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Open Advocacy Protocol
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OPEN ADVOCACY PROTOCOL
PROTOCOL REFERENCE NUMBER
MHA 024/1
DATE RATIFIED August 2014
NEXT REVIEW DATE August 2017
APPROVED BY MH Clinical Policy Council
ACCOUNTABLE DIRECTOR Director of Nursing
PROTOCOL AUTHOR Mental Health Senior Nurse
Protocol Statement/Key Objective:
The Trust requires arrangements to be in
place to ensure that qualifying patients access
Independent Mental Health Advocacy (IMHA)
services. This protocol provides LCFT staff
with guidance on their roles and
responsibilities within the open advocacy (opt-
out) model.
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Executive Summary Title of Protocol: Open Advocacy Protocol
Subject: Access and referral to IMHAs
Applicable to: (state Network,
Services and staff groups)
All Networks, Ward and Community Staff,
Mental Health Act Administrators and
Advocacy Provider Services.
Key Protocol Issues: Information to Service Users, Mental
Health Act Code of Practice, Referral to
IMHAs, Mental Capacity Act, Best Interest
Decisions, Confidentiality.
Original Issue Date: February 2014 (Adult Mental Health)
Issue Date August 2014
Dates Protocol Reviewed: N/A new document
Next Review Date: August 2017
Protocol written by: Senior Mental Health Nurse
Protocol Lead: Senior Mental Health Nurse
In Consultation with: Operational Services Managers, MHA
Administrators, Network Director, Modern
Matrons, Director of Nursing, Networks
Leads, Trust Solicitor, Trust Legal Advisor,
Social Care Leads, Advocacy Focus,
Advocacy Experience, Real Advocacy and
MHA/MCA Committee members.
Monitoring Arrangements: See page 13
Approved by: Mental Health Clinical Policy Council
Authorised by: Director of Nursing
Related Procedural Documents: Code of Practice Mental Health Act. Code
of Practice Mental Capacity Act.
Data Protection Act.
CL 048a MCA Deprivation of Liberty
Safeguards, Managing Authority
Procedure
Links to CQC lines of enquiry: Safe, Effective, Caring, Responsive, Well
Led
Open Advocacy Protocol
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Table of Contents
1.0 Introduction....................................................................................................... 4
2.0 Scope ............................................................................................................... 4
3.0 Definitions......................................................................................................... 4
4.0 Duties ............................................................................................................... 5
5.0 The Protocol ................................................................................................ 6-12
6.0 Training .......................................................................................................... 12
7.0 Monitoring (including Standards) .................................................................... 13
8.0 References ..................................................................................................... 13
9.0 IMHA and Advocacy Providers for LCFT ……………………………………….14 Appendix 1 Record of Patient Rights Under Section 132 MHA 1983……………15 -16
Appendix 2 Qualifying Patient Information Leaflet…………………………………17- 27
Flow chart for Open Advocacy and referral to IMHA…………………………………..27
Open Advocacy Protocol
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1.0 Introduction
Independent Mental Health Advocacy services (IMHAs) provide an additional safeguard
for Service Users who are subject to the Mental Health Act (MHA). IMHAs are specialist
advocates who are trained specifically to work within the framework of the MHA to meet
the needs of Service Users. IMHAs do not replace any other advocacy and support
services that are available to Service Users, but are intended to operate in conjunction
with those services. Department of Health (DH) (2008) Code of Practice: Mental
Health Act 1983, p157.
The Health Committee of the House of Commons (2013) recommended that IMHAs
become an opt-out rather than an opt-in service to help address the difficulties Service
Users face in accessing advocacy and to eliminate some of the practical problems
clinicians face in making Service Users aware of their right to request an IMHA. The DH
is considering this recommendation and it is likely that guidance will become available.
In the interim, the Trust has developed this open advocacy protocol. It is intended that
this protocol will raise awareness in relation to individuals’ right to IMHAs, will improve
practice around Best Interest decision making within the Mental Capacity Act framework
and will improve the access and uptake of IMHA provision.
This protocol provides staff with guidance on their roles and responsibilities within
the open advocacy model.
2.0 Scope
This protocol is applicable to all Mental Health Act Administrators; ward and
community staff providing services to “qualifying patients” (see 5.0 page 6).
3.0 Definitions
CAMHS Child and Adolescent Mental Health Services ECR Electronic Care Record
IMHAs Independent Mental Health Advocacy services
IMHA Independent Mental Health Advocate
LCFT Lancashire Care Foundation Trust
IMCA Independent Mental Capacity Advocate MHA Mental Health Act
MHAA Mental Health Act Administrator
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MCA Mental Capacity Act
DH Department of Health
AMHP Approved Mental Health Practitioner
4.0 Duties
4.1 Trust Board
The Trust Board has responsibility for ensuring that policies and procedures are
implemented effectively across the Trust.
