Health professionals care for some adults who have difficulties representing their own interests or making decisions about their own care or treatment. Informal advocacy services have long existed to support these patients.
As health professionals are generally familiar with informal services, they are only mentioned briefly here. Additionally, the Mental Capacity Act 2005 (MCA) and the Mental Health Act 2007 (MHA) introduced statutory obligations to provide advocacy services in certain circumstances.
This guidance focuses particularly on these statutory advocacy services and when health professionals must involve them.
Informal advocacy services developed piecemeal to help people who have difficulty making decisions, securing their rights, exploring care options or accessing information and services. Such advocates act independently of carers and of other support services and function in various ways.
- Self advocacy helps people to develop the skills to speak for themselves. Self advocacy groups often consist of people who use the same services and can work together to influence how they are run.
- Peer advocacy occurs when people speak up for others in a similar situation to themselves, but who have difficulty making their views known. People living with mental health problems, for example, might use peer advocacy.
- Citizen advocacy involves lay volunteers representing the interests of a person whom they come to know. It entails a partnership between the volunteer and the vulnerable individual, in which the vulnerable person’s wishes are clarified and communicated to relevant people.
- Professional advocacy is usually issue based where a paid independent advocate use their skills and expertise to support a person to express their views on issues which may include, for example, moving home, safeguarding or access to appropriate health and social care. The advocate also provides the person with information about their options and rights to ensure they are able to make an informed decision, even if this decision is only about what they would like the advocate to progress. This type of advocacy is often instructed i.e. the person has asked for an advocate to support them.
- Non- instructed advocacy (NIA) is where a professional will request an advocate on behalf of someone because that person is unable to request the support themselves (usually because of comprehension or communication difficulties). The role of the noninstructed advocate is to ensure that they ask relevant questions about the person’s rights, they will put forward any observations they have made about a person’s preferences, likes, dislikes, or interactions with others to inform those responsible for that person’s care which will support their decision making. The non-instructed advocate will also meet with the person and attempt to ascertain what is important to them in terms of their cultural or religious issues, local community factors, family and friends as well as determining whether the person has previously expressed their wishes, beliefs or feelings. The non-instructed advocate’s role is to ensure that they have represented what is important to that person as closely as they are able to and to ensure their rights are upheld.
- Statutory advocacy services: the MCA and the MHA introduced statutory obligations in England and Wales to provide advocacy services. Independent Mental Capacity Advocates and Independent Mental Health Advocates provide safeguards for people in specific situations defined in the MCA and MHA.
Statutory advocacy guidance (PDF)