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Myth buster – All the things you want to know about Independent Mental Health Advocates (IMHAs) but were to afraid to ask

 

Supplementary Guidance on Access to Patient Records under Section 130B of the Mental Health Act 1983

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Independent Mental Health Advocacy (IMHA)

 

 Mental Health Matters Wales no longer provides the Independent Mental Health Advocacy (IMHA) service for Caerphilly, Blaenau Gwent, Torfaen, Newport, & Monmouthshire area

 

This page is for information only

 

 

Statutory Independent Mental Health Advocacy was introduced on the 3rd November 2008 in Wales (1st April 2009 in England) for qualifying patients. These arrangements are introduced by way of amendment to the Mental Health Act 1983 by section 30 of the Mental Health Act 2007. Under these arrangements, Independent Mental Health Advocates (IMHAs) provide qualifying patients with support and help.

 

Independent mental health advocates provide an important safeguard for certain patients treated under the compulsory powers of the Act. The following provides guidance about the role and functions of IMHAs.

 

The Mental Health (Wales) Measure 2010 (Part 4)  expand the existing IMHA scheme on the 3rd January  2012 to include compulsory patients under sections 4 and 5 Mental Health Act 1983

 

The second stage of the expansion, relating to informal patients, came into force on the 2nd April 2012.

 

The expansion of the IMHA scheme now means anyone in Wales, regardless of age, who meets the following criteria, is entitled to access the support of an Independent Mental Health Advocate (IMHA).

 

      Detained in hospital under the Mental Health Act (excludes sections 135 & 136)

      Subject to a Community Treatment Order (CTO) or Guardianship

      A Conditionally Discharged Restricted Patient

      Being considered for ECT or neurosurgery

      An informal inpatient in any hospital or registered establishment, being treated or assessed for a Mental Health Condition (the patient maybe in hospital for a separate health related matter)

 

 

Quick Links

 

Patients who qualify for advocacy support are:

 

How does a qualifying patient find out about an IMHA service?

 

Responsibility for informing patients of IMHA service

 

Patients’ rights to an IMHA

 

who can refer to the IMHA service

 

The role of the independent mental health advocate (IMHA)

 

What will the IMHA do?

 

Supporting the role and work of the IMHA

 

Access to records

 

 

Further Information

 

 

 

 

 

Patients who qualify for advocacy support are:

 

·         All patients detained under the Mental Health Act 1983 (The Act)

·         Patients discharged to guardianship

·         Patients on a Community Treatment Order

·         Patients conditionally discharged

·         Informal patients who discuss with a registered medical practitioner or approved clinician the possibility of being given a form of treatment to which section 57 treatment applies

 

·         Informal patients under the age of 18 who discuss with a registered medical practitioner or approved clinician the possibility of being given a form of  treatment to which section 58A applies.

 

Please Note: Patients subject to detention under Sections 135 or 136 are excluded from IMHA advocacy support

 

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How does a qualifying patient find out about an IMHA service?

 

Section 130D of the ACT places a duty on a “responsible person” to provide verbal and written information about IMHA services to qualifying patients. This may be a hospital manager, responsible clinician, local social services authority, the patient’s doctor or approved clinician.

 

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Responsibility for informing patients of IMHA service

 

Qualifying patient

Person responsible for informing the

qualifying patient (the “responsible person”)

Patient liable to be detained

 

The hospital managers (delegated to nursing staff)

A patient who is liable to be detained but has been conditionally discharged

 

The responsible clinician (for the patient)

Patient subject to guardianship

 

The responsible local social services authority (LSSA)

 

A community patient

The hospital managers (for the responsible

hospital)

 

A patient for whom treatment under section 57 is proposed, if they do not already fall under one of the categories above

 

The registered medical practitioner or approved clinician with whom the patient first discusses

A patient under 18 years for whom the possibility of such treatment under section 58A is proposed, if they do not fall under one of the categories above

The registered medical practitioner or approved clinician with whom the patient first discusses

 

The Code of Practice explains the responsible person duties:

 

• They must ensure that they tell the patient, both orally and in writing, that support is available to them from an IMHA, and how they can obtain that support.

• That if a patient has a nearest relative, the responsible person should, unless the patient requests otherwise, provide a copy of the same information, in writing, to the nearest relative.

• As well as telling people about the availability of independent mental health advocacy, the responsible person must also ensure that the patient has the opportunity of making use of IMHA support.

• If the patient would like an IMHA, the responsible person should support them in making contact  for example, make arrangements for the patient to meet the IMHA if the patient would otherwise be unable to do this, but they should not at this stage disclose any personal information about the patient to the IMHA service.

• They should record in the patient’s medical records the steps taken to tell that patient about IMHA support. Other people who support the patient should also be informed about whether the patient would like support from an IMHA, and any follow-up action required, if the patient has agreed to such information being shared.

 

If a patient has been fully informed about IMHA support, and chooses not to involve an advocate in their case, the responsible person should:

 

·   record in the patient’s medical records that the patient was informed about independent mental health advocacy and did not want it

·   check with the patient again at a later date in case they have changed their mind

·   tell the patient that legal representation is available and how to access it.

