Read aloud or translate

Improving the Mental Health Act: Automatic advocacy for all

4 May 2021

Offering independent advocacy to all on admission to hospital will […] ensure that patients with mental health issues get the quality support they need to have their voices heard when they need it most.

Emma Foreman, VoiceAbility advocate

The government’s white paper proposing reforms to the Mental Health Act 1983 seems to have been a long time in the making. The good news is, many aspects of it appear to suggest greater freedoms, powers, and choice for the people that it was introduced to protect. One of the proposals is that everyone who is eligible for mental health advocacy should be offered it automatically, on an opt out’ basis – rather than having to ask for it. Another proposal is that advocacy should be a right not only for those who have been detained, but for people who have come to hospital voluntarily. What difference would it make if advocacy was offered automatically to everyone on a mental health ward? Emma Foreman explains, from her experience as a patient and as an independent mental health advocate.

My first experience of advocacy came when I was an inpatient in a psychiatric hospital, aged 44. At this stage, I knew little about advocacy and wasn’t aware that I could get it. I had been diagnosed with schizophrenia and I was terrified by the experience of psychosis. I believe that even if I had known I had the right to an advocate, I would have been unlikely to ask for one. I was experiencing punishing and accusatory delusions and hallucinations that made it difficult to reach out for support.

It wasn’t until I had been in the hospital for two weeks that I met an advocate. His presence was reassuring in amongst the horror that I was experiencing inside my head, and I was relieved to have someone there who appeared to be on my side’. However, almost as soon as the advocacy began, I was discharged from the hospital and unable to benefit from continued support of this kind. 

Because I didn’t know I had the right to an advocate and I wasn’t well enough at the time to ask for an advocate as soon as I arrived in hospital, I didn’t get support that might have made a big difference to my experience. Surely, we want to make sure people find it easy to get support when so unwell and going through such a difficult time? 

In the wake of this, I later became an advocate myself, and I can reflect not only on my own experience, but on the experience of others receiving advocacy. I have often seen people who have not been able to easily access advocacy through the opt in‘ system currently in place. In my experience, people who admit to hospital voluntarily can be just as unwell as those who are detained. The area where I work is one of a few places in the country where advocacy is already available for voluntary patients. This can make a big difference but it’s still not a statutory right. I often find myself directly asking staff whether someone on the ward wants advocacy, and often the response is that the person is a voluntary patient and so they didn’t realise they were eligible. The opt out’ proposals would mean that no one misses out on the offer and benefits of advocacy. If current proposals are fully put into law, access to advocacy would be equal for all patients, and confusion about who is entitled would be eliminated, making it easier and simpler for everyone to get the support they deserve. 

Effective, easy and timely access to advocacy is crucial. Some people who are legally detained for mental health treatment only have 14 days to appeal their detention. The current opt-in’ advocacy system takes time and means that some referrals do not come through to the advocacy service quickly enough to ensure that we can support the person to appeal. At times, advocates like myself have had to argue that because of the delay in referral, someone has effectively been denied their rights to independent advocacy services. If advocacy referrals were automatic, people would always get timely support with appeals. 

Offering advocacy automatically as soon as someone enters hospital allows the time needed to build up trust with a client. Trust is vital to the work required in advocacy: to ensure that a person is heard at the time that it matters most. The relationship built with that person has to be one where the client has faith in their advocate. When someone is admitted to a psychiatric ward, they are often frightened, confused, and anxious about a wide array of issues. When I am there from the start of someone’s admission, seeing them right through to discharge, it can often mean that they will tell me what is needed to support them with the issues that they both want and need to raise. I can think of one client who I continued to support as they moved from hospital into living in the community. They gained the confidence to voice their concerns and get them heard, and I have gradually become, as it were, surplus to requirements’ as they have learnt to advocate for themselves. If that client had had the experience as I did, of only being referred to advocacy as discharge was imminent, this journey of successful advocacy support would not have been possible. 

Offering independent advocacy to all on admission to hospital is essential and will make a huge difference to the experience of people who are admitted to hospital. It will ensure that patients with mental health issues get the quality support they need to have their voices heard when they need it most. With the level of mental health issues experienced in the population rising, it seems imperative that a culture is fostered where advocacy is an integral part of services offered to anyone who needs the care of a psychiatric hospital.