Friday, April 30, 2021

Improving mental health advocacy

I've said before that the government's proposals to reduce coercion in mental health services do not go far enough (see previous post). This applies as far as advocacy services are concerned, as I think they need to be developed even further than the White paper proposals.

Advocacy promotes the human rights of people. The response to the consultation from the British Institute of Human Rights (BIHR) highlights problems currently with a number of human rights issues in mental health services, including "long periods of detention that are not of therapeutic benefit, concerns around people accessing mental health services and their loved ones having little say over their care, treatment and recovery". 

Patients and their families need to be helped to make informed decisions about mental health treatment. They need support to have their voices heard about poor service delivery, inaccessible care and unnecessary enforced treatment. As I’ve said before, detained patients should have a right to a second opinion of their choice both about detention and treatment (see previous post), and this should be available for medical, nursing and social matters. Reports produced by these independent experts should, if necessary, be much more routinely presented by solicitors to Mental Health Tribunals (MHTs). 

The White paper has made welcome proposals to improve the role of the Independent Mental Health Advocate (IMHA), including that the IMHA can appeal to the MHT on the patient’s behalf and can make a challenge to the MHT for the Responsible Clinician to reconsider a specific treatment decision. I think a pilot programme of culturally sensitive advocates to respond appropriately to the diverse needs of individuals from BAME backgrounds is already underway, and surely needs implementation in legislation.

I think there should actually be a national advocacy service, which is culturally appropriate, composed of IMHAs, mental health lawyers and independent experts. This new service would replace local contracts which provide a very variable IMHA service across the country. Such a new service should reduce coercion as patients and their families will be far better represented. 

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