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Ionescu A, Mannell J, Vaughan M, Burgess R. Misunderstood and underappreciated: a critical review of mental health advocacy and activism in low- and middle-income countries. Health Policy Plan 2024; 39:528-539. [PMID: 38441280 PMCID: PMC11095268 DOI: 10.1093/heapol/czae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 05/16/2024] Open
Abstract
Mental health advocacy and activism have been highlighted as important in the effort towards creating environments for better mental health. However, relevant research in low- and middle-income country settings remains limited and lacks critical exploration. We seek to contribute to filling this gap by exploring driving factors behind mental health advocacy and activism efforts in low- and middle-income country settings. This review uses a critically informed thematic analysis employing conceptual frameworks of productive power to analyse peer-reviewed articles on mental health advocacy or activism over the last 20 years. We suggest that the current body of research is marred by superficial explorations of activism and advocacy, partly due to a lack of cohesion around definitions. Based on our findings, we suggest a conceptual framework to guide deeper explorations of mental health advocacy and activism. This framework identifies 'legitimacy', 'context' and 'timing' as the main dimensions to consider in understanding activism and advocacy efforts. The fact that they remain misunderstood and underappreciated creates missed opportunities for meaningful inclusion of lived experience in policy decisions and limits our understanding of how communities envision and enact change.
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Affiliation(s)
- Alma Ionescu
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Megan Vaughan
- Institute for Advanced Studies, University College London, South Wing, Wilkins Building, Gower Street, London WC1E 6BT, United Kingdom
| | - Rochelle Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
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Kendal S, Louch G, Walker L, Shafiq S, Halligan D, Brierley-Jones L, Baker J. Implementing and evaluating patient-focused safety technology on adult acute mental health wards. J Psychiatr Ment Health Nurs 2024. [PMID: 38279658 DOI: 10.1111/jpm.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. WHAT ARE THE IMPLICATIONS FOR PRACTICE This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines. ABSTRACT INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. AIM Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff. METHOD Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. RESULTS Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. DISCUSSION Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context. IMPLICATIONS FOR PRACTICE The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.
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Affiliation(s)
| | - Gemma Louch
- Bradford Institute for Health Research, Bradford, UK
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Salla A, Newbigging K, Joseph D, Eneje E. A conceptual framework for culturally appropriate advocacy with racialised groups. Front Psychiatry 2023; 14:1173591. [PMID: 37496683 PMCID: PMC10367102 DOI: 10.3389/fpsyt.2023.1173591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
Independent mental health advocacy was introduced in England to protect and promote the rights of people detained under mental health legislation. However, shortcomings in access and delivery to racialised people, raising concerns about equity, were identified by a review of the Mental Health Act. The development of culturally appropriate advocacy was recommended. While the term culturally appropriate may be taken for granted it is poorly defined and limited efforts have conceptualized it in relation to advocacy. Ideally, advocacy operates as a liberatory practice to challenge epistemic injustice, which people experiencing poor mental health are at acute risk of. This is amplified for people from racialised communities through systemic racism. This paper argues that advocacy and culturally appropriate practices are especially relevant to racialised people. It clarifies the importance of culture, race and racism to the role of advocacy, and understanding advocacy through the conceptual lens of epistemic injustice. A central aim of the paper is to draw on and appraise cultural competency models to develop a conceptual framing of cultural appropriate advocacy to promote epistemic justice.
