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Independent Mental Health Advocacy (IMHA)
Mental Health Matters Wales no longer provides the
Independent Mental Health Advocacy (IMHA) service for Caerphilly, Blaenau
Gwent, Torfaen, Newport, & Monmouthshire area
This page is for information
only
Statutory
Independent Mental Health Advocacy was introduced on the 3rd
November 2008 in Wales (1st April 2009 in England) for
qualifying patients. These arrangements are introduced by way of amendment
to the Mental Health Act 1983 by section 30 of the Mental Health Act 2007.
Under these arrangements, Independent Mental Health Advocates (IMHAs)
provide qualifying patients with support and help.
Independent mental health advocates
provide an important safeguard for certain patients treated under the
compulsory powers of the Act. The following provides guidance about the
role and functions of IMHAs.
The Mental Health (Wales) Measure
2010 (Part 4) expand the existing
IMHA scheme on the 3rd January
2012 to include compulsory patients under sections 4 and 5 Mental
Health Act 1983
The second stage of the expansion,
relating to informal patients, came into force on the 2nd April
2012.
The expansion of the IMHA scheme
now means anyone in Wales, regardless of age, who meets the following
criteria, is entitled to access the support of an Independent Mental Health
Advocate (IMHA).
•
Detained in hospital under the
Mental Health Act (excludes sections 135 & 136)
•
Subject to a Community Treatment
Order (CTO) or Guardianship
•
A Conditionally Discharged
Restricted Patient
•
Being considered for ECT or
neurosurgery
•
An informal inpatient in any
hospital or registered establishment, being treated or assessed for a
Mental Health Condition (the patient maybe in hospital for a separate
health related matter)
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Patients who qualify for
advocacy support are:
- All
patients detained under the Mental Health Act 1983 (The Act)
- Patients
discharged to guardianship
- Patients
on a Community Treatment Order
- Patients
conditionally discharged
- Informal patients who discuss with a registered
medical practitioner or approved clinician the possibility of being
given a form of treatment to which section 57 treatment applies
- Informal patients under the age of 18 who discuss
with a registered medical practitioner or approved clinician the
possibility of being given a form of
treatment to which section 58A applies.
Please
Note: Patients subject to detention under
Sections 135 or 136 are excluded from IMHA advocacy support
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How does a qualifying patient find out about an IMHA
service?
Section
130D of the ACT places a duty on a “responsible person” to provide verbal and
written information about IMHA services to qualifying patients. This may be
a hospital manager, responsible clinician, local social services authority,
the patient’s doctor or approved clinician.
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Responsibility
for informing patients of IMHA service
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Qualifying patient
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Person responsible for informing the
qualifying
patient (the “responsible person”)
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Patient liable
to be detained
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The hospital
managers (delegated to nursing staff)
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A patient who is
liable to be detained but has been conditionally discharged
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The responsible
clinician (for the patient)
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Patient subject
to guardianship
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The responsible
local social services authority (LSSA)
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A community
patient
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The hospital managers (for the responsible
hospital)
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A patient for
whom treatment under section 57 is proposed, if they do not already fall
under one of the categories above
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The registered
medical practitioner or approved clinician with whom the patient first
discusses
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A patient under
18 years for whom the possibility of such treatment under section 58A is
proposed, if they do not fall under one of the categories above
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The registered
medical practitioner or approved clinician with whom the patient first
discusses
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The Code of Practice
explains the responsible person duties:
• They
must ensure that they tell the patient, both orally and in writing, that
support is available to them from an IMHA, and how they can obtain that
support.
• That
if a patient has a nearest relative, the responsible person should, unless
the patient requests otherwise, provide a copy of the same information, in
writing, to the nearest relative.
• As
well as telling people about the availability of independent mental health
advocacy, the responsible person must also ensure that the patient has the
opportunity of making use of IMHA support.
• If
the patient would like an IMHA, the responsible person should support them
in making contact for example, make
arrangements for the patient to meet the IMHA if the patient would
otherwise be unable to do this, but they should not at this stage disclose
any personal information about the patient to the IMHA service.
• They
should record in the patient’s medical records the steps taken to tell that
patient about IMHA support. Other people who support the patient should
also be informed about whether the patient would like support from an IMHA,
and any follow-up action required, if the patient has agreed to such
information being shared.
If a patient has been fully informed about IMHA support, and
chooses not to involve an advocate in their case, the responsible person
should:
· record
in the patient’s medical records that the patient was informed about
independent mental health advocacy and did not want it
· check
with the patient again at a later date in case they have changed their mind
· tell the patient that legal representation is
available and how to access it.