4.2 Chief Executive
As Accountable Officer, the Chief Executive must ensure that effective systems and
processes are in place to ensure that qualifying patients access IMHA services.
Responsibility for ensuring that this takes place is delegated to an appropriate
Executive lead and this is the Director of Nursing.
4.3 Director of Nursing
The Director of Nursing is responsible for ensuring that effective systems and
processes are in place to ensure that qualifying patients access IMHA services and for
providing assurances to the Executive Management Team (EMT) and the Trust Board
of compliance with this protocol.
4.4 MHA Committee
The committee will receive assurance that this protocol is being implemented.
4.5 Network and Clinical Directors
The Network and Clinical Directors have a responsibility for ensuring the effective
implementation of Mental Health Act, Mental Capacity Act and Data Protection
Codes of Practice and policies.
4.6 Modern Matrons/Service Managers
The Modern Matrons/Service Managers are responsible for ensuring this protocol is
fully adhered to and implemented within their specific area of responsibility.
4.7 Ward/Community Team Managers
The Team Managers are responsible for ensuring that this protocol is understood
and implemented on a day-to-day basis.
4.8 Ward and Community Staff
Staff are responsible for reading and adhering to this protocol on a day-to-day basis and
understanding their professional role and responsibilities under the MHA Code of
Practice and Mental Capacity Act.
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4.9 Mental Health Act Administrators (MHAA)
The Mental Health Act Administrators have responsibility for maintaining confidentiality.
They must collate information from the s132 rights form and forward qualifying patient’s
details to IMHAs where implied consent or a best interest decision has been
documented by qualified staff.
4.10 Advocacy Providers
Advocacy Focus, Advocacy Experience and Real Advocacy representatives will attend
the MHAA meeting on a quarterly basis to optimize learning from good practice
and consider any barriers to the open advocacy model.
5.0 The Protocol
Mental Health Act Administrators, ward and community staff have a central role in
ensuring that qualifying patients access IMHAs.
Criteria for “qualifying patients”;
• Service Users Detained under the Mental Health Act 1983
(However, IMHA services do not apply to s4, s5 or s135/136).
• Service Users Subject to a Guardianship Order
• Service Users on Supervised Community Treatment
• Conditionally discharged, restricted Service Users
• Service Users being considered for Section 57 or 58A Treatment.
(Section 58A Service Users qualify if they are under 18).
Please refer to Chapter 20: MHA Code of Practice for further information.
5.1 The Open Advocacy Model
The role of the Independent Mental Health Advocate (IMHA) is not just to give
information but to ensure that staff provide information to Service Users in a way that
elicits understanding and empowerment. IMHAs are not intended to replace legal
representation.
Role of the IMHA
To provide information to Service Users about their rights under the MHA.
To support the Service Users to understand their care and treatment plan and to
support them to express their views and wishes.
To provide information about people’s responsibilities under the MHA.
To plan for and provide support at tribunals and hospital managers meetings.
To contact the Service User’s solicitor and other agencies like social services.
To provide information and support with complaints.
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It also includes helping Service Users to exercise their rights, which can
include representing them and speaking on their behalf.
IMHAs may also support Service Users in a range of other ways to ensure
they can participate in the decisions that are made about their care and
treatment.
Staff have a duty to inform “qualifying patients” about the availability of IMHAs. Staff
must take whatever steps are practicable to ensure that Service Users understand that
support is available to them and how they can obtain that support. This must include
giving the relevant information both orally and in writing.
5.2 Providing information
When a Service User is detained under the Mental Health Act 1983 and meets the
criteria for a “qualifying patient” information about IMHAs must be given to the
Service User as soon as is practicable. This must be done is conjunction with S132
giving of rights and documented on the “Record of Patient Rights under Section 132
MHA 1983” form. (Appendix 1) The original copy must be sent to the MHA
administrator. A daily record detailing the information provided will also be documented
on ECR.
The role of IMHAs must be verbally explained and supported by an information
leaflet (Appendix 2 page 18). To enable IMHAs to be an opt-out rather than an opt-in
service staff must advise Service Users that they will be automatically referred to
the IMHA service unless they object. This discussion must be recorded on the Daily
Records of ECR and included in the Service User care plan.
In order to provide valid consent the person must be competent to make the
particular decision, not be acting under duress and have received sufficient information
to take the decision.
5.3 Assessing mental capacity
The MHA Code of Practice advises that AMHPs and responsible clinicians should
consider requesting an IMHA visit to a qualifying patient if they think that the patient
might benefit from an IMHA visit but is unable or unlikely to request an IMHAs help
themselves. This consideration must be evidenced on the MHA action form.
Advocacy providers can provide non instructed support for Service Users who lack
capacity around identified areas of their care and treatment as identified by the care
team (See 5.5 Non-Instructed Advocacy page 9).
