I've now had experience in two health boards, of family members in psychiatric inpatient wards, and have found that the independent advocacy is either ineffective or non-existent. What's happened?
In Fife the advocacy, in our experience, wasn't either independent or effective in standing up to human rights abuses in locked wards. Circles Network based in Warwickshire, England, manages the Fife project. Difficult to get an appointment, someone to attend an important meeting. Then when you did get someone they weren't effective in helping the patient speak out. It's like they were standing with the funders, the system and the loudest voice.
In Dundee there seemed to only be collective advocacy in the wards where discussions could at times be overheard by anyone in the next room. So much for confidentiality. No sign of individual, independent advocacy. In fact a nurse said to me that they could advocate for the patient. I tried to explain the importance of an independent voice but not sure if the concept was understood.
No carer advocacy at either place and as a carer I ended up having to advocate in the clinical meetings, representing their views, finding out what the issues were, making sure their voices were heard.
I was an independent advocate in Perth back in 2000-2 and remember it as an important role where I had a range of 'partners', including a male patient in a forensic locked ward. Having an advocate made a difference to all the folk I worked with, helping them to speak out, challenge issues and influence situations for the better.
I'm hoping this isn't a trend in Scotland, that independent advocacy is becoming less important and therefore less available to locked in patients and others with particular issues. There will always be a need for independent advocacy, to uphold the rights of people in the psychiatric system. But the people need to know their rights and be informed about the importance and availability of expert, independent advocacy.
The best advocacy I've witnessed in both areas has come from solicitors at mental health tribunals where they have represented accurately and consistently the views of the patient. This is the quality of advocacy I would like to see available through the independent advocacy projects. It could be achieved through the provision of a national training programme and quality standards.
I'm thinking it's another case of postcode lottery in Scotland's mental health world. Whereas I'd rather have consistency in practice and provision, good mental health services in every health board area. Independent advocacy available to locked in patients, people labelled with a disorder, and their carers, of a high standard, monitored and evaluated. To ensure that human rights are upheld and voices heard.
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