Monthly Archives: March 2019


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I have heard a lot being said about Independent Mental Health Advocates (IMHAs). Advocacy services are free, independent and confidential. Advocacy service is free because the patient does not pay for the service but is entitled to the service. It is independent because the staff are separate from the hospital. They are not part of the hospital staff numbers. They exist to communicate the views and feelings of patients to others. Finally, the service is confidential because it allows the patient to speak freely. They create a safe space where patients can express themselves. The advocates are only permitted to breach confidentiality where there are safeguarding and safety concerns. The patient is made aware of these during the initial introductory meetings. Role To amplify the patient’s opinion. To ensure that the patient understands  their rights including why they are being detained. right to tribunals, right to appeal the section etc. To ensure that the patient’s rights are upheld To create an enabling service that empowers the patient to slowly take responsibility for their advocacy. To provide options to the patient so that patient can make choices. To provide moral support to the patient so that they can feel comfortable within the setting. Being sectioned can be an overwhelming time. New faces, new routines can often make To prepare patient for meetings. For example appointments, CPAs, Manager’s hearing etc. There are two types of advocacy services. The Independent Mental health advocacy (IMHA) and the Normal advocacy service. The addition of the IMHA to the advocacy role was implemented under the Mental Health Act (MHA) amendment in 2007. This made it a statutory requirement for patients detained under sections of the MHA to be entitled to IMHA as an additional safeguarding. The IMHA sees the patient when the patient is admitted. They explain the scope of their involvement to the patient. For example they set boundaries. They do not have access to patient’s notes to help the IMHA remain independent and non judgemental. They make the patient aware that they can disclose information but that the IMHA will break confidentiality for safeguarding reasons, or if they disclose involvement in illegal activities eg drugs, arms etc They do not reflect their views when advocating for patient, The service is all about the patient and free from prejudice. The IMHA does not replace a solicitor. The IMHA shares information with the patient. The IMHA is not bound by duty of care for example, they will still advocate for the patient even though the patient may be making an unwise decision. The IMHA is not a complaints department. However, they can support the patient to make a complaint. The IMHA can carry out an escalation on behalf of the patient where they become aware of ill treatment of the patient or a breach to the patient’s human rights. The IMHA ensures that safeguards are in place to protect the client by keeping vigilant within patient areas. The IMHA attends ward surgeries. There, they ask the patient if they will want to discuss issues further when they are unclear to the patient. NEW IMHA RIGHTS IMHA can now be allowed to interview the patient in a private place. IMHA can also be allowed access to the patient’s notes where risks have been identified. The IMHA does not access capacity. The How will the patient access the IMHA service. Self referral is possible through a free phone service Nurses can refer patients to the service Everyone on the ward that deals with client can refer the patients. The IMHA service is not an emergency service and so they will prioritise clients in the order they will be seen How does the IMHA deal with ethical and moral dilemmas? The IMHA maintains professionalism by remaining independent. They set boundaries with the patient from the inception of the relationship and sets realistic expectations for the patient. The IMHA uses clear communication to avoid ambiguity when relating with patients How does the IMHA uphold the advocacy for children The is achieved by clarifying that the service is for the child and the role of the advocate is to uphold the views and feelings of the child even when they differ from the views of those with parental responsibility. There is also a family advocacy service. This can be handled by a separate advocate where cases conflict of interests arise. Sources Interview with the IMHA within the setting The Maze: A practical guide to the Mental Health Act 1983 (Amended 2007). 3rd Edition. Beckenham: Bethlem Royal hospital pp 133-135 POhWER (2016) Independent Advocacy Service. (Leaflet) POhWER (2016) Secure and Complex Advocacy Services. (Leaflet) Action for Advocacy- The Advocacy Charter

Nursing Diaries: Who are Independent Mental Health Advocates (IMHAs)


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It’s two years now… How time flies. I just received a card in the post from Great Ormond street hospital and it was too special to be quiet about. You see, for those in my boat, they know how it feels. Everyone forgets. No that’s harsh. Everyone becomes silent… they don’t talk about him anymore. Well, it’s not surprising since he no longer exists. Well, I felt elated today by the card though. Sadly when I tried to call back to send my heartfelt thanks, there was no specific person to take the compliment. Them: My name is XYZ, you are through to the bereavement service Me: Oh thanks, I just received a card and I want to speak with the person in charge. Them: Erm, erm…. there is no one here in the office, will you leave a message so that I can get someone to call you back Then I went blank. Leave a message? what do I say? Please call me back so that I can say Thank you to you. Them: Hello, are you there? Me: Yes Them: So what is it regarding? She rephrased the question. This one seemed easier me: It is regarding my son Otito…my late son. Them: Oh, do you need support? Oh I never knew that they could give support! Me: No (Now I sounded lame. Why was I calling?) I just want to speak with the person in charge. Them: Ok, so what is it regarding Me: Thank you Them: You are welcome Me: No, it’s regarding Thank you. I want to say thank you. I received a card just now and I thought it was very thoughtful. Since they are not around…. if only I had an email for you guys, I would have sent a letter, it would have been more profound. Them: Oh, it was sent by our office Me: Who sent it Them: We did. I wanted to ask the question: “who is we”, I was still thinking… Them: I am glad you liked it. Is there anything else I can help you with Me: In shock because I was still gathering my thoughts. So I simply said…No Them: Alright then, bye, bye. Me: Bye She hung up…. It was in that moment that it dawned on me that no one sent me the card. It was probably a computer. My hubby was in the room and he asked me : “so what did they say?”. Now I wished I did not tell him I was making the call because I did not want to break his heart. Me: They said they sent it from that office. Hubby: What office Me: The one I just called. I was entering limbo again (I normally enter a certain numbness that leads to me staring when I am troubled. I call this my limbo phase). I was still in shock. When I received that card, It took me to cloud 9. How compassionate, how thoughtful and kind of them. I should not have tried to call to say thank you. After all, did I do that last year? Mba …No! I was not happy that no one seemed to send the card. First she said they were not around, next she said “we” sent the card. But anyway even if “we” sent me a card, it was better than nothing after all all those I knew had forgotten. So cheers to “WE” at Great Ormond Street Hospital, you rock. You guys always loved my boy. I appreciate you all. In future, I would not call to say thank you though. Leave me in the bubble of love, compassion and thoughtfulness that your cards put me in when I receive them. I do not want to be upset. Thank you all for listening to me as always. Photo Credit : Pixabay

Death at my Door (DAMD): 2 years already. When “WE” sent me a message.