Last week's Parliamentary debate on mental health - in which various MPs spoke movingly about their own struggles - has helped give prominence to a subject that society rarely feels comfortable with.
Too often, mental health issues are swept under the carpet. Nowhere is this truer than with those detained under the 1983 Mental Health Act - the number of which has been steadily rising over the last twenty years.
As the number has risen, so too have concerns about the adverse experiences of people detained in this way. Reports continue to draw attention to the disproportionate rates of detention, negative experiences, dissatisfaction and poorer outcomes for people from black and ethnic minority communities.
In this context, mental health advocacy to provide support for those detained has never been more important. Independent Mental Health advocacy (IMHA) was introduced through the 2007 Mental Health Act and the responsibility for commissioning these services will pass to Local Authorities in 2013, as a consequence of the Health and Social Care Act, although the NHS will still be responsible for promoting access.
It is thus timely that the report of a national review of IMHA services, from the University of Central Lancashire, is being published and launched in the House of Commons this week: at an event sponsored by Charles Walker, MP, Chair of the All Parliamentary Mental Health Group. Our report, The Right to be Heard summarises findings from research commissioned by the Department for Health to investigate the quality and provision of IMHA services - and the difference they can make. The research included over 200 interviews - including 90 with qualifying patients and was undertaken by a team including ten mental health service users from different ethnic backgrounds and with experience of being detained under the Mental Health Act.
The research makes clear the continuing need for IMHA. People ordinarily able to speak up for themselves find the experience of detention disabling and disempowering. But we found that when people used advocacy services they found it valuable, serving to build their confidence to create the conditions for a more respectful dialogue between mental health service users and professionals.
We also found that those who need advocacy support most are the least likely to access and use it. There are various reasons for this, including a lack of awareness and understanding of the role; availability of services and the extent to which the diversity of qualifying patients has been taken into account in commissioning services. Access can be problematic for people from BME communities and older people as well as young people, and those with learning difficulties. This has led us to conclude that IMHA should be provided on an opt-out rather than an opt-in basis.
It was also evident, however, that the experience of IMHA services is dependent on various factors including quality of the individual advocate or the service they work for. Equally important is how well the service has been commissioned and how far mental health professionals go to support the service user's right to self-determination.
Advocacy can be a force for progressive change and supporting a personal journey to recovery; but, it can also simply maintain the status quo and reinforce the more restrictive elements of the Mental Health Act. We need to urgently take steps to ensure access and improve the quality of IMHA services for people detained under the MH Act and consider widening the scope to cover all psychiatric inpatients.
This not only requires a significant investment in the advocacy sector and upskilling community organisations, but also a seismic shift in terms of the attitude to advocacy. We also need to bring about a fundamental change in attitude towards the right of people experiencing mental health problems, including those detained under the Mental Health Act, to self-determination.
Karen Newbigging, University of Central Lancashire, on behalf of the IMHA project team
Further information available at: www.uclan.ac.uk/schools/school_of_health/the_right_to_be_heard.php.