How can Independent Mental Health Advocacy help you?

Last summer we featured Connecting with the mental health advocates in which we found out more about the three different advocacy roles in Powys, and met some of the advocates themselves – in particular those based in Powys. 

Today we talk to Adrianne Cleverly, who works for Conwy & Denbighshire Mental Health Advocacy Services, but actually provides an advocacy service for Powys (which is commissioned by Powys Teaching Health Board). I met Adrianne earlier this year, and we all agreed it was important to try to raise awareness of the advocacy service available in the county.

Tell us what brought you to work in the field of mental health advocacy?

I was fortunate enough, and lucky enough, to fall into the field of mental health advocacy – by complete accident. I was working in child protection; within that role I was working with Child and Adolescent Mental Health Services (CAMHS) and acting as an advocate for some of the children I was working with. The role was so varied that my experiences spread further than I had even realised because when you are doing the job you take those things forgranted and just get on with it. One day someone showed me the job advert for an IMHA (Independent Mental Health Advocate). When I read the job specification, I could not believe a job like this existed. I applied for the job, and what can I say, three years later, I still love the role and still feel lucky enough to work in this position. I love my job! You definitely have job satisfaction when you work as an IMHA. Sometimes the differences you make can seem trivial but the difference you are making to the person is so much more. It is such a rewarding job.

What is your role at CADMHAS and which area do you cover?

My role at CADMHAS is an Independent Mental Health Advocate. Within this role I cover the South Powys hospitals - Ystradgynlais, Bronllys and Brecon. Within the role of IMHA my role means that I visit the hospital wards and meet with qualifying patients (people admitted to hospital for their mental health). I work with them within the remit of accessing their rights under the Mental Health Act and support them with anything to do with medication, treatment and care.

I also deliver awareness raising sessions in North Powys. Those hospitals are Phoenix House, Welshpool, Machynlleth, Newtown, Knighton, Llanidloes and Llandrindod. As part of awareness raising I also work with the community mental health teams which are Ty Illtyd and The Hazels, additionally other professionals that might also be working with the same people as myself, should the scenario require me to.

Many people don’t know about the advocacy service. What are the key benefits of having an advocate?

The benefits of having an advocate will vary for the individual and depend on why they felt they needed/wanted an advocate in the first place. For some people they may have more than one admission to a hospital ward and they may want an advocate on one visit and not another. The beauty of the role is that it is led by the individual. It is not the choice of the professionals or the family, but the choice of the individual.

One main benefit of having an advocate is to ensure that you have a voice when you need it. Also the reassurance of knowing that someone is making sure your voice is heard. Other benefits include empowerment to have a voice. Receiving the knowledge and understanding and being helped and supported to understand your rights when you are in hospital or having some experience of the Mental Health Act (maybe living in the community but being on a Community Treatment Order or Guardianship). Also, having the availability to access those rights. Additional benefits are to feel supported by an independent professional and feeling like someone is on your side.

What key qualities does a good mental health advocate need to have?

The qualities of a good mental health advocate are simple; they will be non-judgemental and listen to what the person is actually saying. An advocate needs to be a good listener, they will be well informed and skilful. They will have confidence in themselves and be comfortable enough to stand up for the person’s rights.

Just for clarity, can you very briefly summarise the three different mental health advocacy roles?

Independent Mental Health Advocate 

An Independent Mental Health Advocacy (IMHA) means the qualifying patient has access to an IMHA which is a statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO). When someone is detained in hospital or on a CTO it can be a very confusing and distressing experience. 

Independent Mental Capacity Advocate 

An Independent Mental Capacity Advocate is available to everyone surrounding the care, treatment and support of people aged 16 and over living in England and Wales who lacks capacity to make all or some decisions for themselves in specific areas. These areas being change in accommodation, care reviews, safeguarding issues and serious medical treatment. An IMCA will also be involved in those detained under a Deprivation of Liberty order. The Mental Capacity Act is designed to protect and restore power to those vulnerable people who lack capacity. 

Community Mental Health Advocate 

Community Mental Health Advocates provide and offer representation and support at meetings and appointments to people who have been treated for their mental health and are now living in the community. An advocate is someone who will listen to your worries and problems and work alongside you to achieve your aims. Advocates are a valuable source of information and can help the people who use their service to feel in control of their own lives – to feel empowered. 

