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


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

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