 

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Patients’ rights to an IMHA

 

A qualifying patient may ask for the support of an IMHA at any time. Certain professionals have a duty to tell qualifying patients that independent mental health advocacy is available and how they may obtain it. Patients may want to consider accessing an IMHA in the following circumstances:

 

·   soon after arrival in an inpatient unit to obtain reassurance and understanding of their situation within the hospital environment and mental health system;

• when they know that their care and treatment is going to be discussed in a meeting or ward round and they want help in preparing for the meeting, or support or representation at the meeting itself

• when they are concerned about particular aspects of their care or treatment and wish to meet with their doctor/responsible clinician

• when they are going to be examined by a second opinion appointed doctor (SOAD)

• When they want to express concern about any aspect of their hospital experience or access the complaints process

• when applying for or attending a hospital manager’s hearing

• when applying to the Tribunal for a hearing, obtaining legal representation, needing support at a hearing or help in understanding the decisions made by a Tribunal

• when they have questions about their rights in relation to their nearest relative

• why they need help to understand, apply to and obtain legal representation for County Court hearings about changing their nearest relative

• when they are being considered for supervised community treatment (SCT)

• when they are talking to their guardian about requirements the guardian is imposing on them (e.g. about where they should live)

• when they want support to access medical or social services records

• prior to a discharge planning meeting to explore all their options and raise concerns about appropriate after-care

• when they want support in accessing other services

 

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who can refer to the IMHA service

 

The Mental Health (Wales) Measures states that IMHAs must comply with any reasonable request to visit and interview a Welsh qualifying compulsory patient, if the request is made by:

 

• the patient themselves

• someone the IMHA thinks is the patient’s nearest relative

• the patient’s responsible clinician (if they have one)

• an approved mental health professional (AMHP)

• a registered social worker who is professionally concerned with the patient’s care, treatment or assessment

• the managers of the hospital (or a person Duly authorised by them where the patient is liable to be detained (if this is the grounds for the person being eligible for independent mental health advocacy)

• the patient’s donee or deputy (if they have one)

 

In respect of Welsh qualifying informal patients, the duty on IMHAs to visit and interview the patient is the same, but only engaged if the request is made by:

 

• the patient themselves;

• the managers of the hospital (or person duly authorised by them) where the patient is an in-patient;

• someone the IMHA thinks is the patient’s carer

• the patient’s done or deputy (if they have one)

a registered social worker who is professionally concerned with the patient’s care, treatment or assessment.

 

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The role of the independent mental health advocate (IMHA)

 

The IMHA provides support to qualifying patients to ensure they understand the Act and their own rights and safeguards. This may include support in obtaining information about any of the following:

 

  • the patient’s rights under the Act
  • the provisions of the Act under which the patient qualifies for an IMHA
  • any conditions or restrictions which affect the patient
  • the medical treatment the patient is receiving, or which is being proposed or discussed, and the reasons for this
  • the legal authority for providing such treatment
  • the requirements of the Act which apply to treatment.

 

 

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What will the IMHA do?

 

The IMHA will:

 

  • ensure that the patient’s voice is heard by supporting the patient to articulate their views and to engage with the multi-disciplinary team
  • support patients to access information, and to understand better what is happening and what is planned, and to understand better the options available to them
  • support patients in exploring options, making better-informed decisions and in engaging with the development of their care plans
  • supporting the patient to ensure they are valued for who they are
  • support the patient to counteract any actual or potential discrimination.

 

 

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Supporting the role and work of the IMHA

 

Patients should have access to a telephone to speak to an IMHA in private.

 

The IMHA has the right to:

 

  • visit and interview the patient in private
  • visit, interview and get the views of anyone professionally concerned with the patient’s medical treatment.

 

IMHAs should be enabled, as appropriate, to:

 

  • have access to the unit and ward where the patient under detention is staying
  • have access to facilities in the community where the patient is a community patient
  • attend relevant meetings and ward rounds when asked to do so by the patient.

 

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Access to records

 

Subject to conditions, the IMHA has a right to access and inspect the patient’s relevant records, including any records:

 

  • about the patient’s detention or treatment in any hospital or registered establishment
  • about any after-care services provided to the patient under section 117
  • of or held by an LSSA about the patient

 

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Confidentiality

 

IMHAs are expected to follow an agreed confidentiality policy. Under this, any information a patient share with an IMHA should remain confidential unless the patient want it to be disclosed, or the IMHA has reasons to disclose it.

 

In most circumstances the IMHA will tell the patient all the information they have received on their behalf.

 

 

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Further Information

 

The IMHA service is not a substitute for independent advocacy as practised in the Health and Social Care sectors. IMHAs specifically provide specialist advocacy within the framework of Mental Health Legislation. Please read Myth buster for additional information.

 

 

 

For additional information please see Chapter 25 of the Mental Health Act 1983 Codes of Practice for Wales