Can an individual be supported by all three types of advocate at once – IMHA, IMCA and Community Mental Health advocate? If so how does that work?

Yes an individual can be supported by all three advocates. All advocates work in different ways so if a person needs support in different areas they will be eligible for different advocates. An IMHA will work with an individual within the remit of medication, treatment and care.

An example of this would be if a patient is on a Community Treatment Order they will be eligible for the support of an IMHA who will support the individual with representation at a managers' hearing or tribunal. They may also have been deemed to lack the capacity to make a decision on their placement so they will then be eligible to have the support of an IMCA as IMCAs will work with the individual around this. They then might need support with things like pension and finances, so they will then require the support of a community mental health advocate.

What happens when a carer refers but the patient/individual does not want to engage?

This goes to the heart of advocacy. The individual is the one that instructs the advocate and decides if they want to work with us. If a person has capacity to understand the role of an IMHA and they don’t want an advocate that is their choice we would not force ourselves on them. The work of an IMHA is client led. If the individual doesn’t want to work with an IMHA, we cannot make them. We can ensure that we give them plenty of choices and just be available for them if they change their mind.

If the person does not have capacity then we can still work with them, but it will be in a non-instructed way. This means that we work with the family and professionals to establish as much information as we can and then work in the person’s best interest.

If someone is placed in a hospital or unit outside Powys, can you still support them? 

Usually our role would stop but we would signpost to other agencies.

If a patient is placed on a Community Treatment Order (CTO) what support can you provide as an advocate?

If a patient is placed on a community treatment order, our role would remain the same as if we were visiting them in hospital, but we would visit them in the community instead. We would still work with them around their medication, treatment and care and we would also attend meetings with them around these themes. We would also still support them with their rights under the mental health act and support them at managers' meeting and appeals.

Which organisations do you work most closely with in Powys? 

As an advocate in Powys there are quite a few organisations we have worked with. The main people we work with are Social Services and Community Mental Health teams. Additionally we also work with organisations like Age Cymru and the Alzheimers Society. We also work with the ward staff, and Best Interest Assessors.

What are the main challenges of your role?

Some of the main challenges experienced are having the ability to manage the expectations of not only the client but also their family. Another challenge is when delays happen and it is completely out of our control but there is an expectation on us to make it happen. Another challenge would be the conflict of interest and other people’s understanding of our role, including professionals.

Tell us about some of the most rewarding work you have done so far with CADMHAS?

For me personally, the most rewarding part of my job is when the client gets what they want! Especially when the work started it was not even a possibility, knowing that you have made that difference to that person. This includes things like making sure the clients are listened to and that there is communication between staff and patients.

When you are not working for CADMHAS, how do you enjoy spending your time?

I love to spend time with my family, doing things like mountain biking, surfing and walking. I enjoy listening to music, reading and cooking. It sounds a bit cliché but I love the ‘normality’ and chaos of family life! 

Many thanks to Adrianne for telling us all about her work as a mental health advocate. If you want to find out more you can contact the Powys Independent Mental Health Advocacy Service managed by CADMHAS by emailing admin@cadmhas.co.uk or ringing 01745 816501.

Connecting with the mental health advocates

Powys mental health advocates Kirstie Morgan and Lynda Evans

“Advocacy”, it says on a whiteboard opposite my desk, is “taking action to help people: say what they want, secure their rights, and obtain the services they need.”

Many are the times I have signposted people calling our Information Service to the mental health advocates working in Powys. Last week two of them, Lynda Evans (North Powys), and Kirstie Morgan (South Powys), came along to the July team meeting of the PAVO Community Connectors to update them about the advocacy services available in the county. I was lucky enough to join them, and this is what we found out.

The three different advocacy roles in Powys

Independent Mental Health Advocate

This role was introduced in 2007 when the Mental Health Act was revised and advocacy was put on the statute books. Advocates suddenly had rights which they had not enjoyed before, such as advocating for mental health patients in hospital, on a Community Treatment Order, or detained under the Mental Health Act.

The provision is much broader in Wales than in England. Anyone in a hospital bed in Wales who is being treated for a mental health “disorder” is entitled to a mental health advocate. The IMHA can support someone who wants to challenge, for example, their detention under a Section 3 of the MHA.

