Advocacy
And
Mental Health
Mental Health Is A Human Right
Why mental health advocacy is needed
Mental health determines and is determined by a wide range of social and health outcomes at individual, community and social levels[i]. It is recognised that there is a correlation between diagnosis of a mental health condition and various forms of discrimination, including barriers to employment, social support and other opportunities which those without a mental illness label take for granted[ii]. By training volunteers, carers or service users themselves to speak on behalf of those who have no voice in society, it is possible to access the support to which this group of people are entitled.
Mental health advocates speak on behalf of individual service users and their families, many of whom, in the past, have had no voice in their care and treatment. Modern advocacy services developed as a result of determined campaigning in the 1970s by psychiatric patients and their supporters, but this movement was rooted in centuries of campaigning against mistreatment and abuse of psychiatric patients. Radical changes in the law were eventually achieved, culminating in the Mental Health Act 2007 which established the role of Independent Mental Health Advocates (IMHAs), with a view to providing important safeguards for service users[iii].
Bethlem Patient, 1815, James (William) Norris
[i] “Promoting Mental Health: Concepts, Emerging Evidence, Practice” World Health Organisation, Geneva 2004. See also http://www.mentalhealth.org.uk/content/assets/pdf/publications/starting-today-background-paper-3.pdf
[ii] Pinfold, V and Byrne, P, “The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care”, Psychological Science in the Public Interest October 1, 2014 15: 37-70
[iii]http://www.mentalhealthalliance.org.uk/resources/Independent_Mental_Health_Advocacy_report.pdf
[iv] Mental Health Act 2007; s 30
[v] Mental Capacity Act 2005; ss 35-41
[vi] BMA Statutory Advocacy Services
bma.org.uk/-/media/files/pdfs/.../statutoryadvocacyguidance2010
[vii] Wise S: “Inconvenient People, Lunacy, Liberty and the Mad Doctors of Victorian England; Bodley Head, London 2012; xviii
[viii] Fennell, P, “Treatment without Consent: Law Psychiatry and the Treatment of Mentally Disordered People Since 1845; Routledge 2002
[ix] McSherry P, Weller B: “Rethinking Rights Based Mental Health Laws”; Bloomsbury Hart Publishing 2010
[x] Wise S. Inconvenient people, lunacy, liberty and the mad doctors of England., 2 ed: Bodley Head, London; 2013: xvii
[xi] Chamberlin, J, Schene AH: “A Working Definition of Empowerment”:- Psychiatric Rehabilitation Journal, 1997: Spring 1997—Volume 20 Number 4
[xii] http://healthcare.uslegal.com/patient-rights/ this is typical of websites informing patients of their legal rights
[xiii] http://www.ncbi.nlm.nih.gov/pubmed/7333723
[xiv] Curtice M, “The European Convention on Human Rights: An Update”, BJPsych Advances, April 2010
[xv] Bewley T, “Madness to Mental Illness: A History of the Royal College of Psychiatrists” RCP Publication 2008. See also, Wise S: “Inconvenient People, Lunacy, Liberty and the Mad Doctors of Victorian England; Bodley Head, London 2012; 388
[xvi] “Valuing People: A New Strategy for People with Learning Disabilities” DOH 2001
The Rake in Bedlam, 1733, William Hogarth
Advocates support and promote the rights of service users within health care settings, and are needed when patients are suffering from serious psychiatric conditions requiring treatment under the Mental Health Act 1983[iv]. Service users who lack capacity as defined in the Mental Capacity Act 2005[v] also need the support of advocates in navigating the healthcare system and the requirements of the law[vi].
Somewhat confusingly, advocates appointed under the Mental Capacity Act 2005 are called Independent Mental Capacity Advocates, (IMCAs), while those appointed to act on behalf of patients treated under the Mental Health Act are called Independent Mental Health Advocates (IMHAs).
The distinction between these two different types of advocate is important, and the interface between these two pieces of legislation is extremely complex.
The history of abuse of patients by those running a system designed to protect them can be traced back several centuries. The literature abounds with stories of patients being taken advantage of by friends, relatives and others in order to extract money or inflict lunacy certification[vii].
Only over the last few decades have the rights of service users become the central consideration in planning the management of mental health conditions in the context of the best interests of the patients concerned[viii]. More specifically, legislation passed in 2005 and 2007 forced this cultural change[ix] and some argue that without legislation this change in social attitudes and provision for the mentally ill might well never have been achieved.
The legal and ethical climate in the 21st century is far removed from the lunacy panics of the 19th century, which were caused by medical professionals curtailing the liberty of individuals by labelling unconventional behaviour a pathological condition[x] The patients’ rights movement, a relatively recent phenomenon, and part of the wider “consumer movement” in the USA and Europe, has been instrumental in identifying fundamental rights of patients, and including service users in decisions[xi] regarding the treatment they receive[xii]. This has reduced the use of psychosurgery, lobotomies and over drugging.[xiii].
While the concept of empowerment for those who are vulnerable as a result of mental illness presupposes that they will be involved in decisions about their treatment, it is inevitable that at times of crisis, service users will need the help of an advocate to speak for them.
These notions of empowerment have been reinforced by the European Convention on Human Rights and Fundamental Freedoms in 1950[xiv], preceded by a long line of legislation in the UK from the 1774 Act for the Regulation of Private Madhouses, the first to introduce rights for the patient[xv], however inadequate. In conjunction with the emphasis on valuing people, there emerged a driving force for a basic statutory right to advocacy for certain groups detained under the Mental Health Act 1983[xvi].
The 2007 revision of the Mental Health Act introduces more community based treatment which reduces the likelihood of patients becoming institutionalised and encourages their independence and autonomy. However, as will be observed in the context of access to advocacy services, patients are still managed within an imperfect system, and there are continuing oversights in the rights and freedoms of service users.