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How opt-out mental health advocacy can help create lasting change

17 October 2022

VoiceAbility’s new research makes a clear case for automatic advocacy referrals.

Often don’t have a voice, struggle to be believed and don’t feel safe. They want that to change.” 

Those were BBC reporter Alan Haslam’s words at the conclusion of his disturbing Panorama expose of the abuse and poor treatment of people detained at the Edenfield Centre in Prestwich, Greater Manchester.

Independent mental health advocacy is one important means by which people admitted to mental health in-patient services can have a greater voice. However, we know that many people who are entitled to support from an Independent Mental Health Advocate (IMHA) don’t receive it. For example, in its 2019/20 MHA monitoring report, the Care Quality Commission (CQC) found wards where staff did not routinely refer any eligible patients to an IMHA”.

As part of the reforms to the Mental Health Act, we call on the government to legislate for opt-out advocacy for everyone who is an inpatient on a mental health ward.

In an opt-out system, everyone is automatically referred to an advocate by the hospital or healthcare provider. The advocate then contacts each person to explain the service, and the person can then decide whether to proceed or not.

Opt-out advocacy: our research

We have recently undertaken a research project to look at the outcomes from five advocacy services that have been trialling opt-out advocacy, including VoiceAbility’s advocacy service in Bradford. 

All five case studies demonstrate that opt-out leads to a significantly higher uptake of advocacy services. 

We have published a report on what we found called The impact of opt-out advocacy’.

The report concludes that the benefits of opt-out are that it:

  • ensures that every individual who is eligible for support receives a visit from an advocate and an explanation of the service (including those who may not otherwise come into contact with the service: for example, if they have been placed in seclusion or segregation and are not visible on the hospital ward)
  • significantly increases uptake of advocacy services and ensures referrals are not dependent on variables outside of the patient’s control (such as the attitude of staff or healthcare providers to facilitating access to advocacy)
  • enables more people to have a greater voice in their care and treatment which leads to improved outcomes for them, and for the wider health and care system, if people are not kept in hospital for any longer than they need to be
  • supports people to advocate for themselves and be discharged sooner when they can be better supported in the community, reducing strain on in-demand inpatient mental health services

Independent mental health advocacy is only one aspect of the support that should be available to people in mental health hospitals, but we believe it is a vital one.

Our thanks to the advocacy providers who supported this research project: Onside Advocacy, The Advocacy People, Sheffield Advocacy Hub, and Rethink Advocacy.

This research project has been undertaken as part of the 2022/23 work programme of the Complex Needs Consortium for the VCSE Health and Wellbeing Alliance.

Download the full research project below.