IMHAs can also go into a ward and observe a patient’s treatment and interactions with staff – they cannot be prevented from doing so except in extreme circumstances – such as if the client is unwell and may present a danger to the advocate. IMHAs may, in addition, interview psychiatrists and social workers in private, access the medical notes with permission and share information with the client.

With her IMHA hat on Lynda ensures that proper process is followed, and that a person’s rights are upheld. “If a patient is told they can’t have leave because they’ve not been good, that is punishment. They can’t do that. There has to be a clinical reason to stop leave.” In another situation, a patient who is not being detained under a section may be told that they will be detained if they don’t behave. “This is wrong and totally illegal. Our job is to challenge on behalf of a patient. The first loyalty is always to the client/patient”.

Independent Mental Capacity Advocate

The Mental Capacity Act 2005 introduced the role of the Independent Mental Capacity Advocate. An IMCA is instructed either by Health or Social Services, not by the patient as they lack capacity. The lack of capacity may be due to a brain injury, mental health issues or dementia. IMCAs can be called on when treatment is about to start or to be withdrawn, and the patient has no family or friends who can be consulted. Or, there could be safeguarding issues which mean that it is not appropriate for the family to act on the best interests of the client.

An IMCA has many roles, including:

1. To support the client whilst a Deprivation of Liberty Safeguards assessment is made. The Alzheimer’s Society states that: “If a care home or hospital plans to deprive a person of their liberty… they must get permission. To do this, they must follow strict processes called the Deprivation of Liberty Safeguards (DoLS). DoLS are a set of checks that are designed to ensure that a person who is deprived of their liberty is protected, and that this course of action is both appropriate and in the person’s best interests.” So, for example, when rehousing someone in a nursing home it is important to consider a person’s preferences (they may previously have preferred the countryside to the town).
2. To support a family member who feels overwhelmed by the whole process of being the “relevant person’s representative” – who must be kept informed about the person’s care and treatment and any changes to it.
3. To visit the nursing home once a month to make sure all is as it should be. 

Community Mental Health Advocate

People in contact with statutory mental health services from age 18 and over in Powys are entitled to receive support from a Community MH Advocate if they wish. Those in receipt of local primary mental health support services (ie: through a GP surgery) have to be screened first as so many people seek support for mental distress from a GP.

The majority of the work in this area is for people supported by secondary mental health such as Community Mental Health Teams and Crisis Resolution & Home Treatment Teams. Kirstie explained that the work is vast and varied. The work could be long or short-term depending on the situation or the nature of the issue. “Quite often people are very poorly before they come to us and have to address a number of issues.”

Clients can self-refer, be referred by a relative or the voluntary sector (Mind centres or Ponthafren Association for example), or via the Community Mental Health Teams. “People see advocates when everything has gone wrong. In cases where the individuals have a dual diagnosis and their mental health is the prominent issue we will advocate. We work alongside many projects and advocacy schemes in Powys. Our aim is to build a good rapport and understanding with the client and there is a high level of professional trust.”

People have an entitlement under the Mental Health Measure (Wales) to access the CMHT duty desk and regain entry to services within 3 years. Advocates can support clients with this process.

Appropriate Adults

Kirstie and Lynda will also sometimes act as Appropriate Adults at police stations in the county to support and advise vulnerable people known to advocacy in police custody. The mental health charity Hafal is the main provider of Appropriate Adults in Powys.

A bit more about our Powys advocates

Lynda has been an advocate for 14 years now She is employed by Powys Teaching Health Board to be an IMCA and a community advocate, and for a small number of hours a week by Conwy & Denbighshire Mental Health Advocacy Service to be an IMHA in North Powys. Her current base is Fan Gorau at the Montgomery County Infirmary in Newtown, tel: 07736 120 924.

Kirstie is employed as a Community Mental Health Advocate by Powys Teaching Health Board, and provides advocacy in Mid and South Powys. She has worked in the field for 13 years now and is currently based at Neuadd Brycheiniog in Brecon, tel: 01874 615996 or mobile: 07967 808 145.

Linda Woodward also provides IMCA services across the county, and community advocacy for over 65s in North Powys. She is based with Lynda at Fan Gorau and can be contacted on 07974 935 355.

CADMHAS employs three other advocates in Powys – John Curtis in the North, and Adrianne Cleverly and Jane Wazir cover the South. You can contact them by ringing: 01745 816501.