Mental capacity is the ability to make a decision. When there is no doubt that the
Service User has capacity staff must respect the Service User’s view. However,
when there is doubt of a Service Users capacity there must be an assessment of
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their capacity to make this decision. Staff must be guided by the Mental Capacity Act
Code of Practice.
Diagnostic Test
Anyone assessing someone’s capacity to make a decision for themselves should
use the two-stage test of capacity;
Functional Test
• Does the person have an impairment of the mind or brain, or is there some sort of
disturbance affecting the way their mind or brain works? (It doesn’t matter whether
the impairment or disturbance is temporary or permanent.)
• If so, does that impairment or disturbance mean that the person is unable to make the
decision in question at the time it needs to be made?
Assessing ability to make a decision
• Does the person have a general understanding of what decision they need to make
and why they need to make it?
• Does the person have a general understanding of the likely consequences of
making, or not making, this decision?
• Is the person able to understand, retain, use and weigh up the information relevant to
this decision?
• Can the person communicate their decision (by talking, using sign language or any
other means)?
The Service User is assessed as having capacity to make the decision and
objects to the referral;
1. The assessment of the Service User’s capacity to make the decision and discussion
must be recorded on the daily records of ECR and included in the Service User care
plan.
2. Staff must ensure that Service Users who have capacity and decide to object to
referral are regularly reminded of the availability of the IMHA service. Any such
discussions must be recorded on the daily records of ECR.
3. Staff must not release the names of Service Users who have capacity and object
to referral. This would be a breach of confidentiality.
5.4 Making the referral
The Service User is assessed as having capacity, is fully informed to make the
decision and does not object to referral;
1. The referral process must be explained and the Service User must be supported
to make referral to the IMHAs. If the Service User would like a discussion with
IMHAs a referral can be made using telephone number;
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ADULT MENTAL HEALTH AND OLDER ADULTS
Advocacy Focus - 0300 323 0965
SPECIALIST SERVICES (GUILD LODGE)
Advocacy Experience – 01772 773 520
TIER 4 CAMHS
Real Advocacy - 07919246261
2. If the Service User does not want to speak directly to IMHAs the referral will be
accepted via the MHAA admissions report. The Service User must be made
aware that the process can take up to 3 days.
3. The assessment of the Service User’s capacity to make the decision and
discussion must be recorded on the daily records of ECR and included in the
Service User care plan.
The Service User is assessed as not having capacity to make the decision
One of the key principles of the Mental Capacity Act is that any decision made on
behalf of a person who lacks capacity must be done, or made, in that person’s best
interests. As long as decisions are in the best interests of the person who lacks
capacity to make the decision for themselves then the decision-maker will be protected
from liability. (MCA Code of Practice p64)
1. The assessment of the Service User’s lack of capacity to make the decision and
rationale for the best interest decision must be recorded on MCA module on ECR
and included in the Service User care plan.
2. The referral process must be explained to the Service User and they must be
made aware that this can take up to 3 days. If the Service User would like a
discussion with IMHAs a referral can be made using telephone number;
ADULT MENTAL HEALTH AND OLDER ADULTS
Advocacy Focus - 0300 323 0965
SPECIALIST SERVICES (GUILD LODGE)
Advocacy Experience – 01772 773 520
TIER 4 CAMHS
Real Advocacy - 07919246261
3. If the Service User does not want to speak directly to IMHAs the referral will be
accepted via the MHHA admissions report.
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5.5 Non-Instructed Advocacy
Non-Instructed Advocacy is a safeguard that ensures that those who are unable to
express their wishes clearly (or at all) or who otherwise lack the capacity either
temporarily or permanently to instruct or direct an advocate are represented by
someone independent of those who have responsibility for making decisions on their
behalf.
Central to non-instructed advocacy practice is the assertion that everyone has
certain needs that are fundamental to their well-being – even if they are unable to
express them. These include;
• Access to satisfactory care
• Freedom of choice
• Promoting self-value
• Opportunities for progression
When it has not been possible to establish communications with an individual, or
their wishes and views are unclear, the care team should consider using a non-
instructed advocate. This will include circumstances where it is unclear if the Service
User fully understands the issues related to their care and treatment, or key
decisions that are to be made about their future.
The focus of non-instructed advocacy is to ensure that basic rights and entitlements are
asserted on behalf of people who are unable to assert them for themselves. This
includes advocating on behalf of those who are unable personally to communicate their
own wishes and views.
The advocate will work towards non instructed advocacy principles to ensure that the
qualifying patient’s perspective is at the centre of any decisions made, and also
establish the person's wishes, preference and values. It is not the role of the
advocate to offer their own views or opinions as to what is in the person’s best interests.