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Affiliation(s)
| | - Karen Newbigging
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Doreen Joseph
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Emachi Eneje
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
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Hutton P, Kelly J, Taylor CDJ, Williams B, Emsley R, Alexander CH, Vikram A, Saddington D, McCann A, Burke J, Eliasson E, Harper S, Karatzias T, Taylor PJ, Watson A, Dougall N, Stavert J, O'Rourke S, Glasgow A, Murphy R, Palmer K, Zaidi N, Bidwell P, Pritchard J, Carr L, Woodrow A. Accelerating the development of a psychological intervention to restore treatment decision-making capacity in patients with schizophrenia-spectrum disorder: a study protocol for a multi-site, assessor-blinded, pilot Umbrella trial (the DEC:IDES trial). Pilot Feasibility Stud 2023; 9:117. [PMID: 37422659 PMCID: PMC10329297 DOI: 10.1186/s40814-023-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND A high proportion of patients diagnosed with schizophrenia-spectrum disorders will at some point in their lives be assessed as not having the capacity to make their own decisions about pharmacological treatment or inpatient care ('capacity'). Few will be helped to regain it before these interventions proceed. This is partly because effective and safe methods to do so are lacking. Our aim is to accelerate their development by testing, for the first time in mental healthcare, the feasibility, acceptability and safety of running an 'Umbrella' trial. This involves running, concurrently and under one multi-site infrastructure, multiple assessor-blind randomised controlled trials, each of which is designed to examine the effect on capacity of improving a single psychological mechanism ('mechanism'). Our primary objectives are to demonstrate feasibility of (i) recruitment and (ii) data retention on the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; planned primary outcome for a future trial) at end-of-treatment. We selected three mechanisms to test: 'self-stigma', low self-esteem and the 'jumping to conclusions' bias. Each is highly prevalent in psychosis, responsive to psychological intervention, and hypothesised to contribute to impaired capacity. METHODS Sixty participants with schizophrenia-spectrum diagnoses, impaired capacity and one or more mechanism(s) will be recruited from outpatient and inpatient mental health services in three UK sites (Lothian, Scotland; Lancashire and Pennine; North West England). Those lacking capacity to consent to research could take part if the key criteria were met, including either proxy consent (Scotland) or favourable Consultee advice (England). They will be allocated to one of three randomised controlled trials, depending on which mechanism(s) they have. They will then be randomised to receive, over an 8-week period and in addition to treatment as usual (TAU), 6 sessions of either a psychological intervention which targets the mechanism, or 6 sessions of assessment of the causes of their incapacity (control condition). Participants are assessed at 0 (baseline), 8 (end-of-treatment) and 24 (follow-up) weeks post-randomisation using measures of capacity (MacCAT-T), mechanism, adverse events, psychotic symptoms, subjective recovery, quality of life, service use, anxiety, core schemata and depression. Two nested qualitative studies will be conducted; one to understand participant and clinician experiences and one to investigate the validity of MacCAT-T appreciation ratings. DISCUSSION This will be the first Umbrella trial in mental healthcare. It will produce the first 3 single-blind randomised controlled trials of psychological interventions to support treatment decision-making in schizophrenia-spectrum disorder. Demonstrating feasibility will have significant implications not only for those seeking to support capacity in psychosis, but also for those who wish to accelerate the development of psychological interventions for other conditions. TRIAL REGISTRATION ClinicalTrials.gov NCT04309435 . Pre-registered on 16 March 2020.
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Affiliation(s)
- Paul Hutton
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK.
