People denied the right to be heard
1 psychiatric ward in 7 is not complying with the law according to the Care Quality Commission report Monitoring the Mental Health Act in 2010/11 The report states that people’s ability to know their rights and speak up about their care was being unfairly taken away due to a lack of funding for advocacy services and a lack of training amongst mental health staff.
Action for Advocacy (a4a) is the leading network body for the advocacy sector and campaigns for a strong and equal voice for all citizens. They believe that these figures mean that up to 5000 people with mental health problems are currently being denied their legal rights. People subject to compulsory treatment orders and those unable to ask for an advocate personally (e.g. people in later stages of dementia) seem particularly ill served by the current arrangements.
Independent advocacy has been supporting people to make their voice heard in the last few decades. However, until recently there was no requirement for advocacy to be provided, so access to support from an advocate varied widely across the country. But since April 2009, the Mental Health Act has given people who subject to powers of the Mental Health Act the legal right to support from an Independent Mental Health Advocate (IMHA). The IMHA supports people to understand and use their rights relating to care, treatment and the Mental Health Act.
The CQC report recognised the significant impact that many IMHA services had in making people more able to take part indecisions about their own care. However, the report also said many people’s ability to access the IMHA service was merely “theoretical”. There were a number of factors influencing this. The funding that organisations receive to provide the service is often insufficient to meet the need.
Many ward staff were found to be unaware of the IMHA service, meaning that neither the patient, nor their nearest relative can have been given information about the IMHA service. For those people unable to ask for an advocate themselves, or in hospitals where staff do not want to be challenged, their legal right to be heard is compromised. This could be addressed if IMHAs were regularly available on in-patient wards, but the CQC said that this was only happening in 68% of cases, partly due to funding arrangements. In fact the report showed that only 85% of wards were able to demonstrate the ability to contact an IMHA on request. In other words, at least 15% of in-patient wards – more than 1 in 7 – are breaking the law, leaving people without the support they are entitled to at a particularly difficult time in their lives.
According to a4a this fits with another worrying trend. Despite the vital role that advocacy has been shown to have in protecting people from abuse, and despite support the Law Commission’s recommendation for a right to advocacy for all disabled people, funding for advocacy is currently being cut. . a4a’s report “Advocacy in a Cold Climate” showed that the majority of advocacy services (for all people) were having funding reduced but receiving more requests for support. It is projected that advocacy services in England will be able to support approximately 60,000 fewer people this year. This is even true where there is a legal duty to fund the advocacy service. A report by the Mental Health Alliance in 2011 showed a significant increase in the use of compulsory powers of the Mental Health Act. This suggests that the shortfall in IMHA provision is only going to get wider, leaving more people without support.
Action for Advocacy (a4a) is calling upon people who use services, families, health and social care professionals, advocacy services and charities to sign up to support its 100 Words On Advocacy campaign. The campaign is designed to raise awareness of the need for and benefits of independent advocacy. It calls upon the Government to implement a ‘right to advocacy’ for all users of social care services, and compel local authorities to publish their plans for local advocacy provision.