If a Service User meets the criteria for Non-Instructed Advocacy contact;
ADULT MENTAL HEALTH AND OLDER ADULTS
Advocacy Focus - 0300 323 0965
SPECIALIST SERVICES (GUILD LODGE)
Advocacy Experience – 01772 773 520
TIER 4 CAMHS
Real Advocacy - 07919246261
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5.6 The role of the MHA Administrator in supporting open advocacy
The MHA Administrators (MHAA) will collate information from the s132 rights form
(Appendix 1) to produce a weekly report. This report must be edited to remove the
names of Service Users who have capacity and object to IMHAs referral. MHA
Administrators must not release the names of Service Users who fall into this category
as this would be a breach of confidentiality. The edited report with details of Service
Users who did not object or if lacking capacity where a best interest decision to refer
has been made, must be forwarded to local IMHAs providers. All reports must be
password protected or sent through secure NHS email. The MHAA must ensure that
this report is forwarded at least once a week.
Advocacy Focus - Secure Email: [email protected]
5.7 Supporting IMHAs
MHA Administrators, as well as ward and community based staff, must ensure that they
have a supply of up to date information about all of the IMHA services in their area and
that qualifying patients have access to the information (Appendix 2 and 3).
Ward and community staff must ensure that consideration is provided to involve the
IMHA in relevant meetings by timetabling key meetings and providing advance
notice to the qualifying patients and their IMHA.
Ward and community staff must ensure that “qualifying patients” can contact and meet
their IMHA in private.
5.8 Confidentiality and open advocacy
All staff must demonstrate that information governance issues have been considered
and addressed prior to sharing patient identifiable information. This includes
ensuring that reports are password protected or sent through secure NHS email. The
open advocacy model can be made compliant with the law on information sharing
provided that: Service Users are first informed about the role of IMHA when
provisions of the MHA are to be invoked. Staff must advise Service Users that they
will be automatically referred to the IMHA service unless they object.
For Service Users assessed as lacking capacity to decide whether they agree to a
referral, a best interest decision about the referral would authorise release of their
name.
Staff must not release the names of Service Users who have capacity and object
to referral. This would be a breach of confidentiality and may be unlawful.
Therefore these Service Users cannot be included in the referral list.
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5.9 Access to records
If the Service User consents (which presumes capacity) then the IMHA will have the
right to see any care records held by the detaining authority or social services authority.
IMHAs also have a right to visit and speak to any person who is currently professionally
concerned with a Service User’s medical treatment, provided it is for the purpose of
supporting that Service User in their capacity as an IMHA.
When a Service User lacks capacity, access to care records should not be
automatic. Ward and community staff must ask the IMHA to provide reasons why
they believe it to be relevant and appropriate. “The key consideration will therefore
be whether the disclosure is in the Service User’s best interests. Record holders
should start from a general presumption that it is likely to be in the Service
User’s best interests to be represented by an IMHA who is knowledgeable about
their case. But each decision must be taken on its merits”. Any such
considerations must be documented in ECR within the daily record. Please refer
to MHA Code of Practice, Chapter 20, for further information.
6.0Training
Clinical staff must be appropriately trained in assessing and recording whether
the Service User has mental capacity to make decisions and whether they
consent to treatment. All relevant staff identified by the Network training matrix
must complete MCA and information governance training.
Staff working with Service Users subject to Supervised Community Treatment
should receive further training about their obligation to inform qualifying service
user about their right to, and eligibility for, an IMHA.
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7.0Monitoring Standard Time frame How Whom
A representative from
Advocacy Focus, Advocacy
Experience and Real
Advocacy will attend the MH
Act Administrators meeting to
optimize learning from good
practice and consider any
barriers to the open advocacy
model.
Quarterly Standing agenda item on the
MHA Administrators meeting.
Barriers to open advocacy to be
escalated to the Mental Health
Senior Nurse by the MHAA,
Advocacy Focus, Advocacy
Experience and Real Advocacy.
Advocacy Focus, Advocacy
Experience and Real Advocacy
will provide a quarterly report on
referral uptake and activity.
The MHA Manager will provide a
highlight report to the locality
governance meetings and the
Quality and Effectiveness Boards.
MHAA
Manager Advocacy
Focus Advocacy
Experience Real
Advocacy
Report on open advocacy
referral activity and outcomes
to be submitted to the MHA
committee
Quarterly Report from the MHA
Administrators meeting. This will
include the IMHA referral, uptake
and activity information provided
by Advocacy Focus, Advocacy
Experience and Real Advocacy.
MHAA
Manager
8.0 References and related documents
1. Data Protection Act (1998).
2. DH (2008) Code of Practice: Mental Health Act 1983.
3. DH (2005) Code of Practice: Mental Capacity Act.
4. DH (2009) Reference guide to consent for examination or treatment.
5. House of Commons (2013) Post-legislative scrutiny of the Mental Health Act
2007. First Report of Session 2013–14.
6. MHA 024 - Section132: Policy for the giving of information to patients and
nearest relatives.
http://trustnet/docs/policies/DOCUMENTS%20POLICIES/Section%20132%20
Policy.pdf
7. SLAM (2013) The Maze: Third Edition.
8. UCLAN (2103) The right to be heard.
www.uclan.ac.uk/research/environment/projects/the_right_to_be_heard.php
9. http://www.parliament.uk/business/committees/committees-a-z/commons-
select/health-committee/news/13-08-14-mha2007cs/
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9.0 IMHA and Advocacy Services for LCFT
Advocacy Focus provide IMHA services to qualifying patients receiving care
and treatment from LCFT’s adult mental health and older adult mental health.
Telephone: 0300 323 0965
Email: [email protected]
Secure Email: [email protected]
Write to: Advocacy Focus, 54 Blackburn Road, Accrington, BB5 1LE
Advocacy Experience provide IMHA services to qualifying patients receiving
care and treatment from LCFT’s specialist services based a Guild Lodge.
Telephone: 01772 773 520
Real Advocacy provide IMHA services to qualifying patients receiving care
and treatment from LCFT’s Tier 4 specialist Child and Adolescent Mental
Health Service.
Telephone: 07919246261
Email: [email protected]
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2
3
4
5(4)
5(2)
17A
35
36
37
37/41
38
48/49 or other please state section of MHA:
Appendix 1- Record of Patient Rights under Section 132 MHA 1983
Patient’s Name: Ward: NHS No.
PATIENT’S RIGHTS
This is to certify that the above named was given notice, orally and in writing of his/her* rights, whilst detained under section: - Please circle as appropriate:
The reason for the rights to be read was due to (please circle as appropriate):
Admission Inter-Ward Transfer
Renewal of Section
Regrade of Section
(inc 5(4) & 5(2)
Restricted (Annually)
The rights were given by name/designation: Signature:
At time: am/pm* on date:
He/She* Understood / Did not understand / Lacked capacity / Refused
Entry onto ECR made Yes/No*
If the patient is incapable of understanding their rights, further attempts to notify him/her* will be on-going as per their care plan and recorded accordingly.
INDEPENDENT MENTAL HEALTH ADVOCATE REFERRAL
IMHA services do not apply to Sections 4, 5(4), 5(2), 135 or 136
Is the Service User a qualifying patient? Yes/No*
Patient’s right to an IMHA discussed and the ‘Open Advocacy’ model explained / leaflet provided?
Yes/No*
(A) The Service User is assessed as having capacity to make the decision and is fully informed
The Service User objects / does not object* to referral to IMHA.
IF SERVICE USER OBJECTS DO NOT RELEASE THEIR DETAILS
(B) The Service User is assessed as not having capacity to make the decision
The rationale for the best interest decision to refer to IMHA has been recorded in the MCA module on ECR and the care plan.
Yes/No*
Were any special circumstances used to assist with this undertaking of reading their rights?
Yes/No*
If yes what were these circumstances:
Please Turn Over (PTO)
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NEAREST RELATIVE INFORMATION
(Not applicable to patients detained under: Sections 35, 36, 37/41, 38, 45A, 47, 47/49, 48, 48/49)
The patient has/has not* agreed that their nearest relative can be notified. (* Please delete as appropriate)
The nearest relatives’ relationship to the patient (please refer to AMHP application for identification of Nearest Relative):
Name of the nearest relative:
Address of the nearest relative:
I have had my rights read to me / declined to have them read to me
Patients Signature: Date:
TO BE COMPLETED BY MENTAL HEALTH ACT ADMINISTRATOR ONLY Letter sent notifying the patients’ nearest relative of their rights, and a copy of the rights leaflet was sent on
Date:
Letter sent notifying the patient of their rights, and a copy of the rights leaflet was sent on
Date:
Referral to IMHA service if applicable Date
Signed: (Mental Health Act Administrator)
Date:
This form is to be completed ON ADMISSION, INTER-TRANSFER, REGRADE, RENEWAL OF MHA SECTION AND RESTRICTED SECTIONS ANNUALLY and sent to the MHA Administrator.
A copy must be made and placed in the patients’ notes.
GUIDANCE NOTES
This form is designed to be completed at the following events:
On Admission to each clinical area- including inter-ward transfers. On each subsequent attempt if rights refused, service user lacked capacity or
did not understand.
Upon renewal of MHA Section
Upon re-grade of MHA Section
Upon restricted section annually
A care plan must be completed on ECR for all those who did not understand their rights on the first attempt.
Monthly rights need to be clearly documented within the Record of Care and the appropriate monthly record of rights form needs to be completed.
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Appendix 2
How to access
Advocacy Services
While you are under the protection of the Mental Health Act (1983)
you have the right to the services of an Advocate.
This leaflet will give you information about how to contact an
Advocate, and how they can support you.
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Independent Mental Health Advocacy ~ ‘IMHA’
IMHA’s are Advocates specifically for people who are subject to the Mental Health
Act. Advocacy services are provided in each area by specialised teams and are
independent from Lancashire Care NHS Foundation Trust staff.
The service is completely free and works in conjunction with other Advocacy services. They
don’t make decisions for you and they don’t make judgments about you.
It is your choice to have help from an IMHA, and having help from an IMHA does
not stop you having help from another Advocate or a Lawyer.
An IMHA advocate can:
Provide information to Service Users about their rights under the MHA.
Support the Service Users to understand their care and treatment plan
and to support them to express their views and wishes.
Provide information about people’s responsibilities under the MHA.
Plan for and provide support at tribunals and hospital managers meetings.
Contact your solicitor and other agencies like social services.
Provide information and support with complaints.
How do I contact an Advocate?
Service Area Provider Service Telephone Inpatient units
Adult Mental Health
and Older Adult
Services
0300 323 0965
In Lancashire and for
those subject to
Supervised Community
Treatment, Conditional
Discharge and
Guardianship.
Specialist Services
01772 773 520
Guild Lodge
Child & Adolescent
Mental Health
Services
07919246261
For young people at
The Platform and The
Junction (Tier 4).
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You can telephone the Advocacy Service yourself, your nearest relative can make
contact for you or you can ask a member of staff to contact them for you.
You are a qualifying in-patient If you are subject to the Mental Health Act 1983 (MHA 1983), you will be given
information about your Rights under the MHA 1983 and you will be told about your
right to see an Advocate.
To qualify for Advocacy support, you must be subject to the Mental Health Act 1983.
Sections that do not qualify are Section 4, Section 5(4), Section 5(2) Section 135 and
Section 136.
You will be automatically referred to the Advocacy (IMHA) service unless you object.
If your nurse thinks that you are too unwell to make a decision about seeing an
Advocate they may ask for you to be seen. You can still decide if you do not wish to
see the Advocate again. You will be given a leaflet and be told about your Rights, and when you may appeal
against your detention. The leaflet also explains about medication. A list of questions
you might want to ask about you medication are included on page 4.
You may appeal to the First Tier (mental health) Tribunal and/or to the Hospital
Managers dependent on your Section type. Information about these services and
application forms can be found on pages 7 and 8.
You are a qualifying community patient if you are on Supervised Community
Treatment, Conditional Discharge and Guardianship. If you are subject Mental Health Act 1983 (MHA 1983) in the Community, you will be
given information about your Rights under the MHA 1983 and you will be told about
your right to see an Advocate.
Details of who to contact can be found on page 2. You will be given a leaflet and be told about your Rights, and when you may appeal
against your detention. The leaflet also explains about medication. A list of questions
you might want to ask about you medication are included on page 4.
You may appeal to the First Tier (mental health) Tribunal and/or to the Hospital
Managers dependent on your Section type. Information about these services and
application forms can be found on pages 7 and 8.
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Questions to ask about your Medication
Your Doctor will tell you about any rules that apply to your medication while you
are subject to the MHA 1983.
You may want to ask some questions about the medication and how it might
affect you. Below are some suggested questions that might help you.
Why am I being given this medication?
How does it work?
What is the usual dose?
What dose will I be given?
When should I take this medication?
Do I have to take this medication every day?
Does this medication have any side effects?
Are there any special side effects that I need to watch out for?
What should I do if I have any side effects?
How long will it take for the medication to work?
How will I know if the medication is working?
When can I stop taking the medication?
What happens if it doesn’t work?
Does alcohol affect this medication?
Is this the only medication available?
What other treatments are available?
Are there any natural remedies I should not take with this medication?
Open Advocacy Protocol
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How do I Appeal?
Mental Health Act Administrators will make sure you have information about
your rights under the Mental Health Act 1983 and can help you with your
appeal
To appeal to the Hospital Managers
You may complete an application form, which is on page 7.
You may write a letter to the MHA administrator asking for an appeal to be
arranged.
You can ask an IMHA (Advocate).
You may ask a Solicitor to make an appeal on your behalf. A list of Solicitors
is on page 11.
To appeal to the First Tier Mental Health Tribunal
You may complete an application form, which is on page 8.
You may write a letter to the MHA administrator asking for an appeal to be
arranged.
Your can ask an IMHA (Advocate).
You may ask a Solicitor to make an appeal on your behalf. A list of Solicitors
is on page 11.
If you do not feel well enough to contact a Solicitor yourself, your nurse, Care
Coordinator or the MHA Administrator can ask for a Solicitor on your behalf.
Further information about the Mental Health Act and how to appeal can be found
online at http://www.lancashirecare.nhs.uk/about-us/Mental-Health-Act-
Information.php
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APPLICATION FOR A HOSPITAL MANAGERS REVIEW
Please complete this form as far as you are able. If you are unsure how to complete it, you can ask anyone at the hospital, a relative or friend, to help.
I am detained in hospital under the Mental Health Act 1983 and I wish to apply for a Hospital Managers’ Review.
1. My full name is
2. I am detained under Section of the Mental Health Act 1983.
3. I would like you to notify and invite my nearest relative to the review hearing:
My nearest relative’s name is_
4. I would like to be legally represented at the hearing.
Yes No
5. I intend to appoint a Solicitor myself
6. I would like to discuss the appointment of a Solicitor with the Mental Health
Act Administrator. Signed Dated
Send completed application form to Mental Health Act Administrator
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APPLICATION TO FIRST TIER TRIBUNAL (MENTAL HEALTH) Mental Health Act 1983 (as amended)
The Tribunal Procedure (First-tier Tribunal) (HESC) Rules 2008
Please tick the relevant application type
Application by or on behalf of a patient detained for assessment (S.2)
Application by or on behalf of a patient subject to a Guardianship Order
Application by or on behalf of a non-restricted patient detained for treatment
Other application by a non- restricted patient (specify *)
Application by or on behalf of a patient subject to a Community Treatment Order
Application by the patient’s Nearest Relative (specify *)
Application by or on behalf of a RESTRICTED patient
*
Please complete all information requested in this part of the application form. An application must, if possible, contain all the information requested.
If you cannot provide the information required below, please give reasons. The tribunal may return an incomplete application form.
Patients Full Name1
Date of Birth1
Provision /Section under which the patient is detained, liable to be detained, or subject to an
Order under the Act1
Date(s) of relevant Section, Admission, and/or Order
1
Hospital (where patient is, or is liable to be, detained)1
Responsible Authority1
(Name & Address - see Guidance)
LANCASHIRE CARE NHS FOUNDATION TRUST
For patients in the community please give
1) Patient’s address and
2) Name and address of
Community Supervisor or
Care Coordinator1
1 Parties must cooperate with the tribunal and this information is required to enable the tribunal to deal
with the case effectively and to avoid delay. An incomplete application form may be returned.
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Nearest Relative details if known
Name:
Address:
Relationship to patient:
Solicitor’s details if known
Name of solicitor:
Name & address of solicitor’s firm:
Telephone number:
Secure email address:
Unrepresented: *Delete as appropriate
I intend to appoint a solicitor myself*
I would like a solicitor to be appointed on my behalf*
I do not wish to appoint a solicitor as I intend to represent myself at the hearing*
Does the patient require an interpreter/have other special requirements?
If an interpreter is required please enter the language and dialect required
Please tell us of any other special requirements
DECLARATION (*Delete as appropriate)This application is submitted by the patient or nearest relative OR This application is submitted on behalf of the patient or nearest relative, who has personally authorised me to submit this application on their behalf.
Signature
Print Name
Date
Completed forms should be sent by secure email to: [email protected] (if you have a CJSM account then you should send to [email protected]) or by first class post to: The Tribunal Service (Mental Health), PO Box 8793, 5
th Floor, Leicester
LE1 8BN. Please do not submit the form more than once.
Open Advocacy Protocol
SOLICITORS LIST Blackburn
Roebucks Solicitors 12 Richmond Terrace Blackburn BB1 7BG Keith Adamson Gina Steele Barbara Howarth David Griffiths
07903 559909
Louise Neville Tel: 01254 274000
01254 52821 Fax: 01254 274001
Blackburn Lisa Marie McNulty Solicitors 756 Whalley New Road Blackburn BB1 9BA Lisa Marie McNulty Alison Cox Annette Bateman Debbie Kempson Ruth Sagar
Rachael Glover
Tel: 01254 248209 Fax: 01254 246795
Bradford Switalski’s Solicitors 2a Darley Street Bradford BD1 3HH
Lynn Melia
07891 341831 Katherine McCabe Angela Hunt
Tel: 01274 720314 Fax:
Harrogate Francina Whelan & Co New Barn House Hall Mews Clifford Road Boston Spa LS23 6DT
Francina Whelan
Tel: 01937 534022 Fax: 01937 534022
Liverpool Jackson & Canter 40 St Mary’s Road Garston Liverpool L19 2JD
Mike Davies
Tel: 0151 282 1782
Carlisle Carlisle Law Chambers 8 Spencer Street Carlisle CA1 1DG
Margaret Payne
Tel: 01228 521383 Fax: 01228 818169
Burnley Southerns Solicitors PO Box 21 Mackenzie House 66/68 Bank Parade Burnley BB11 1UB
Neil Cronin Rachel Eastham Henry Saunders Emma Jackson
Tel: 01282 422711 Fax: 01282 470320
Preston O’Donnells Solicitors 68 Glovers Court Preston PR1 3LS
John O’Donnell Laura Wilson Ruth Muncaster Phillippa Curran
Tel: 01772 881000 Fax: 01772 883178
