Independent Mental Health Advocates (IMHAs) and statutory advocacy providers are commissioned and funded by NHS Trusts or Local Authorities — the very bodies whose actions they are meant to scrutinise. This creates a troubling conflict of interest: when safeguarding concerns arise, charities risk losing funding if they challenge too hard. As a result, patients in psychiatric care can fall through a loophole where no one is truly safeguarding them. Should we not be questioning whether the Mental Health Act itself needs reform, so that advocacy is genuinely independent and safeguarding cannot be side-stepped by funding arrangements? If a system designed to protect the most vulnerable cannot guarantee their safety, what does that say about our wider approach to mental health care?
I agree. Proving that such occurs in the tendering process for advocacy services is more difficult! That much used Hans Christian Andersen moral folk tale of “The Emperor’s New Clothes” comes to mind. Meaning a moral that it is best to trust oneself and be honest; Speak up for the truth and what is right. Lessons learnt in the contemporary environment of health and social care is not to do it on your own. I applaud you raising this.
I know you wish to focus on IMHAs. I think the issue sits in a wider landscape.
I want to share some experience drawing form ‘advocacy services’ in one nameless patch.
The certain hospital in the UK is known to ‘house’ a concentration of the most dangerous and mentally disordered people in the country. 20-odd years ago, they retained advocacy services that were quite active. Consultants in psychiatry groaned regularly on notice of an advocate appearing at a Ward Round, and even more after they left. Why? Obviously advocates asked searching questions and really advocated for patients.
Then 20-odd years later, on my return to said institution, I hardly heard of advocacy and only spotted an advocate once at a WR over several months. So, I made my way over the the advocacy offices and met FTF with their top level people.
Oh yeah - they talked the talk. But in reality did not walk the walk. I learned that the ‘institution’ had gone through several changes of advocacy services.
What seemed to happen is that eventually they settled on a limp group of advocates who would do just enough to tick boxes somewhere.
Nobody can ‘guarantee’ anybody’s safety. But I think drawing from my above experience, NOBODY in services cares much about advocacy. I am hopelessly biased by working in all the wrong places.
Across the land this is what I have experienced in the last 5 years:
- The most vulnerable are unlikely to come to notice of an advocate of any type (e.g. LD services).
- In non-LD services ‘you’ put in a request for an advocate and wait for weeks - yuh know, similar to requesting a SOAD from the CQC.
- MDT members will try to help patients but they’re stretched thinner than cling film and are running around like headless chickens.
The reality is that many systems around the world have been changed by a virus, about 3 years ago. Advocacy has various forms but at the core of the concept it is about protecting or defending people’s rights.
The erosion of legal aid, the concentration of executive power, and the economic pressures on ordinary people—are not unique just from my perspective. They are widely recognised challenges to the rule of law and the principle of equal access to justice in the UK.[Justice does not mean ‘just the courts’ - it includes fairness. And I’m aware that legal aid is not necessary for the sort of advocacy in this thread. Reference to it is only to show the landscape of things.]
The key challenge is how to rebuild and strengthen the institutions and services that provide a check on power and ensure that justice is not just a privilege for the wealthy, but a fundamental right for everyone.
This will likely require significant policy changes, increased public funding, and a renewed commitment to democratic accountability. But what we need is not likely to be what we get, with a £50 billion fiscal blackhole ahead (up from £22 Billion) and with £60 billion sitting in piggy bank waiting to payout via CNST - and maternity services claims circa £45 billion. Reality is painful place!