Sunday, November 07, 2021

Mental health advocacy is not just about IMHAs

The 2007 amendments to the Mental Health Act (MHA) in England and Wales introduced Independent Mental Health Advocates (IMHAs). As the Code of Practice makes clear, IMHAs may, if appropriate, help detained patients to exercise their rights by assisting patients to access legal advice and supporting patients at Tribunal hearings. I’m not convinced this happens as much as it should, and in practice IMHAs tend to regard legal advice and Tribunals as a separate process. Their role may include helping patients to seek advice from a lawyer, but once this has happened the lawyer is expected to take over responsibilities. IMHAs generally concentrate on helping patients with their care plan and if necessary supporting them in care plan review meetings.

The government plans to improve the quality of IMHA services in its MHA reforms (see eg. previous post). I think one way of improving that quality would be for IMHAs to have more integrated relationships with mental health lawyers and independent experts. A proper advocacy service should be seen as made up of IMHAs, mental health lawyers and independent experts. I think this more complete way of viewing advocacy services is even more important as the government also says it wants to expand Tribunal powers to treatment as well as detention decisions. The Responsible Clinician may be required by the Tribunal to reconsider particular aspects of the care plan and the suggestion is that the IMHA can challenge a specific treatment decision on behalf of a patient that lacks the relevant capacity.

Personally I would prefer if the government created a national mental health advocacy service but I am realistic enough to know that politically this is unlikely to happen. I suspect responsibilities will be left to local authorities to commission mental health advocacy services. What I would like to see is an expectation that commissioners purchase the more complete advocacy service I have been suggesting. Providers will have to build up relationships with mental health lawyers and independent experts, who could continue to be funded through legal aid.

I think implementation work leading to a new MHA Reform Bill should look at the commissioning of more compete advocacy services rather than just IMHAs. As I've said before (eg. see previous post), there seems to me to be considerable work to do before a new Bill is put before parliament. 

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