What is an Independent Mental Health Advocate (IMHA)?
Independent mental health advocacy services provide an additional safeguard for patients who are subject to the Act. IMHAs are specialist advocates who are trained specifically to work within the framework of the Act to meet the needs of patients. See Chapter 20 of the Mental Health Act Code of Practice for information on Independent Mental Health Advocates (IMHAs). Visit our download page for more information.

The role of the IMHA
The Act says that the support which IMHAs provide must include helping patients to obtain information about and understand the following:

their rights under the Act;

the rights which other people (e.g. nearest relatives) have in relation to them under the Act;

the particular parts of the Act which apply to them (e.g. the basis on which they are detained) and which therefore make them eligible for advocacy;

any conditions or restrictions to which they are subject (e.g. as a condition of leave of absence from hospital, as a condition of a community treatment order, or as a condition of conditional discharge);

any medical treatment that they are receiving or might be given;

the reasons for that treatment (or proposed treatment);

The legal authority for providing that treatment, and the safeguards and other requirements of the Act which would apply to that treatment.

Who is eligible for an IMHA?
The Act describes those patients who are eligible for IMHA services as 'qualifying patients'.

This includes patients who are:

detained under the Act (even if they are currently on leave of absence from hospital); for example s2, s37

Conditionally discharged restricted patients;

subject to guardianship; or

on supervised community treatment (SCT)

It does not include patients who are detained:

on the basis of an emergency application (section 4) until the second medical recommendation is received

under the holding powers in section 5; or

in a place of safety under section 135 or 136.

Patients who don't otherwise qualify are also eligible for help from an IMHA if they are being considered for a section 57 treatment or if they are under 18 and being considered for a section 58A treatment. These patients will remain eligible until either the treatment is finished or it is decided that the treatment will not be given for the time being.

The types of treatment to which the special rules in Section 57 apply are:

Neurosurgery for mental disorder

Surgical implantation of hormones to reduced the male sex drive.

The types of treatment to which the special rules in Section 58A apply for patients under 18 (whether or not they are detained) are:

Electro-convulsive therapy (ECT)

Medication administered as part of ECT

Traditionally advocacy services have informed patients and relevant staff about independent advocacy services. Under the Act, the responsibility also falls on hospital managers, approved clinicians, responsible social services authorities and registered medical practitioners, who have a duty to inform patients about the IMHA services as set out in the table below.

Approved Mental Health Practitioners (AMHPs) and Responsible Clinicians (RCs) should consider requesting an IMHA to visit a qualifying patient if they think that the patient might benefit from an IMHA’s visit but is unable or unlikely for whatever reason to request an IMHA’s help themselves. Please click here to download an IMHA referral form.

Type of patient	Steps to be taken by	As soon as practicable after
Detained patient	The managers of the hospital in which the detained patient is liable to be detained	The patient becomes liable to be detained
Guardianship patient	The responsible local social services authority	The patient becomes subject to guardianship
SCT patient	The managers of the responsible hospital	The patient becomes an SCT patient
Conditionally discharged patient	The patient's responsible clinician (RC)	The patient is conditionally discharged
Other patient	The doctor or approved clinician (AC) who first discusses with the patient the possibility of them being given the section 57 or 58A treatment in question	The discussion (or during it)

As with giving any other information to patients, consideration will need to be given to how and when the information is provided to the patients. It is important for professionals to make a judgement about the best time to speak with the patient about the IMHA service. This must include giving the relevant information both orally and in writing.

In addition to the statutory requirements to inform patients about heir rights to access an IMHA service, it is good practice to ensure that information about the service is provided again in situations where the patient could particularly benefit from their help. For example, when the patient is:

being considered for s17 leave from hospital

being consider for SCT

having their care plan agreed or reviewed

preparing for a Mental Health Review Tribunal or hospital managers hearing

Information for nearest relatives
As well as providing the information to the patient, the responsible person must, wherever practicable, give a copy of the written information about the IMHA service to the patient's nearest relative, unless the patient requests otherwise (and subject to the normal considerations about involving nearest relatives – see paragraphs 2.27-2.33 of the Code of Practice). It should be made clear to the nearest relative that the IMHA services is for the patient themselves and not for the nearest relative.

Duty of IMHAs to visit patients
IMHAs must also comply with any reasonable request to visit and interview a qualifying patient, if the request is made by the patient’s nearest relative, an approved mental health professional (AMHP) or the patient’s responsible clinician (if they have one). But patients may refuse to be interviewed and do not have to accept help from an IMHA if they do not want it.

IMHAs access to patients and professionals
When instructed by a patient, the nearest relative, an AMHP or the responsible clinician, an IMHA has the right to meet the patient in private. IMHAs also have a right to visit and speak to any person who is currently professionally concerned with a patient’s medical treatment, provided it is for the purpose of supporting that patient in their capacity as an IMHA.

IMHAs should:

have access to wards and units on which patients are resident;

meet with the patients they are helping in private, where they think appropriate; and

be able to attend meetings between patients and the professionals involved in their care and treatment when asked to do so by patients

IMHAs access to patients' records
Where the patient consents, IMHAs have a right to see any clinical or other records relating to the patient’s detention or treatment in any hospital, or relating to any after-care services provided to the patient. IMHAs have a similar right to see any records relating to the patient held by a local social services authority. Where the patient does not have the capacity (or in the case of a child, the competence) to consent to an IMHA having access to their records, the holder of the records must allow the IMHA access if they think that it is appropriate and that the records in question are relevant to the help to be provided by the IMHA. When an IMHA seeks access to the records of a patient who does not have the capacity or the competence to consent, the person who holds the records should ask the IMHA to explain what information they think is relevant to the help they are providing to the patient and why they think it is appropriate for them to be able to see that information. The Act does not define any further what it means by access being appropriate, so the record holder needs to consider all the facts of the case. But the starting point should always be what is best for the patient and not (for example) what would be most convenient for the organisation which holds the records. In deciding whether it is appropriate to allow the IMHA access, the holder of the records needs to consider whether disclosure of the confidential patient information contained in the records is justified.

At all times Spiral Skills works to the Advocacy Code of Practice..
Extract from the Code of Practice: "People are entitled to be in control of their own lives but sometimes, whether through frailty, disability, financial circumstances or social attitudes, they may find themselves in a position where their ability to exercise choice or present their own interests is limited. In these circumstances advocates can help ensure that an individual's views and needs are heard, respected and acted upon. Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need. Advocates and advocacy schemes work in partnership with the people they support and take their side. Advocacy promotes social inclusion, equality and social justice.”

Please click here to download a full copy of the Advocacy Code of Practice. This is a PDF file if you don't already have Adobe Reader click here to download free.

Confidentiality.
Spiral Skills Advocacy Service has a confidentiality policy and guidelines. We will keep the things you tells us confidential unless it would be dangerous to you or someone else not to. Please visit our downloads page to read the Spiral Skills confidentiality policy, your advocate will be happy to discuss this with you.

Complaints.
If you have a complaint about Spiral Skills Advocacy service, you can be reassured that the appropriate procedure is in operation. If you would like to discuss making a complaint, or you would like a copy of the complaints procedure please contact Spiral Skills or alternatively you can download a copy of the procedure from our web site.

How to get in touch.
Please visit the contact us page for ways to get in touch and visit the downloads page for referral forms, leaflets, policies, guides and feedback forms. Thank you.

Spiral Skills Independent Mental Health Advocate (IMHA) Service.