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Patients’ rights to an IMHA
A qualifying patient may ask for
the support of an IMHA at any time. Certain professionals have a duty to
tell qualifying patients that independent mental health advocacy is
available and how they may obtain it. Patients may want to consider
accessing an IMHA in the following circumstances:
· soon
after arrival in an inpatient unit to obtain reassurance and understanding
of their situation within the hospital environment and mental health
system;
• when
they know that their care and treatment is going to be discussed in a
meeting or ward round and they want help in preparing for the meeting, or
support or representation at the meeting itself
• when
they are concerned about particular aspects of their care or treatment and
wish to meet with their doctor/responsible clinician
• when they are going to be examined by a second opinion
appointed doctor (SOAD)
• When
they want to express concern about any aspect of their hospital experience
or access the complaints process
• when applying for or attending a hospital manager’s hearing
• when
applying to the Tribunal for a hearing, obtaining legal representation,
needing support at a hearing or help in understanding the decisions made by
a Tribunal
• when they have questions about their rights in relation to
their nearest relative
• why
they need help to understand, apply to and obtain legal representation for
County Court hearings about changing their nearest relative
• when they are being considered for supervised community
treatment (SCT)
• when
they are talking to their guardian about requirements the guardian is
imposing on them (e.g. about where they should live)
• when they want support to access medical or social services
records
•
prior to a discharge planning meeting to explore all their options and
raise concerns about appropriate after-care
• when
they want support in accessing other services
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who can refer to the IMHA
service
The Mental Health
(Wales) Measures states that IMHAs must comply with any reasonable request
to visit and interview a Welsh qualifying compulsory patient, if the
request is made by:
• the patient themselves
• someone the IMHA thinks is the patient’s nearest relative
• the patient’s responsible clinician (if they have one)
• an approved mental health professional (AMHP)
• a
registered social worker who is professionally concerned with the patient’s
care, treatment or assessment
• the
managers of the hospital (or a person Duly authorised by them where the
patient is liable to be detained (if this is the grounds for the person
being eligible for independent mental health advocacy)
• the patient’s donee or deputy (if they have one)
In respect of Welsh
qualifying informal patients, the duty on IMHAs to visit and interview the
patient is the same, but only engaged if the request is made by:
• the patient themselves;
• the
managers of the hospital (or person duly authorised by them) where the
patient is an in-patient;
• someone the IMHA thinks is the patient’s carer
• the
patient’s done or deputy (if they have one)
• a
registered social worker who is professionally concerned with the patient’s
care, treatment or assessment.
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The role of the independent mental health
advocate (IMHA)
The
IMHA provides support to qualifying patients to ensure they understand the Act
and their own rights and safeguards. This may include support in obtaining
information about any of the following:
- the patient’s
rights under the Act
- the
provisions of the Act under which the patient qualifies for an IMHA
- any
conditions or restrictions which affect the patient
- the medical
treatment the patient is receiving, or which is being proposed or
discussed, and the reasons for this
- the legal
authority for providing such treatment
- the requirements
of the Act which apply to treatment.
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What will the IMHA do?
The IMHA will:
- ensure that the
patient’s voice is heard by supporting the patient to articulate their
views and to engage with the multi-disciplinary team
- support patients
to access information, and to understand better what is happening and
what is planned, and to understand better the options available to
them
- support patients
in exploring options, making better-informed decisions and in engaging
with the development of their care plans
- supporting the
patient to ensure they are valued for who they are
- support
the patient to counteract any actual or potential discrimination.
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Supporting the role and work of the IMHA
Patients
should have access to a telephone to speak to an IMHA in private.
The IMHA has the right
to:
- visit and
interview the patient in private
- visit, interview
and get the views of anyone professionally concerned with the
patient’s medical treatment.
IMHAs should be enabled,
as appropriate, to:
- have access
to the unit and ward where the patient under detention is staying
- have access
to facilities in the community where the patient is a community
patient
- attend relevant meetings
and ward rounds when asked to do so by the patient.
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Access to records
Subject
to conditions, the IMHA has a right to access and inspect the patient’s
relevant records, including any records:
- about the
patient’s detention or treatment in any hospital or registered
establishment
- about any
after-care services provided to the patient under section 117
- of
or held by an LSSA about the patient
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Confidentiality
IMHAs
are expected to follow an agreed confidentiality policy. Under this, any
information a patient share with an IMHA should remain confidential unless
the patient want it to be disclosed, or the IMHA has reasons to disclose
it.
In
most circumstances the IMHA will tell the patient all the information they
have received on their behalf.
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Further
Information
The IMHA service is not a substitute
for independent advocacy as practised in the Health and Social Care
sectors. IMHAs specifically provide specialist advocacy within the
framework of Mental Health Legislation. Please read Myth buster for additional information.
For additional information please
see Chapter 25 of the Mental Health Act 1983 Codes of Practice for Wales
Charity Number:
1123842 Registered Company Number: 6468412
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© 2006 Mental Health Matters Wales. All rights reserved
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