1. APPLICATION OF CLINICAL AUDIT TECHNIQUES TO THE GENDER SPECIFIC ADVOCACY SERVICE OF A MENTAL HEALTH CHARITY Dr Sarah Markham, HQIP SUN

2. WISH Wish is a national mental health charity for women detained under the MHA in secure & forensic setting One of the services Wish offers is its Gender Specific Advocacy Service This service is possibly unique as most advocacy services, though they may focus on supporting clients with certain needs e.g. mental health, physical disability, legal status etc., few are set up to be gender specific when the need (in this case mental health) presents in male and females

3. In 2012… I, an academic mathematician and former teacher with an interest in clinical audit joined… HQIP as a member of the HQIP SUN (Service User Network) Wish as a volunteer research consultant Wish had a need for someone to design a protocol for an evaluation of their Gender Specific Advocacy Service with a view to providing an evidence basis for their service…and I with (thanks to HQIP) a basis knowledge and a strong interest in clinical audit (and quality improvement cycles as a whole) was happy to take on the task…

4. How I went about it… I reviewed all Wish’s literature on their GS Advocacy Service, including… Job specification of their advocates (most of whom were qualified IMHAs – Independent Mental Health Advocates) Client and Service Provider oriented information leaflets Past research papers published by Wish touching upon the need for a gender specific advocacy service for women in secure & forensic services. …I also talked to all their advocates either in person or using Skype and the Director of Wish, Joyce Kallevik

5. I also looked (mainly online) for other gender specific advocacy services… In order to conduct a compare and contrast analysis with the service Wish provides… However I couldn’t find a single other example… I did get excited when I found a link to a ‘gender specific service for women in China’… …it turned out to be political advocacy! I also discovered that in the US they seem to do almost as much (political) advocacy evaluation as they seem to actually advocate! However they seemed very good at it!

6. Wish’s Gender Specific Advocacy Service aims to… …empower women in secure and forensic mental health settings to: find a voice with which to communicate their needs and experiences to the staff who have a duty of care towards them It offers women regular one to one support sessions to help them develop an awareness and ability to articulate clearly and with confidence their needs and aspirations to clinical staff. supports them to communicate their needs to staff to whatever extent they want until they have the confidence to speak for themselves at all times encourages positive communication and negotiation with service providers and wherever conflict arise; resolution & reconciliation whenever possible

7. In developing the framework for the evaluation I took into account: the laws governing what advocates may and may not do for their clients especially with regard to client confidentiality and when this can and cannot be breached, e.g. the advocate’s duty to inform clinical staff were a client to disclose she was planning to hurt herself and/or someone else Data protection laws – what the advocates recorded of their interviews with their clients and how they stored and communicated this information (if justified) both within and without Wish. The accessibility of the service; both in terms of service promotion and information provision e.g. flyers and leaflets and the accessibility of the individual advocates

8. I also wanted to include criteria to measure: Client satisfaction Secure and Forensic Service provider (who contracted Wish to provide a (required by law) advocacy service within their hospital) satisfaction Advocate satisfaction with the service they were able to provide and the Wish GS Advocacy Service as a whole In developing this framework I looked at IMHA services provided by other charities e.g. SEAP, POhWER and Mind.

9. With a view to the future and what Wish might want to do with the results of an evaluation… …and inspired by what I had learned through HQIP about clinical audit cycles… I decided to extend the evaluation framework to incorporate a quality improvement audit cycle…

10. In creating the protocol of the service evaluation I had incorporated: …Wish’s aims and intended outcomes in setting up and providing a GS Advocacy Service…which would serve as excellent audit criteria (although they perhaps might be amended in the wake of a full service evaluation). …analysis of the evaluation results together with discussion of what they might need to change and improve… …provision for an incipient audit cycle… Wish were enthused when I suggested extending the evaluation to include a quality improvement audit cycle and so it became a formal paret of the final approval

11. Wish are currently… …using the evaluation proposal document I drew up to accompany the evaluation protocol to seek funding for a full scale evaluation of the GS Advocacy Service… …they are already discussing possible ways in which they may further develop their advocacy service… …with sufficient funding grants they envision repeating an audit at regular intervals with a view to suing the findings to continuously improve their service and attract new contractors…