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The purpose of this paper is to address a knowledge gap on advocacy outcomes from mental health service users’ perspective, and the implications for evaluating advocacy impact. The studies discussed highlight challenges for measuring the outcomes of advocacy, but underline the importance of doing so, and of involving service users alongside other stakeholders in co-designing evaluation systems.

The paper uses findings from three qualitative studies of independent advocacy involving focus groups and interviews with: 30 African and African Caribbean men who were mental health service users; 90 “qualifying patients” in a study of Independent Mental Health Advocate services; and nine young women in children and adolescent mental health services (CAMHS).

A comparative analysis and synthesis of findings from three studies identifies four common dimensions: how mental health advocacy is conceptualised and understood; how service users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacy outcomes. Advocacy outcomes were conceptualised as increasing involvement, changing care and treatment and supporting personal development. There was evidence of advocacy acting to empower mental health service users, and of broader impacts on service regimes and policies. However, there was limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen as important.

Few researchers have focused primarily on the perspectives of people using independent mental health advocacy, or on the experience of “advocacy as empowerment”, and none have done so across diverse groups. This analysis adds insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems.

This paper aims to discuss an audit evaluation of a specialist independent mental health advocacy service based in the London Borough of Bexley.

The audit included qualitative interviews with ten service users, resident in two specialist forensic mental health and challenging behaviour units. All participants were long‐term in‐patient residents. A number of ethical issues required consideration, in particular respondent confidentiality and informed consent.

Findings indicate that the service's approach, which combines formal advocacy methods with a proactive ethos, had a positive impact on engagement. The importance of trust in the relationships between advocates and service users was also highlighted by the study and is discussed here. The audit also indicates a significant increase in self‐reported wellbeing, self‐efficacy and empowerment for participants. Given that enhancing personal empowerment is one of the primary objectives of the advocacy service, the positive wellbeing outcomes reported are encouraging.

The paper relies on a small number of individuals. There is no attempt to claim representativeness or endeavour to generalise from the findings.

It is recommended that, in the absence of a comprehensive national evidence base, the advocacy needs of patients in forensic and specialist settings be constantly reviewed. Additionally, further action research, to inform educational material and guides for advocacy in specialist settings, may be beneficial and timely.

The purpose of this paper is to measure any impact that IMHA support had on patient’s self-determination.

The study used a questionnaire design, co-produced with patients to ensure question relevance, accessibility and ease of use. The theoretical framework used by the study was Deci & Ryan’s empirically validated self-determination theory (SDT) as it is predictive, across cultures and domains (including healthcare), of psychological well-being and self-determined action following the satisfaction of three fundamental human needs for autonomy, competence and relatedness.

Following advocacy support, increased self-determination, was found in 70 percent of the patients surveyed. In this study, increased self-determination was inferred by patients’ subjective responses to survey questions which measured satisfaction with contextual aspects of autonomy, competence and relatedness. The extensive SDT research has identified that the satisfaction of these needs is essential for psychological well-being and a prerequisite for self-determined and motivated action. Research has also linked psychological needs fulfilment to the personal recovery journey for those diagnosed with a mental illness.

Although limited, qualitative research evidence has identified that IMHA support helps to empower their partners (referred to in the text as patients or patient partners) to be more self-determined. This is an important finding, particularly for those patient partners detained under the Mental Health Act, given the often disempowering and autonomy reducing nature of mental illness and the characteristics of detained environments. However, a gap in the literature exists for quantitative outcome data identifying the specific impact that IMHA support has for patients. Obtaining measurable outcome data which seek to understand how and why Independent Mental Health Advocacy support impacts its patient partners is essential for developing and validating outcome measures that can lead to best practice improvements in IMHA service delivery. Furthermore, this knowledge is pivotal in optimizing IMHA services’ potential for empowering patients and providing commissioners with the much-needed evidence for effective commissioning of such services.

The Mental Capacity Advocacy Project (MCAP) with older people is a three‐year pilot project funded by the Department of Health and Age Concern England; the pilot phase of this project is due to finish in October 2009. In this article, the MCAP co‐ordinator, Neil Mapes, highlights some of the voices from the project, discusses some of the emerging issues with the Mental Capacity Act (2005), and highlights the MCAP resources and key messages from the work to date.

The need for advocacy for autistic adults is emphasised in many government policy and good practice guidelines. The purpose of this paper is to investigate legislation and policy relevant to advocacy for autistic adults in England and explore whether this translates into practice. It also seeks to clarify which policies can be enforced under current legislation and highlight the gaps in legislative power to ensure implementation of good practice.

This paper aims to define what is meant by autism advocacy. Relevant legislation, including human rights, disability and autism-specific guidelines, are discussed in respect to autistic adults in England.

