The University of Central Lancashire has been commissioned by the Department of Health to review the quality of Independent Mental Health Advocate (IMHA) Services (further information here) . Nine focus groups are being organised to involve mental health service users, carers and family members, Independent Mental Health Advocates, staff from mental health services and commissioners in developing quality measures for IMHA services. Each focus group will involve 8-10 people and will explore both experience of IMHA service and what makes for a good IMHA service. These focus groups will take place during December and January 2010. The first two focus groups are taking place on:

December 8^th 2010, 10am-12 noon in central Manchester for IMHA services only

December 8^th 2-4pm in central Leeds for service users, carers, mental health providers, IMHA commissioners and IMHA services.

Information about the 2011 dates for focus groups for mental health service users, mental health services, commissioners and other IMHA services in other venues, including London and Birmingham, for 2011 will be posted shortly.  An information sheet on what is involved in participating in the research is available from ljbuckley@uclan.ac.uk or you can contact Karen Newbigging on KNewbigging@uclan.ac.uk or 07974-929367 for more information.

Review of Independent Mental Health Advocate Services by the University of Central Lancashire

Independent Mental Health Advocate (IMHA) services are relatively new and were introduced in the 2007 Mental Health Act. Primary Care Trusts became responsible for ensuring the availability of IMHA services in April 2009. An IMHA is a specialist type of mental health advocate, granted specific roles and responsibilities under the 2007 Act. Their role is to help qualifying patients understand the legal provisions to which they are subject under the 1983 Mental Health Act and the rights and safeguards to which they are entitled, and help those patients exercise their rights through supporting participation in decision-making. It is estimated that 42,000 people will qualify for IMHA services[1] with the majority being based in hospital and aged over 18. The Count Me In census of in-patients has consistently found that overall detention rates are higher for specific black and minority ethnic (BME) groups, with twenty-two percent of inpatients from BME groups, and detained patients from these communities may be particularly vulnerable[2] but face particular difficulties in accessing appropriate advocacy[3].  

Whilst the concept of independent mental health advocacy is not new[4], a recent systematic literature review[5] found that there have been few systematic evaluations of mental health advocacy to help guide commissioners and providers of IMHA services. The Department of Health has commissioned a research team led by the University of Central Lancashire to undertake a review of the quality of IMHA services in England. The specific objectives of the research are to:

1. Develop measures of service quality for IMHA services through reviewing the literature and undertaking focus groups with mental health service users, IMHA services and mental health services, with both providers and commissioners.
2. Identify and describe the organisation, management, deployment, characteristics and activities of IMHA services and their relationship with other services, from interviews with key stakeholders; analysis of referrals to and from IMHA services and analysis of key reports.
3. Evaluate equity of access to effective and appropriate IMHA services through collecting data on who is accessing and using IMHA services.
4. Identify the outcomes for service users from using IMHA services through analysis of advocacy case records and interviews with service users and mental health staff, staff of PCTs, local authorities and IMHA services.
5. Explore the experiences and views of a diverse range of qualifying patients of IMHA services, both instructed and non-instructed advocacy, to determine the extent to which they are meeting their needs and to identify issues affecting the quality of provision.
6. Explore the views of commissioners and providers of advocacy services and staff working in the service provider on aspects of implementation and delivery of IMHA services.

This study started in April 2010 and involves:

• 8 focus groups scheduled for December 2010 to January 2011 to identify indicators of quality for IMHA services
• Shadow visits with IMHA services
• 6-8 case studies on the provision of IMHA, which will involve in-depth interviews and analysis of information on referrals and outcomes, scheduled to start in February 2011.

The project will be completed by September 2011 and the report published early 2012.

The study is being undertaken in partnership with Equalities National Council, eMpowerMe (previously Lancashire Advocacy), Aawaz and Manchester African Caribbean Mental Health Services and includes mental health service users as peer researchers and as members of a reference group for the project. For further information contact Karen Newbigging, the project lead on KNewbigging@uclan.ac.uk or 07974-929367.

[1] Department of Health. (2009). Mental Health Act 2007: Independent Mental Health Advocacy. Mental Health Act 1983 (independent Mental health advocates (England) regulations 2008 130 (6)(d) arrangements. Independent mental health advocacy: guidance for commissioners: statement of Equalities Impact assessment. http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_092057.pdf
[2] Commission for Healthcare Audit and Inspection (2008). Count me in 2008. Results of the 2008 national census of inpatients in mental health and learning disability services in England and Wales.

http://www.cqc.org.uk/_db/_documents/Count_me_in_census_2008_Results_of_the_national_census_of_inpatients_in_mental_health_and_learning_disability_services.pdf

[3] Newbigging , K. & McKeown, M. 2007, "Mental health advocacy with black and minority ethnic communities: conceptual and ethical implications", Current Opinion in Psychiatry, vol. 20, no. 6, pp. 588-593.
[4] Steven, K. & Symington, J. (2009). The role of independent mental health advocates. Mental Health Today. May, 22-7.
[5] Newbigging, K. McKeown, M. Hunkins-Hutchinson, E. & French, B. (2007).  Mtetezi:  Mental health advocacy with African and Caribbean Men.  London: Social Care Institute for Excellence (SCIE). http://www.scie.org.uk/publications/knowledgereviews/kr15.pdf.

The National Mental Health Development Unit (NMHDU) is the agency charged with supporting the implementation of mental health policy in England by the Department of Health in collaboration with the NHS, Local Authorities and other major stakeholders.