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This paper reports on key findings from the practice survey wing of a broader knowledge review into mental health advocacy with African and Caribbean men funded by the Social Care Institute for Excellence (SCIE). Selected themes from the analysis are discussed in the light of theory regarding ethnicity, masculinity and mental health. Conclusions are drawn that suggest that understandings of mental health and advocacy within black communities are congruent with ideologies of holism, recovery and transformational goals for services and society at large. This is in contrast to experiences in mainstream mental health services which privilege a relatively narrow medical model and treatments that are emasculating. The empowerment and emancipatory potential wrapped up in both individual and collective notions of advocacy can be seen as one part of a resistance to oppressive practices and a means of reclaiming personal efficacy and potency by virtue of challenging emasculation in services.

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.