I am an Independent Mental Health Advocate AMA

[Fliesinmyeyes]

I am an Independent Mental Health Advocate. I work with people who are sectioned under the Mental Health Act. Ask me anything.

How did you get into the role? What qualifications did you need?

Are you allowed to talk to patients that are not sectioned?
I have been sectioned, and had an advocate explain things to me. When I had a complaint about staff on the ward, they were also there to listen to me.
But another time, I agreed to admission, so was not sectioned. I asked about seeing an advocate, and was told they could not speak to me. Even the advocate did not agree with that, and said just because someone is not sectioned does not mean they do not need an advocate.

I applied for the role. You need to have the City & Guilds Level 4 Independent Advocacy qualification or be working towards it. You also need individual module practice qualifications for each area of advocacy you want to work in.
Other qualifications (eg degree or a levels will depend on the criteria set by the employer.
I applied for the post and my employer paid for my training to get the advocacy qualification. It took about 18 months.

Do you think it would be a good or a bad thing to reopen some sort of mental institutions? Sorry if that name is incorrect terminology.

Well if you are sectioned under the Mental Health Act, you are legally entitled to an advocate. But in your case, the ward staff were correct. As a voluntary or informal patient (not sectioned) you wouldn't get an advocate.

An advocate visiting the ward would not be allowed to work with you for several reasons. Firstly, funding for advocates is paid for under contract by the local authority, and is only available to sectioned patients, then there is the issue of consent, data protection and sharing medical information. Part of the IMHA role is to support the patient to understand their health and treatment and to ensure their viewa and wishes are hears. This could not be done without legal consent and via a referral for advocacy from the clinical team.
The advocate is right however when they say that just because someone is not sectioned they don't need an advocate. Sadly though, they would not be entitled to one.

I'm not entirely sure what you mean. The old 'mental institutions' made way for psychiatric hospitals which specialise in care and treatment for people with mental health issues. So the institutions are kind of still there, but care and treatment is delivered differently. The hospitals now still have residential units, some have flats or bungalows for people to slowly reintegrate into the community. But if you mean should we go back to the old image of a large institution full of people just being kept there, sedated with little chance of returning to normal society, well no I don't think that would be a good idea. I think the draconian methods used in those days to 'treat' mental illness has moved forward a long way. (Which does not mean I necessarily approve of everything that happens in psychiatric hospitals today)

Do you support patients who also have sugnificant family involvement, or mainly those with no one to speak up for them?

Amd linked to that - In terms of providing a voice for a patient, do you think IMHAs are be listened to more than a family member trying to advocate on behalf of their relative?

What advice do you have for long stay patients seeking tribunal? Or regarding the tribunal process generally?

How do you switch off once finish work so not to think work related issues in your own time?

How long is it acceptable to wait for a bed once it’s decided you need to be sectioned and admitted?

Those who are sectioned, what is useful to pack along when you don't know the length of stay? Likewise what is helpful to bring when come to visit them?

What percentage of mental illness do you think is rooted in neurodiversity? Eg autism, ADHD etc. Do you have specific training on this?

How soon after a section does the person feel like them old selves again? Would three sections in three years be normal?

Clean and comfy PJs, a nice dressing gown (cord removed). Nice toiletries. Something simple like colouring in supplies, puzzle books, any books or magazines they like to read. Photos of family and pets.
Some people visiting me used to bring a board game for us to play. I found that better to deal with than just sitting and talking, and it was a great distraction. Most wards will have their own board games too.

Hi OP, can I ask if there is any support for people following section? I don't mean 117 aftercare, but for those who might have been held on section 2 even just for a short time before being made informal or discharged. I work in mental health and come across people who are struggling following section, usually related to the events and treatment around them being held. This might be from trauma around how they felt they were treated, not understanding why it happened etc. It's often only once they are recovering that things can hit them. There doesn't seem to be the opportunity for a debrief in the aftermath like someone might get following a difficult birth with a specialist midwife for example.

Would an advocate be able to help with this or can you only support whilst they are actually under section and in hospital?

I suppose it's like a lot of other jobs which can get a bit intense at times. Switching off is something you learn to do. Sometimes if it's a long drive home, that helps. Usually it's ok, and if you have been able to support people that day that also enables you to put it aside. Every now and then something happens which is harder to switch off from but not frequently.

Advocates usually work as part of a team and have their own little support network amongst themselves, so you get a chance to offload, rant etc. You do need to be a bit resilient and able to separate work from home life

Once you have been sectioned and placed on a hospital ward you should be allocated a room that day.

In a nutshell, what do you do?

I work with individuals who have been sectioned under the Mental Health Act, helping them to understand the process, their care and treatment and ensuring that their views and wishes are heard (or expressing these on their behalf).I can also support them at meetings and with tribunals. I liaise with clinicians, social workers and legal representatives with and/or on behalf of the patient. All patients who are sectioned are entitled to have an advocate, and it is the duty of the hospital staff to offer this and make a referral to the advocacy service. Every local authority area has an independent advocacy service, which is procured via a tender process by the local authority.

This is such a good question, and you make such a valid point in that often patients problems really begin once their mental illness has been treated and patients are pushed back possibly into the situation that causes their mental health to suffer in the first place. Statutory advocacy is only available while they are under the Mental Health Act (ie sectioned) and once they are discharged/made informal, the entitlement ends and the advocate must close the case. Fortunately some advocacy services are able to provide a general advocate, who may be able to provide some support after discharge, but it will be dependent on what the issues are and subject to availability. I make that point because there is a shortage nationally of trained advocates as well as funding to provide these services. I think this is very unfortunate as people are often at their most vulnerable at this stage.

There is no definitive answer to this question. So much would depend on the nature of the illness and the treatment provided.
Often diagnosis can be a slow process and psychiatric clinicians will often need to try different medication before finding what works. Then time is needed to titrate this before there is significant improvement.
Often people are brought into hospital by the crisis teams and patients are discharged within hours, but I have also worked with patients who have been in hospital for several years. I would say that most admissions on average are between 2 or 3 days and perhaps 3 weeks. The Mental Health Act has specific timescales under which people can be detained for treatment, which would take to long to explain here, but in answer to your question, most of my clients tell me they feel like their old selves within a few days, but that may just be because they want to go home!

Mental illness and ADHD & ASD are not related in a clinical sense, but it would be fair to say that ADHD and ASD and the challenges that can come from these conditions can lead to mental health issues. However ADHD and ASD are conditions that cannot be 'cured' but rather managed via therapies and sometimes drugs, whereas a mental illness can often be treated and cured.
Advocacy training does not specifically cover ADHD or ASD , but most advocates. (myself included) will usually seek additional training in order to have an understanding of these conditions, as it is extremely useful for finding the most effective ways to provide support.

Great thread. As someone who works in mental health, I really appreciate your role.

Do you support patients who also have sugnificant family involvement, or mainly those with no one to speak up for them?

Amd linked to that - In terms of providing a voice for a patient, do you think IMHAs are be listened to more than a family member trying to advocate on behalf of their relative?

What advice do you have for patients seeking tribunal? Or regarding the tribunal process generally?