Conflict of roles, a conflict of ideas? The unsettled relations between care team staff and independent mental health advocates.

Drawing on a national study of Independent Mental Health Advocacy we explore the social relations of independent advocacy. The study was commissioned by the Department of Health (England) and involved a case study design covering eight different geographies and service configurations, and interviews or focus groups with a total of 289 stakeholders across two phases of inquiry. This paper focuses on analysis of qualitative data relevant to the relationship between mental health care services and independent advocacy services, drawn from interviews with 214 participants in phase two of the study. Discussion of these particular findings affords insights into the working relations of independent advocacy within mental health services beset by reorganizational change and funding cuts, and increasing levels of legally sanctioned compulsion and coercion. We offer a matrix which accounts for the different types of working relationships that can arise and how these are associated with various levels of understanding of independent advocacy on the one hand, and appreciation for the value of advocacy on the other. The discussion is framed by the wider literature on advocacy and the claims by practitioners such as nurses for an advocacy role as part of their professional repertoire

The chronicity of self-injurious behaviour: A long-term follow-up of a total population study

Background: Self-injurious behaviour (SIB) is a relatively common problem for people with intellectual disabilities and it is known to be associated with various risk markers, such as degree of disability, sensory impairments, and autism (McClintock et al. 2003). Less is known about its long-term course however. Method: The present study was conducted to examine the quality of life and changes in behaviour for a cohort of 49 people with intellectual disabilities and SIB who were all part of a previous total population study conducted in the south of England by Oliver, Murphy and Corbett (1987). Assessment tools used in the original study, and an additional quality of life measure, the Life Experience Checklist (Ager, 1990), were carried out with informants in the participant's homes or places of day activity. Results: The results show that 84% of the sample continued to self-injure nearly 20 years on, with no significant mean changes in number of topographies or severity of SIB across the group. No one was living in hospital in this study (cf. many individuals in the first survey) but for those who had moved out of hospital, their SIB had not reduced. More people were receiving psychological treatment; more were also receiving anti-convulsant and anti-psychotic medications, though polypharmacy had reduced somewhat. The number of people accessing full-time day activities had decreased substantially, with 44% of people only accessing structured daily activities for 21/2 days per week or less. Conclusions: The results of the study add to the growing evidence of extreme chronicity for SIB and the relative lack of impact of treatment for people in whom self-injury has become well-established. They imply that early intervention is essential if such behaviour is to be eliminated long term