Commissioning Care Act Advocacy

Local Authorities in England are required under the Care Act 2014 to make independent advocacy available to eligible service users and carers. In October 2014, the Social Care Institute for Excellence (SCIE) launched guidance to support good practice in commissioning independent advocacy. Early studies examining implementation of the Act highlighted lower than expected referrals for independent advocacy support and that many of those potentially eligible for advocacy under the Care Act might not be receiving it. In 2016, the Universities of Birmingham and Central Lancashire were commissioned by SCIE to undertake a rapid appraisal of how advocacy is being commissioned under the Care Act, and to identify the features of promising practice. This involved surveys of and interviews with commissioners and providers; documentary analysis; and a roundtable discussion involving people with experience of using social care services and other stakeholders to identify improvements in the commissioning process

Epistemic struggles: The role of advocacy in promoting epistemic justice and rights in mental health

Advocacy for people using health and social care services is widely promoted but its theoretical foundation is under-developed and its impact poorly conceptualised. This paper explores the liberatory potential of independent advocacy, using Fricker's concept of 'epistemic injustice' as a framework. People experiencing mental distress are particularly vulnerable to epistemic injustices as a consequence of deeply embedded social stigma resulting in a priori assumptions of irrationality and unreliability such that their knowledge is often discounted or downgraded. The mental health service user/survivor movement is at the forefront of validating personal experience and narrative to secure a different ontological and epistemological basis for mental distress. A foundational strand of this is advocacy to enable people to give voice to their experience. The case of independent mental health advocacy (IMHA) services under mental health legislation in England, provides an opportunity to critically examine whether advocacy can promote epistemic justice as a result of the legally sanctioned encounter between clinical assessment and subjective experience, pivoting on judgements about risk. This paper draws on empirical data from a national evaluation of IMHA services, which included 90 individual interviews with people subject to detention and three focus groups with mental health service users. Fricker's concept of epistemic injustice is used as a lens to investigate how this type of advocacy might mitigate forms of epistemic injustice, and thereby promote greater social justice in mental health. The concept of epistemic injustice provides a valuable theoretical basis for understanding the worth of advocacy in addressing testimonial injustice as well as its relative weakness in overcoming hermeneutical injustice. The challenge of independent advocacy to the dominant discourse within mental health is considered and questions raised about the place of advocacy in modern democratic mental health systems. [Abstract copyright: Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mental health advocacy outcomes from service user perspectives

Purpose This paper addresses 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 codesigning evaluation systems. Methods The paper uses findings from three qualitative studies of independent advocacy involving focus groups and interviews with (1) 30 African and African Caribbean men who were mental health service users; (2) 90 ‘qualifying patients’ in a study of Independent Mental Health Advocate (IMHA) services; and, (3) nine young women in Children and Adolescent Mental Health Services (CAMHS). Findings A comparative analysis and synthesis of findings from the three studies identified 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 a) increasing involvement; b) changing care and treatment; c) 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. Originality Few studies have focused on the perspectives of people using independent mental health advocacy, or on the experience of ‘advocacy as empowerment’, and none has done so across diverse groups. These studies add insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems

A Pilot Study of the Early Experience of Consultant Psychiatrists in the Implementation of the Mental Capacity Act 2005: Local Policy and Training, Assessment of Capacity and Determination of Best Interests

The Mental Capacity Act 2005 (MCA) was partially implemented in April 2007 and fully implemented in October 2007 in England and Wales (with the exception of the Deprivation of Liberty Safeguards which were implemented in April 2009). The government estimated that up to 2 million adults in England and Wales may have issues concerning their decision-making capacity (henceforth ‘capacity’), and these will included 840,000 people with dementia, 145,000 people with severe learning disability, 1.2 million people with mild to moderate learning disability and 120,000 people with severe brain injury. Additionally, the prevalence of schizophrenia, mania and serious depression are 1%, 1% and 5% respectively, and some of these individuals may also lack capacity. Moreover, up to 6 million family and unpaid carers are estimated to provide care or treatment for individuals lacking capacity. Furthermore, many other people who do not lack capacity may use aspects of the MCA for future planning

Realising the right to equal recognition for disabled people: commissioning statutory advocacy in England

Article 12 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) asserts the right to equal recognition and non-discrimination before the law. It places an obligation on countries to enable people to access support to exercise this right. This is viewed as a shift from ‘substituted decision-making’ to ‘supported decision-making’, with various models emerging. This article considers the right to equal recognition in the context of independent advocacy for people requiring social care, introduced, by the Care Act 2014 in England, as one such model. Data from surveys of local authority commissioners and advocacy providers are used to examine early implementation of this statutory duty. The legitimization of advocacy through statute was universally welcomed. However, our findings raise questions about its commissioning and implementation as an effective model for supported decision-making and the extent to which it ensures disabled people exercise their right to equal recognition