• Arrangements should be made for the provision of an independent mental health advocacy service.
• Help from mental health advocates must be made available to:
• All patients who are subject to compulsory powers under Part 2 or 3 of the Bill and
• Those who qualify for safeguards such as patients with long term incapacity under Part 5.
• The patient’s nominated person if the patient does not object

The help advocates are expected to give includes:

• Obtaining information about:
• the medical treatment being provided
• the legal authority under which treatment is provided
• the patient’s right to challenge the use of these compulsory powers
• Supporting patients exercise their right to challenge

• Mental health advocates will have the right to:
• Meet patients in private at any reasonable time
• Inspect any records relating to the patient
• It will be unlawful for any hospital staff to prevent a mental health advocate’s access to the patient and/or his records

• Advocates will be ‘approved’ – standards can be set that advocates must meet to become approved mental health advocates
• Advocates must be ‘independent’ – i.e. independent of any person responsible for the patient’s treatment
• Advocates can be paid for their work without compromising their independence

• Identified good practice and issues often encountered in current practice through a programme of visits to advocacy services
• Carried out a Delphi study
• Visited advocacy provision in the Netherlands
• Worked with a stakeholder steering group

If specialist mental health advocacy is to be available to
everybody who is subject to the powers of the new
Mental Health Act then these services must be:

• available throughout England and Wales
• well defined, working within clear boundaries
• delivered to an agreed standard
• delivered by trained advocates working to a common code of practice
• complementary to other advocacy provision

• Model of advocacy
• Independent
• Professional advocacy provided by paid workers - Volunteers may ‘add value’
• Focused issue-based advocacy
• For individuals not groups
• Reactive AND proactive – everybody who is subject to MHA to be seen within 3 days of compulsion

• Everybody subject to the powers of the new MHA including:
• People in hospital and the community
• Children and young people
• People with learning disabilities
• People with long-term mental incapacity including ‘Bournewood’ cases (Part 5)
• People who are high risk

• What specialist skills will SMH advocates need?
• Should specialist advocacy services support:
• Families and carers?
• All inpatients?
• What role does SMHAS have in supporting children and young people when their parents are involved?
• What happens on discharge from compulsion?

• Statutory right of access therefore statutory funding
• But how should it be paid for?
• National allocation?
• Per capita levy be raised on all service users subject to the MHA?
• Pooled health and social care budgets?
• Alternatives

Commissioning should ensure:

• National provision
• A strategic approach which locates SMHAS within overall advocacy provision
• Independence
• Appropriate performance management
• Mechanisms for advocates ‘signalling’ concerns about services and expect action to be taken

To ensure independence:

• Advocates should have no conflicts of interest
• Advocacy services should be independent of mental health service provision

Three options for independent SMHAS provision:

• Agencies which provide MH services and wish to provide SMHAS should set up a separate arm to manage the advocacy service
  - New independent SMHAS agencies should be formed throughout England and Wales
  - SMHAS should be provided by a National service run by a new national agency

• Experienced advocates – SMHAS is not for novices
• National salary scale:
• SO1/2 for advocates
• SO2/PO1 for Team Leaders
• Managers scale to depend on responsibilities
• Accreditation or ‘approval’ within 6 months
• Supervision and support essential
• Networking between SMHAS services

• Who should accredit?
• Who should provide the training?
• What form should the accreditation take?

• Standards could ensure:
• Consistent provision throughout the country
• A better understood and trusted service
• Greater accountability through performance management and review
• An ‘engagement protocol’ should be negotiate between advocates and provider staff to set out ground rules for service delivery
• Cross-referral procedures should be agreed between SMHAS and PALS and ICAS

• A national monitoring body should :
• Monitor the monitors
• Provide a National overview of service provision and scrutiny of commissioning arrangements
• Provide advice on the MHA
• Be alerted by advocates about concerns in service provision and lend weight to ensuring appropriate action is taken
• Be independent enough to investigate complaints made against a SMHAS

• Can common core standards for SMHAS be agreed?
• Can a code of practice be adopted?
• Who should set the standards? Should it be the Commission?

• The full report and consultation questions can be downloaded from:
• www.doh.gov.uk/mentalhealth/advocacy
• www.nimhe.org
• Or copies can be obtained from:
• D.K.Barnes@durham.ac.uk