1. The Right to be Heard: advocacy and empowerment
Dr Karen Newbigging, University of Birmingham and Laura Able, University of Central Lancashire
with Stephanie De la Haye, Karen Machin, Dr Julie Ridley and June Sadd, University of Central Lancashire

2. Background
A presumption of irrationality effectively silences people experiencing mental health problems
People’s voices are not heard judged irrelevant, ignored or discounted (testimonial injustice)
People’s knowledge and testimonies are downgraded or denigrated on the basis of prejudice (hermeneutic injustice)

3. Contribution of advocacy to empowerment
Enabling people who feel unable to speak for themselves by having their views represented
Enabling shared decision-making
As a safeguard to prevent abuse of rights
e.g. in relation to compulsion under the Mental Health Act
As an appropriate adjustment
- enabling service users to have the same access to the same quality of services as non-disabled people

4. Advocacy Promoting voice Self-advocacy Voice Citizen Advocacy IMHA
Solutions
Power
Options
IMCA
Independent Mental Capacity Advocacy
Communicate
Complaints advocacy
Community advocacy
Educate
Legal advocacy
Link
Convey
Self-determination
Talk
Citizen Advocacy
Results
Imagine
Peer advocacy
Relationship
Voice
Advocacy
Learn
Explore
Facilitate
Personalisation
Support
IMHA
Independent Mental
Health Advocacy
Trust
Choices
Time
Represent
Different forms of advocacy with their roots in the service user movement and with the potential to forge new understandings and strategies both individually and collectively. In this presentation we are going to draw on our experience of undertaking research into Independent Mental health Advocacy in England.
Self-advocacy
Decisions
Confidence
Connection
Feel
Collective advocacy 4

5. Review of Independent Mental Health Advocacy (IMHA) in England
Specific form of advocacy for people subject to compulsion under the Mental Health Act In England
Introduced in 2009 as a consequence of 2007 Mental Health Act reform
289 people participated in our study: 75 in focus groups and 214 people were interviewed
108 service users participated including 98 people eligible to use IMHA services

6. Impacts for service users
Reported outcomes included:
Greater understanding of rights and rights under the MH Act protected
Changes in individual care and treatment
Resolution of complaints
User-defined outcomes achieved
Increased capacity to self-advocate
Greater voice and equalising power
Changes in ward environment and wider changes at a system level
And sometimes maintaining the status quo!
+ve experiences linked to utility of the advocacy & quality of relationship
-ve experiences linked to uncertainty, not achieving desired outcomes, aspects of delivery

7. Advocacy as a strategy for social justice
Promoting the right to be heard
(Testimonial justice)
Ensuring service users have a voice
Increasing service users’ confidence to self-advocate
Providing information to increase understanding
Increasing participation in decisions affecting care and treatment
Safeguarding rights
Advocate presence alters professional behaviour: more respectful and empowering stance
Opens up clinical environments to external scrutiny
Diversion to less restrictive care
Creating the space for different understandings
(Hermeneutic justice)
Facilitates a more holistic appreciation of the service user as a person
Challenging assumptions based on gender, ethnicity, sexuality, disability, faith
Appreciation of personal assets, strengths and resources
Appreciation of outcomes valued by service users
Increased understanding of a social model
Some staff unable to name local IMHA or service
Community-based professionals most likely to confuse with IMCA role
Not all mental health professionals understood their obligation to promote IMHA
Fewer professionals understood that IMHAs can access records
Training on IMHA generally superficial, with exception of AMHPs 7

8. Empowerment Indicators for advocacy
Universal access to high quality advocacy – opting out
Accessibility of IMHA services to the diversity of service users
Involvement/coproduction of service users in commissioning process, planning, delivery and monitoring of IMHA services
Independence and person-centred nature of provision
Ability to support people who are at greater risk of exclusion
– availability of non-instructed advocacy
Support of the role by mental health services
Impact on decisions and care and treatment

9. Thank You Karen Newbigging and Laura Able k.v.newbigging@bham.ac.uk
Study reports available at:
More information about the implementation project: