From petitions to professionals

Peter Campbell

Extract from Openmind 107, Jan/Feb 2001

The development of independent advocacy has been a feature of mental health services in the last 15 years. In that period, we have moved from an environment where the need for advocacy was just beginning to be seriously discussed, to one where numerous mental health organisations are now calling for a right to advocacy in any new Mental Health Act...

Mental health advocacy has a long history. ...Nevertheless, until the early 1980s, there was no great focus among professionals on independent advocacy for health and social care users, and a general lack of information and awareness among service users themselves.

The International Year of the Disabled (1982) and the establishment of the Advocacy Alliance stimulated a greater appreciation of advocacy, and this was accelerated in the mental health field by the rapid emergence of service user action groups from 1985 onwards. It soon became clear that independent advocacy would be a core demand of local groups throughout the UK.

The growth of advocacy has undoubtedly benefited from official discovery (during the 1980s) of the mental patient as consumer of the health and social services. This brought individual needs and wants closer to the heart of developing cost-effective care, and made it increasingly important that individual and collective voices were properly heard.

Although the status of advocacy has not yet been reinforced by effective legislation, the significance of consultation and involvement, with which it is so closely linked, has now been widely recognised.

In the mid-1980s, much of the pioneering work on service user-led advocacy was done by Nottingham Advocacy Group, drawing on the experience of advocacy organisations in the Netherlands. Initially, the emphasis was on establishing patient's councils to provide collective advocacy for service users in in-patient settings. But the focus has widened subsequently, so that we have now reached a position where individual advocacy is at least as important as collective and many people have access to advocates in the community as well as in hospital...

The organisation of advocacy is not highly co-ordinated. The United Kingdom Advocacy Network (UKAN) includes many service user-led advocacy projects and has produced a code of practice and a training package [UKAN, Voserve House, 14-18 West Bar Green, Sheffield S1 2DA - see also The Mind Guide to Advocacy ]. Other regional networks exist, such as the Greater London Mental Health Advocacy Network. Citizen advocacy and legal advocacy also have their own support networks.

At the recent advocacy national conference organised by Greater London Mental Health Advocacy Network and Mind, participants voted for work to start on a new code of practice for England and Wales. A move towards greater uniformity in advocacy provision is anticipated.

Although the importance of independent advocacy is now widely accepted, there are some questions that remain unanswered. The Government seems reluctant to give advocacy a significant and defined role in a new Mental Health Act. If they are persuaded to do so, what impact will this have on the systems currently delivering advocacy? Will training need to become standardised? How will advocates be monitored? Will there be a danger that the demand for legal advocacy pushes other types of advocacy to one side? If practice becomes more 'professional', will it be more difficult to have service-user controlled advocacy services? Will it really matter if it is?

Whatever the organisational uncertainties, independent advocacy should be available for all who want it. Advocacy is not a miracle cure. Indeed there is currently a lack of research evidence on the extent to which mental health advocacy can be said to 'really work'. But at its best it increases the chance that people will receive a service that meets their wishes. It tips the balance a little in favour of the recipient...