Bolton Fieldings Porter Silverwell House Silverwell Street Bolton BL1 1PT
Basil Herwald
Tel: 01204 540900 / 591123 Fax: 01204 305345
Hoylake Peter Edwards Law Ventura House 8 Market Street Hoylake CH47 2AE
Salil Kumar Steven Beard Paul Williams Andrew Perks
Tel: 0151 632 6699 Fax: 0151 632 6606
Manchester Rowlands Otten Penna 339 Palatine Road Northenden Manchester M22 4HH
Ruth Edwards Gareth Miller Susan Cragg Morna Rivers
Tel: 0161 945 1431 Fax: 0161 946 0408
Manchester John Black Solicitors 64 Cross Street Sale Manchester M33 7AN Fay Acklam Joanne Black Tel: 0161 972 5999
Manchester
Blavo & Co Solicitors 3 Piccadilly Place Manchester M1 3BN
Sian Bradley
Tel 01612 421 222
Oldham Quality Solicitors Gruber
Garratt King Street Buildings Manchester Street Oldham, OL8 1DH
Andrew Cole
Tel: 0161 665 3502 Fax 0161 665 4060
Liverpool Hogans Solicitors 10 Station Street Prescot MerseysideL35 0LP
Kevin Lloyd Caroline Sims Robert Beech
Tel: 0151 430 7529
Liverpool Swain & Co 2
nd Floor
Bulloch House 10 Rumford Place Liverpool L3 9DG Joanna Dean Adrian Syms
Tel: 0151 255 2286
Liverpool RMNJ Solicitors 63 Hamilton Square Birkenhead Wirral, CH41 5JF Richard Nicholas Nicola Cho Louise Wilson Fay Acklam Ian McEvoy
Tel: 0151 647 0000
Harrow Duncan Lewis Spencer House 29 Grove Hill Road Harrow On the Hill Middlesex HA1 3BN
Peter Wusu
Tel: 0203 114 1124
London Nieko Solicitors (London) Rachel House 214-218 High Road London N15 4NP
Michael Curwen
Tel: 0208 808 3067
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Page 27 of 27
LCFT Flow Chart for Open Advocacy and Referral to IMHA
Service User admitted to Inpatient Services who is detained under the Mental Health Act
1983 and meets the criteria for a “Qualifying Patient”.
Qualifying Patient
Service Users detained under the Mental Health Act 1983
However, IMHA services do not apply to s4, s5 or s135/136
Service Users Subject to a Guardianship Order
Service Users on Supervised Community Treatment
Conditionally discharged, restricted Service Users
Service Users being considered for Section 57 or 58A Treatment
Section 58A Service Users qualify if they are under 18.
Information about IMHAs must be given to the Service User as soon as is practicable.
This must be done is conjunction with S132 giving of rights. Staff must advise Service
Users that they will be automatically referred to the IMHA service unless they
object.
The Service User is assessed
as having capacity, is fully
informed to make the
decision and does not object
to referral
The referral process must be
explained and the Service User
must be supported to make
referral to the IMHAs. If the
Service User would like a
discussion with IMHAs a referral
can be made using the telephone
numbers below.
If the Service User does not want
to speak directly to IMHAs the
referral will be accepted via the
MHHA report. The Service User
must be made aware that the
process can take up to 3 days.
The Service User is assessed as not
having capacity to make the decision
The assessment of the Service Users
lack of capacity to make the decision
and rationale for the best interest
decision must be recorded on MCA
module on ECR and included in the
Service User care plan
The referral process must be explained
to the Service User and they must be
made aware that this can take up to 3
days. If the Service User would like a
discussion with IMHAs a referral can be
made using telephone numbers below.
If the Service User does not want to
speak directly to IMHAs the referral will
be accepted via the MHHA report.
The Service User is assessed as
having capacity to make the
decision and objects to the
referral. Staff must not release
the names of Service Users
who have capacity and object
to referral. This would be a
breach of confidentiality.
Staff must regularly remind the
Service User of the availability of the
IMHA service. Any such discussions
should be recorded on the daily
records of ECR.
The Service User is assessed as
having capacity, is fully informed to
make the decision and does not
object to referral
How to Make a Referral for IMHA
The assessment of the Service
Users capacity to make the
decision and discussion must be
recorded on the daily records of
ECR and included in the Service
User care plan.
The Independent Mental Health Advocacy Service
An IMHA is an advocate that helps support the rights of service users who are
detained under the Mental Health Act 1983. The Advocate will work with
health and social professionals to help support the service user and to ensure
their voices are heard.
Adult Mental Health & Older Adults
Advocacy Focus
By Telephone: 0300 323 0965 By Email at: [email protected]
Specialist Services (Guild Lodge)
Advocacy Experience
By Telephone: 01772 773 520
Tier 4 CAMHS
Real Advocacy
By Telephone: 07919246261