York and District Mind Advocacy Service

1. Independent Mental Health Advocacy (IMHA's) Presenters – Patrick Love and Karon Waddell York and District Mind Advocacy Service

2. York and District Mind Services • YDM is a leading Mental Health Charity • Established in York in the 1950's • Supports people with mental health issues in a variety of ways • Advocacy Service • Counselling Service / Carers Counselling • Mental Health Information Line • Befriending Scheme • Support Groups

3. What is Advocacy? • Advocacy is independent help and support with understanding issues, and assistance in putting forward a person's own views, feelings and ideas • Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need • Advocacy is about enabling every person to have a voice of their own and ensuring they are not excluded because they do not express their views in a way that people understand.

4. Who are Advocates? • Advocates are independent people who enable vulnerable people to have their voices heard • An advocate is not: a support worker, a mentor, a befriender, a counsellor or mediator and advisor • An advocate is not voicing their own views or opinions on a person's care or treatment • An advocate does not influence what and how a person's says what they need to

5. Advocacy at York and District Mind • YDM Advocacy delivers a range of advocacy services • In-patient Advocacy (informal and detained) • Community (generic) Advocacy • Interim Contract for Independent Mental Health Advocacy

6. In-patient Advocacy • This project was developed to support people in a range of in-patient settings • In-patient advocate works with both patients who are informal (voluntary) and detained (sectioned) • Advocates work on behalf of patients in a variety of ways: attending meetings, ward rounds, information giving and liaising with mental health professionals.

7. Community Advocacy • Community Advocates work with vulnerable people in community settings • They support people to access their rights, services and support • Community issues may involve: benefits, housing, social isolation and exclusion, rights to services, challenging discriminatory practices, complaints, employment and training and family issues. • Liaise with statutory services, mental health organisatons.

8. Independent Mental Health Advocacy • Patient's subject to compulsion under the MHA 1983 often require support to help them: • Understand what is happening to them • Find out what choices and options are available • How to express their views • Secure their rights

9. Statutory Foundations of the IMHA Role • Section 130A of the MHA 1983 requires that the appropriate authority makes arrangements for IMHA's to be available to support qualifying patients. • IMHA's will help patients understand and exercise their legal rights under the Act. • The apporpriate authority in England means the secretary of State for Health. He has delegated his duty to Primary Care Trusts who inturn may commission other organisations to deliver this service.

10. Who can act as an IMHA? • Under IMHA regulations, someone can only act as an IMHA if they are employed as an IMHA by: • A PCT (or other body) responsible for commissioning IMHA services; or • An organisation commissioned by such a body to provide IMHA services

11. Conditions for being an IMHA • Have appropriate experience or training or a combination of both • Are a person of integrity and good character • Are able to act independently of any person who is professionally concerned with the qualifying patient’s medical treatment • Are able to act independently of any person who requests them to visit or interview the qualifying patient

12. Duties and Roles of the IMHA • Under the Act, the support which IMHA’s provide must include helping patients to obtain information about and understand the following: • Their rights under the Act • The rights which other people (e.g. Nearest Relative) have in relation to them under the Act • The particular parts of the Act which apply to them (e.g. The basis upon which they are detained) and therefore make them eligible for an IMHA service.

13. Duties and Roles of the IMHA • Any conditions or restrictions to which they are subject (e.g. As a condition of leave of absence from hospital, as a condition of CTO or conditional discharge. • Any medical treatment they are receiving or might be given. • The reasons for that treatment (or proposed treatment) • The legal authority for providing that treatment, the safeguards and other requirements of the Act • Helping patients to exercise their rights under the Act, which can include representing the patient and speaking on their behalf

14. What an IMHA Service or an IMHA is not. • A service offering impartial advice to all parties • Befriending ‘buddying’ or social support activity • A lobbying or campaigning organisation or activity • A substitute for other services that are not effective • A complaints service • A patient led organisation • Working in the ‘best interest’ of qualifying patients • A legal advocacy service (replacing lawyers)

15. Duty of IMHA’s to visit Patients • IMHA’s have a statutory duty to comply with any reasonable request to visit a qualifying patient when a referral is made by any one of the following people: • The patient’s Nearest Relative • The patient’s Responsible Clinician • An Approved Mental Health Professional (AMHP) acting on behalf of the local social service authority.

16. Definition of a Qualifying Patient. • A patient who is: • Detained under the Act (even if they are currently on leave of absence from hospital) – see exceptions to follow • Conditionally Discharged • Subject to Guardianship • On Supervised Community Treatment (SCT) • Being considered for a treatment to which the Special Rules apply in Sec 57 of the Act apply • Under 18 years of age and being considered for treatment to which the Special Rules in Sec 58A of the Act apply

17. Detained Patients not eligible for an IMHA • A patient does not qualify for an IMHA service by being detained: • On the basis of an emergency application (sec 4) until the Second Medical Recommendation is received • Under the Holding Powers in Sec 5 or • In a Place of Safety under sec 135 or 136. • (This is because IMHA services are not intended to provide an emergency response service)

18. Informing Patients of the IMHA Service • Who is responsible and when: • Detained Patient – the managers of the hospital in which the patient is liable to be detained – as soon as practicable after the patient becomes liable to be detained • Guardianship Patient – the responsible local social service authority – as soon as practicable after the patient becomes subject to guardianship

19. Informing Patients of the IMHA Service • Who is responsible and when: • SCT Patient – the managers of the responsible hospital – as soon as practicable after the patient becomes an SCT patient. • Conditionally Discharged Patient – the patients Responsible Clinician – as soon as practicable after the patient is discharged • Informal Patient – The Doctor or Approved Clinician who first discussed with the patient the possibility of them being given the Sec 57 or 58A treatment in question – as soon as practicable after that discussion (or during it)

20. Informing the Patient of their right to an IMHA • The code of practice explains that the responsible person should: • Take whatever steps are practicable to ensure that qualifying patients understand that an IMHA service is available to them as a statutory right • Inform the patient on how they can obtain that help, both orally and in writing in a language the person understands.

21. Informing the Patient of their right to an IMHA • The code of practice explains that the responsible person should: • (For most patients) take whatever steps are practicable to give a copy of the written information to the patient’s nearest relative unless the patient requests otherwise and subject to the normal considerations about involving nearest relatives • When giving information to the NR the information should make clear that the IMHA service is for the patient and not the NR themselves

22. Being an IMHA • Working with patients detained in hospital settings – Patrick Love • Working with patients on Supervised Community Treatment Orders – Karon Waddell

23. Resources • York and District Mind Advocacy – 01904 647030 – www.yorkmind.org.uk • National Mental Health Development Unit - www.nmhdu.org.uk • IMHA Commissioning Guidance (DH London – 2009) • Codes of Practice (The Stationary Office) Mental Health Act • Deprivation of Liberty • Reference Guide to the Mental Health Act

24. Thank You • Any Questions?