Implementation of autism advocacy policy appears to vary greatly according to local and individual resources.

Autistic adults, and services that support them, may be unaware of the policies and guidelines relevant to advocacy, they may also be confused by the plethora of different guidelines or unsure how to implement these. Further research is needed to review obstacles to the practical application of autism advocacy policy.

The modernisation of mental health legislation took time in England and Wales, and resulted in an amendment to the law through the Mental Health Act 2007. The changes under way are extensive, and will affect the mental health workforce. This article outlines some of the changes and new roles, and argues that workforce changes are important features of the new legislation that confirm policy goals of integrated working and practice.

The third sector has been promoted by progressive English governments as a provider of health and social care services for people with mental health difficulties. This article aims to consider the assumptions that lie behind these polices and reviews the evidence that third sector organisations can be said to have a “unique” role and approach. The challenges and opportunities of the current market‐based reforms for the third sector are discussed.

The article is based on literature reviews of the third sector's role in mental health care and commissioning of third sector organisations.

The third sector delivers a range of mental health services in England, in particular those related to accommodation, advice, advocacy and employment. Its activity extends into other roles such as campaigning and development of new approaches to care and support. Evidence of the distinctiveness of the sector as a whole is limited, but there are examples of such organisations providing innovative and user‐led services. Market‐based reforms are seen as posing a threat to smaller organisations in particular but personalised approaches (including allocation of individual budgets), outcome‐based payments and a need for large‐scale service redesign are seen as offering considerable opportunity for expansion.

For the new market to include a strong third sector will require leadership within organisations, a collaborative approach within the sector, and commissioners that understand and engage positively with the sector in all its diversity.

This article draws together the research literature on the third sector's engagement in mental health and the impact of market‐based reforms and in doing so provides original value in the fields of mental health and third sector studies.

This article aims to outline simple measures which, by making better use of existing legislation and provision, could change the day‐to‐day experience of individuals with learning disabilities currently in long stay hospitals, whilst phased local provision is being sourced for them. The proposals will also promote the safety and dignity of the minority of patients who ultimately cannot be settled successfully within their own community. Further, these measures may help ensure that any individual undergoing assessment and treatment at such a unit, for whatever period, and for whatever reason, will receive care in an environment where abuse cannot go unnoticed or unchecked.

The paper provides a review of the potential to use current legislation and provision to better effect, highlighted by case studies.

Commissioners contracting with providers could include measures to promote the safety and protection of adults with learning disabilities from abuse at little or no cost to the commissioning authority.

This is an original piece of work – developed from a short opinion/comment piece (750 words) originally prepared for the benefit of mental health lawyers in the Law Society Gazette. It is primarily of value, however, to social workers, care providers, adult safeguarding teams, advocacy services and commissioners of services.

Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secure hospitals in England between 2010 and 2018.

In this qualitative study, 49 CQC inspection reports from three high-secure hospitals were subjected to thematic analysis.

Five central themes emerged: staffing and management; restrictive practice; physical environment and ward atmosphere; patients’ needs and involvement in their care; and legal and statutory matters. There was some variation in the overall quality of care between the hospitals. Positive staff–patient interactions and good practice in assessing and delivering care were consistently observed. However, enduring staff shortages within each hospital were experienced negatively and sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen with regard to staffing levels, staff morale and management involvement. While services progressed over time in providing patients with access to advocacy and information concerning their rights, in some recent inspections it remained unclear whether patients were adequately involved in the care-plan process.

These findings provide preliminary indicators for areas requiring further attention from policymakers, clinicians and advocates.

This study appears to be the first systematic analysis of key concerns expressed in CQC reports of English high-security hospitals.

Secure mental health services in one UK region have acted within a network to develop a range of involvement practices. A new quality benchmarking tool has been created to appraise the implementation of these involvement practices. The purpose of this paper is to report upon a qualitative evaluation of this development.

Staff and service users involved in the co-production of the benchmarking tool were engaged in a series of focus groups and participatory inquiry approaches enacted in the course of scheduled network meetings. Data thus collected was subject to thematic analysis.

Four distinct themes were identified which were titled: Taking time, taking care; The value not the label; An instrument of the network; and All people working together. These are discussed in relation to recent theorising of co-production.

Effectively, this study represents a case study of developments within one region. As such, the findings may have limited transferability to other contexts.

Staff and service users can work together effectively to the benefit of each other and overall forensic services. The benchmarking tool provides a readymade mechanism to appraise quality improvements.

Despite a prevailing culture of competition in wider health-care policy, cooperation leads to enhanced quality.

The benchmarking tool is a unique development of a longstanding involvement network, demonstrating the positive implications for enacting co-production within secure services.