Advocacy Support

Advocates are independent professionals who work with people to help them understand their options, know their rights and say what they want. This helps to make sure that people are involved as much as possible in decisions about their health and care.

Your duty to refer to Advocacy is a statutory right for eligible people. The Mental Capacity Act and Care Act state that you must refer eligible people for advocacy. The Mental Health Act states that you must make eligible people aware of how to access advocacy.

Types of Advocacy include:

Independent Mental Health Advocacy (IMHA)
Care Act Advocacy
Independent Mental Capacity Advocacy (IMCA)
NHS Complaints Advocacy
Relevant Person’s Representative
Community Advocacy
Advocacy Services for Children and Young People

In hospital the main advocacy services patients will require referral to are Care Act Advocacy, Independent Mental Health Act Advocacy and Independent Mental Capacity Act Advocacy.

What is an Care Act Advocate?

Care Act Advocates support people to understand their rights under the Care Act and to be fully involved in a local authority assessment, care review, care and support planning or safeguarding process.

When to refer?

Make an advocacy referral when all three conditions apply:

One of these processes is taking place: social care needs assessment, carers assessment, care planning, care review or s.42 safeguarding investigation
Without support, the person will have substantial difficulty being involved.
There are no appropriate, able and willing family or friends to support the person’s active involvement.

What are the exceptions?

People who have an appropriate individual to support them are not usually eligible for Care Act advocacy support. However, there are two exceptions to this:

Where the assessment or planning might result in a placement in NHS-funded provision, either in a hospital for more than 4 weeks, or in a care home for 8 weeks or more, AND the local authority believes that arranging an advocate would be in the best interests of the person.
Where the local authority and the friend or family member disagree on something relating to the person, but agree that it would benefit the person for them to have an advocate.

What is an Independent Mental Capacity Advocate (IMCA)?

In hospital the main Advocacy support that will need to be requested is in relation to mental capacity. Independent Mental Capacity Advocates (IMCAs) support people when they are assessed to lack capacity to make a best interest decision, and they do not have family or friends appropriate to consult about the decision.

An IMCA can support someone with best interests decisions about:

Long-term accommodation (to hospital for more than 28 days or to other accommodation for more than 8 weeks)
Serious medical treatment (this can be a decision about whether to stop or withhold treatment, as well as a decision to start it)

Also, if the person is or may be deprived of their liberty, the IMCA can provide support:

During an assessment under Deprivation of Liberty Safeguards (DoLS)
Between the appointment of Relevant Person’s Representatives (RPRs) when an authorisation is in place.
What does an Independent Mental Capacity Advocate (IMCA) do?

IMCA’s will as far as possible, make sure that the person’s views and wishes are taken into account in the best-interests decision. They will support the person to be involved in the decision, or to represent them if necessary. Even when someone can’t tell their advocate what they want, advocates will use a range of approaches to establish their views and wishes as far as possible and secure their rights.

Please note a separate referral is required for a patient in relation to each separate decision ie a patient will require 1 referral for support with decisions relating to long term accommodation and an additional referral for support with decisions relating to serious medical treatment.

What is an Independent Mental Health Advocate?

Independent Mental Health Advocates (IMHAs) support people with issues relating to their mental health care and treatment. They also help people understand their rights under the Mental Health Act. Patients can refer themselves or ask a professional to make the referral.

What can an advocate do?

A patient can get an advocate at any time during treatment. If a patient doesn’t agree that they should be in hospital, the advocate can advise whether they can appeal this.

Advocates can also support patients to:

Tell doctors what they want during ward rounds
Speak to staff about any worries or problems they have
Request leave if they are entitled to it
Appeal the section
Get a solicitor
Prepare for mental health tribunals

Who can get an advocate?

Detained under the Mental Health Act (except under short-term sections 4, 5, 135 and 136).
Conditionally discharged restricted patients
Subject to a Community Treatment Order
Subject to a guardianship
Being considered for s.57 or s.58A treatment, or Electro-Convulsive Therapy