Mental health and advocacy

Advocacy is about enabling people to say what they want, obtaining their rights and gaining the services that they need. People are entitled to be in control of their lives but sometimes, through mental illness, they may find themselves in a position where their ability to exercise choice or represent their own interests is limited. In these circumstances, an advocate can help to make sure that an individual's views are heard, respected and acted upon.

Advocacy support is needed in the mental health services because people who use them can feel disempowered by the rules, procedures and professionals providing services. Advocates can help while people wherever they live; although there is no legal right to an advocate.

There are five different sorts of advocacy.

1. Formal advocacy is usually run by groups such as Rethink and is generally not user-led, meaning that the service is not necessarily run by service users. This is the most likely form of advocacy service you will come across and tends to be one-to-one and is independent of the mental health and social services. An advocacy relationship is built on trust and confidentiality.

2. Citizen advocacy is usually run by groups which are generally not user-led. Citizen advocates form a long-term relationship, often with someone who is socially excluded and help them to speak up and act up for what they want. Citizen's advocates can help with the things formal advocates help with such as benefits applications, but they can also empower people to gain a social life as well. There is more likely to be a more personal relationship with a citizen's advocate than with a formal advocate, as the sort of relationship formed is usually long-term. Once again, an advocacy relationship is built on trust and confidentiality.

3. Peer advocacy is where the advocate is also a service user. Peer advocates can either act in the role of a formal advocate or in the role of a citizen's advocate depending on the project. Peer advocates are often supported by self-advocacy groups, other forms of group advocacy, citizen's advocates or a combination of these.

4. Self advocacy is representing one's own interests. Self advocacy groups offer people the chance to speak up and have their say in a supportive environment, where people have the chance to discuss issues that affect their lives. There is also group advocacy which is used sometimes to describe what happens when a group of advocates act collectively over an issue which affects a large number of its members.

5. Legal advocacy provides advice and representation in courts and tribunals. It is provided by legally qualified advocates, usually solicitors. People often have to pay for this kind of advocacy although there may be an entitlement to legal aid.

Independent Mental Capacity Advocates (IMCA)
This is a new type of advocate introduced in April 2007. They support people who may lack capacity to make decisions. Under the Mental Health Act, local authorities must ensure that people who lack capacity have an IMCA appointed when serious decisions are being made about their medical treatment, NHS accommodation and/or some care reviews. This service only applies if a person has no family or friends who could be consulted regarding their wishes.

Independent Mental Health Advocates (IMHA)
This is new type of advocacy introduced as a result of the Mental Health Act 2007. There is a now a legal right to an Independent Mental Health Advocacy for certain ‘qualifying' patients. To be a 'qualifying' patient you must be:

• Detained in hospital under the Mental Health Act (except under short emergency sections)OR
• Subject to a Guardianship Order under the Mental Health Act OR
• Subject to a Community Treatment Order under the Mental Health Act OR
• Discussing the possibility of serious treatments such as neurosurgery or any patient under 18 years old who is discussion the possibility of ECT.

The IMHA can assist in helping a patient find out about their rights and how to exercise them. Their aim is to assist patients to fully participate in decisions about their care and treatment. It is the duty of the hospital to make sure that they advise patients of the availability of IMHA service.

What do advocates do?

• Listen and give information
• Encourage the client to speak on their own behalf
• Liaise with different agencies
• Mediate so people can understand each other
• Represent or act on behalf of someone.

Some of the typical problems that advocates might help with include:

• Accessing and sorting out benefits, accommodation and other services
• Understanding illness
• Fighting discrimination and fear
• Strains within a family
• Debt problems.

Advocates do not offer counselling; do what they think is best for their client; advise on which choice to make; make decisions for people; nor offer legal representation (unless they are legal advocates). Not all advocates have the knowledge and skills to help with benefits and debt problems and advice may need to be sought from a Citizens Advice Bureau or similar organisation.

How to find an advocate
For more information on finding an advocacy service, contact your local community mental health team or contact Rethink on 0845 456 0455 or visit www.rethink.org

Further information
The Rethink National Information and Advice Service provides information and advice on issues affecting people with mental illness, their families, friends and carers. They can be contacted at:
Rethink National Information and Advice Service
15th Floor, 89 Albert Embankment, London, SE1 7TP
Tel: 0845 456 0455 or 020 7840 3188 (Mon to Fri 10am-1pm).
Email: advice@rethink.org

For the full version of the factsheet, and others covering a variety of mental health topics, please visit Rethink's Mental Health Shop

This article was produced in collaboration with the mental health charity, Rethink.

Rethink, the leading national mental health membership charity, works to help everyone affected by severe mental illness recover a better quality of life. We provide hope and empowerment through effective services and support to all those who need us, and campaign for change through greater awareness and understanding.

For further information on Rethink
Tel: 0845 456 0455
Email: info@rethink.org

Registered Charity Number 271028.