Commissioning effective IMHA services: turning research into practice

1. Karen Newbigging February 19th, London Commissioning effective IMHA services: turningresearch into practice

2. Overview • What is the purpose of IMHA services? • What does good commissioning look like? • Relevant findings from the IMHA research • Current commissioning context • Action to commission IMHA services locally

3. Background • Service user-led development • Recognises inherent imbalance of power between service providers and service users • Disempowerment and disengagement • Human rights and right to have a voice • A variety of forms

5. Having a voice “They’re there to help people to actually be their voice because when somebody is poorly it’s very, very difficult to sort of speak out or to even see beyond the confusion sometimes. They’re there to look after their interests and their basic human rights: to see that there’s no abuse of power and to advocate their interests. “ IMHA partner (Acute ward)

6. Purpose of IMHA services • Mental Health Act underpinned by a principle of self-determination • Help patients to obtain information about and understand their rights under the MH Act • Help patients to exercise their rights  • Support patients to ensure that they can participate in the decisions about their care and treatment • Equality Act 2010: IMHA as a reasonable adjustment

7. Purpose of IMHA services? What do you think the purpose of IMHA services is? Procedural rights - Safeguard - Protection Substantive rights - Promote health and recovery

8. The Commissioning Cycle

9. What does ‘good’ look like?

10. Our findings

11. Six critical issues to consider • Variations in need • Access: demand is not a proxy for need • Significant lack of appreciation of diversity • Purpose of IMHA and relationship with other forms of advocacy and service user-focused initiatives • Distinction between process and tangible outcomes • Quality of delivery influenced by delivery context

12. 1.Variations in access Number of detained patients in the urban and rural case study sites between 2008 and 2011 Source: Mental Health Bulletin Annual Returns 2011.

13. 2. Access: demand is not a proxy for need • Lack of awareness of qualifying patients, and their family carers • Lack of understanding and negative attitudes on part of some staff • Visibility of IMHA service • Historical development of advocacy and roots in instructed advocacy • Confusion about arrangements for people placed out of area Those requiring advocacy accessing it the least – “hard to reach, easy to ignore”

14. 3. Significant lack of appreciation of diversity • In commissioning process • No attention to Count Me In Data • Trend to commissioning national providers • By IMHA services • Confidence not matched by experience • Examples of partnership working with community organisations rare • Compounded by different conceptions of advocacy, experience of mental health services and British society

15. “BME organisations) wouldn’t recognise it as advocacy, they would recognise it as supporting someone from their community, so they wouldn’t look at an advocacy tender and say `oh that’s what we do’ they wouldn’t know that that’s what they do, they just get on with the business of supporting the community where they set themselves up to support. So for example as a member of the African Caribbean Society, we do quite a lot of support and I would call it Advocacy but whether they know what Advocacy is.” BME advocacy provider (Focus group participant)

16. 5. Commissioning for outcomes What difference should IMHA services make to the experience and outcomes of people detained under the MH Act?

17. Impacts for service users • Greater understanding of rights and rights under the MH Act protected • Changes in individual care and treatment • Resolution of complaints • User-defined outcomes achieved • Increased capacity to self-advocate • Greater voice and equalising power • Changes in ward environment and wider changes at a system level And sometimes maintaining the status quo!

19. disposition Positive to advocacy Effective working Superficial relationships understanding Lack of Good understanding understanding of advocacy of advocacy Conflictual Distant working working relationships relationships Negative disposition to advocacy 6. IMHA and Mental Health Services

20. Conclusion

21. Recommendations for commissioners • Thorough needs assessment, paying particular attention to seldom heard groups • Coproduction and involvement of IMHA partners in the commissioning process • Provision on an opt-out basis • Dedicated IMHA services for children and young people, older people, people from BME communities and deaf people • Investment in IMHA services to provide a sustainable basis for delivery • Investment in IMHA provision to include infrastructure costs and capacity building • Agree a standardised system for capturing information on both the process and impact of IMHA provision • Requirements in relation to the role of mental health services in providing a supportive context to be included in contracts for mental health providers

22. Over to you • What are the current challenges and opportunities facing IMHA commissioners? • How could commissioning of IMHA services be improved locally? • Any thoughts on national indicators?