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Why voluntary patients in mental health hospitals need opt-out independent advocacy

15 February 2024

Visit the ward of a typical mental health hospital in England and you will meet some people who have been detained there under the Mental Health Act 1983 (MHA) and others who have consented to their hospital admission, known as voluntary or informal patients.

Despite voluntary patients making up around half of the 100,000 people admitted to a mental health hospital in England each year, their experiences are comparatively under-researched. 

As part of their work to reform the MHA, the Department of Health and Social Care (DHSC) asked VoiceAbility to examine the advocacy needs of voluntary patients. 

Our new report The advocacy needs of voluntary patients in mental health hospitals’ is based on 9 focus groups with Independent Mental Health Advocates (IMHA) in England, Wales and Jersey with experience of supporting voluntary patients. 

The headline findings are:

  • Voluntary patients often experience de facto detention’ and are subject to the same rules and restrictions as detained patients, but have low awareness of their rights and are sometimes unaware of their legal status.
  • Voluntary patients need advocacy support for a similar range of issues as detained patients. However, there is a particular need for support around the potential application of MHA holding powers and how to challenge aspects of their care and treatment without access to the formal processes of the MHA (such as a Mental Health Tribunal).
  • Safeguarding concerns can apply equally to voluntary patients, and advocates have an important role in supporting people to raise safeguarding alerts. Expanding advocacy to voluntary patients can, therefore, contribute to system-wide initiatives to improve patient safety and outcomes for mental health inpatients.
  • Advocates described challenges when someone’s legal status changed from detained to voluntary and access to advocacy suddenly falls away”. Many felt that voluntary patients were disadvantaged because of having no advocacy support”.
  • There was consensus among all the focus groups that voluntary patients should have a legal right to advocacy and that this should also be on an opt-out basis.

The report also contains a number of individual case studies demonstrating where access to advocacy has assisted voluntary patients and contributed to a more patient-centred mental healthcare system.