What is advocacy?
Advocacy is a way of supporting an individual to say what they want, ensure their rights are upheld, access services or other resources that they are entitled to. Paid professional advocates are independent of other service providers such as the NHS or local authority to ensure that they represent the person only and to ensure there is no conflict of interest.
There are several forms of advocacy including legal advocacy (a solicitor for example); peer advocacy (where the advocate and the person they represent have shared/similar experiences for example in mental health); self advocacy (where someone speaks for themselves but may have been supported to do this); collective or group advocacy (where a group progress a commonly shared experience or issue for example patient groups or campaigning groups); informal advocacy (where a friend or relative acts as an advocate for someone to ensure they have support and have their views heard); as well as instructed, non-instructed and statutory advocacy.
Overall advocacy seeks to ensure and promote social justice, equality and inclusion.
Instructed advocacy means the person is able to state their wishes as well as the actions they would like the advocate for take, for example write a letter on their behalf, represent them in meetings or contact professionals in their lives. Those that are able to instruct an advocate have the capacity (ability) to understand the advocacy role and how the advocate can represent them. Capacity is decision specific and is defined as someone being able to understand, retain, weigh up and communicate their views and wishes on a particular decision. There may be occasions where a person may be deemed not to have capacity to make a particular decision but has the capacity to comprehend the advocacy role and instruct them.
Non instructed advocacy takes place when a person is unable to instruct an advocate due to communication issues, comprehension or ability, this might be because they have dementia, a learning difficulty, be acutely unwell (mentally or physically) or have a brain injury. The person may still be able to articulate what they think or feel but unable to inform the advocate of the exact actions they would like them to take or they may be unable to retain what the advocate explained their role was or why they’re there. The non instructed advocate seeks to ensure the persons wishes, views and beliefs are still represented and ensures their rights are secured. There are several models attached to non instructed advocacy which include a rights based model (focusing on the persons basic fundamental human rights); witness observer model (where the advocate might spend time with the person observing how they interact with others/the environment around them by way of getting to know them); Watching Brief (a model developed by ASIST which focuses on 8 domains of quality of life and uses questions to enable representation); and finally the person centred model which focuses on getting to know the person and what is important in their life.
Non instructed advocacy is vital for those most vulnerable in society who are often in a position where others (carers and professionals) are making decisions on their behalf. The non instructed advocate is an independent person that ensures the person is kept at the heart of all decisions and that their voice is heard.
Statutory advocacy is enshrined within the law and there are currently two main forms of statutory advocacy. Independent Mental Capacity Advocates (IMCA) and Independent Mental Health Advocates (IMHA).
IMCAs have to be instructed (by the local authority or NHS) on behalf of someone who lacks the capacity to make a particular decision and who does not have any family or friends that are practical or appropriate to consult with. IMCAs are non instructed advocates. The Mental Capacity Act 2005 outlines the role further including the rights and responsibilities of all that are part of this process.
IMHAs are a right afforded to patients that are detained under the Mental Health Act 1983 (there are some exceptions to this for those under the age of 18/where certain treatment is proposed and the person is not detained). There is no requirement to instruct an IMHA but rather a responsibility to inform all qualifying patients that they have a right to this particular type of advocate. IMHAs can be instructed or non instructed advocates and the Mental Health Act advises professionals to request advocacy involvement if a person is unable to instruct an advocate.
Non statutory advocacy
Non statutory advocacy means there is no legal framework that governs the role unlike IMCA and IMHA but is equally important. Often non statutory advocacy services are part of charities and work in specific areas such as mental health, domestic violence, learning difficulties, physical difficulties, older people or are gender/ethnicity specific.
We believe the role of an advocate is a vitally important one and as such should be effective in its delivery and provide quality representation. Our work focuses largely on non instructed advocacy across all sectors and we deliver training for advocates on different elements of the role including legislation that affects it’s delivery. We also believe that it is equally important to raise awareness of the advocacy role within health and social care as well as across the general public and include this aspect within training that we can offer to all groups.