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What role can advocates play in supporting the use of Advance Choice Documents in mental health hospitals?

20 February 2024

Giving people more choice and influence over their care and treatment in mental health hospitals is one of the main aims of the UK government’s planned reforms to the Mental Health Act 1983 (MHA).

Advance Choice Documents (ACDs) are one means by which people can record care and treatment preferences for use in the future should they become unwell. 

The aim is to ensure timely and effective intervention to either avoid admission to hospital entirely or ensure that any hospital stay is as short as possible. 

Academic research in the UK and experience in other parts of the world suggests that ACDs can be effective but also that uptake can be low – partly because of a lack of support for people to complete an ACD. 

As part of their work to reform the MHA, the Department of Health and Social Care (DHSC) asked VoiceAbility to examine what role advocacy services might play in supporting the implementation of ACDs in England.

Our new report​‘The potential role of advocacy in supporting the use of Advance Choice Documents (ACDs) in mental health hospitals’ is based on 7 focus groups with independent mental health advocates (IMHAs) in England.

The headline findings are:

  • Advocates felt ACDs would be a useful tool in promoting people’s preferences. However, their effectiveness would be dependent on big cultural change’ in mental health hospitals.
  • Advocates felt ACDs would help them to perform their advocacy role of supporting the person’s voice while in hospital. They were interested to know how they could be made aware of, and access, an ACD as part of the advocacy referral process.
  • Advocates felt that some people may be interested in completing an ACD while still in hospital. However, for many people it was more likely to be after discharge when they are back in the community and further on in their recovery journey.
  • The potential role for advocates to support people to complete ACDs is uncertain and inevitably limited as only people currently in hospital have a legal right to support from an IMHA (except for those on Community Treatment Orders).