approaches to care and support, and facilitating people with mental health difficulties to be involved in service development and commissioning (Curry et al 2011, DH 2012a (p238).…”