| | - James Kelly
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Christopher D J Taylor
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian Williams
- School of Health, Social Care & Life Sciences, University of the Highlands and Islands, Inverness, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Anvita Vikram
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | | | - Andrea McCann
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Joseph Burke
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Emma Eliasson
- NHS Lothian, Edinburgh, UK
- NHS Research Scotland Mental Health Network, Edinburgh, UK
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Sean Harper
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jill Stavert
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Suzanne O'Rourke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Karen Palmer
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Nosheen Zaidi
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Polly Bidwell
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | | | - Lucy Carr
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Amanda Woodrow
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
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Blakley L, Asher C, Etherington A, Maher J, Wadey E, Walsh V, Walker S. 'Waiting for the verdict': the experience of being assessed under the Mental Health Act. J Ment Health 2021; 31:212-219. [PMID: 34006171 DOI: 10.1080/09638237.2021.1922624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Following the Independent Mental Health Act review, there is increasing focus on this coercive part of mental health services and a call for service user views to be central to proposed changes. Although there are numerous studies into being detained in hospital, there is a lack of data exploring the service user experiences of the assessment process. AIM To explore the subjective experience of being assessed under the Mental Health Act (MHA). METHOD 10 participants were interviewed about their recent assessment experience and the transcribed interviews were analysed using framework approach. RESULTS The overarching theme of person centred care emerged from these interviews with interconnecting sub themes: 1) information and options; 2) "the barrage of three"; 3) "sit down and listen"; and 4) service user voice. CONCLUSION As one of the first studies into service user experiences of MHA assessments, this exploratory study indicates that there is lack of person centeredness. The Independent Mental Health Act review has set a challenge for treating person as individual and increasing rights and involvement of service users. This study suggests service user's experiences do not yet meet this aspiration and they want to discuss these experiences and have their voices heard.
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Affiliation(s)
- Louise Blakley
- Research and Development Department, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Carolyn Asher
- Research and Development Department, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Angela Etherington
- Research and Development Department, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Joanna Maher
- Acute Mental Health Team, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Emma Wadey
- Deputy Director of Nursing, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Valerie Walsh
- Research and Development Department, Southern Health NHS Foundation Trust, Hampshire, UK
| | - Sandra Walker
- Health Sciences, University of Southampton, Southampton, UK
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Abstract
People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities.
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Macgregor A, Brown M, Stavert J. Are mental health tribunals operating in accordance with international human rights standards? A systematic review of the international literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e494-e513. [PMID: 30993806 DOI: 10.1111/hsc.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
Mental health tribunals are responsible for making decisions about compulsory treatment for individuals considered a risk to themselves and others due to mental disorder. They are generally designed to provide safeguards for individuals subject to compulsory treatment by testing whether national legislative criteria and international human rights standards have been met. Despite this, they have been criticised for being dominated by the medical domain, focusing rigidly on legal criteria and for restricting human rights, including the rights to liberty and access to justice. As a result, questions have arisen over the extent to which mental health tribunals are indeed operating in line with their legislative intentions and international human rights requirements. The aim of this systematic review was to synthesise international evidence on this and to assess the extent to which this is reflected in such literature. A systematic search of the literature was conducted on the 17 April 2018 for articles published between 2000 and 2018 in MEDLINE, CINAHL, PsychINFO, ASSIA and Web of Science. All study designs were included within this review, provided they reported empirical findings. Thirty-two studies met the inclusion criteria. Eight themes were identified across the literature and these were participation, information and understanding, patient representation, the power of the medical domain, feelings of powerlessness, perceptions of fairness, risk and the impact on relationships. The findings call into question whether mental health tribunals necessarily operate in compliance with international human rights standards. This article suggests that mental health tribunals may need to do more to safeguard legislative principles and human rights standards that promote patient autonomy.
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Affiliation(s)
- Aisha Macgregor
- School of Health and Social Care, Centre for Mental Health and Capacity Law, Edinburgh Napier University, Edinburgh, UK
| | - Michael Brown
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Jill Stavert
- School of Health and Social Care, Centre for Mental Health and Capacity Law, Edinburgh Napier University, Edinburgh, UK
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Montgomery L, Wilson G, Houston S, Davidson G, Harper C. An evaluation of mental health service provision in Northern Ireland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:105-114. [PMID: 30027604 DOI: 10.1111/hsc.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
Although Northern Ireland has high levels of mental health problems, there has been a relative lack of systematic research on mental health services that can provide an evidence base for legal, policy, and service developments. This article aims to provide a review of the central issues relating to mental health service provision in Northern Ireland, and to gather the perceptions of different stakeholders of these services. The study utilised in-depth qualitative interviews, focus groups, and an online survey to collect data from respondents throughout the region. This method involved the completion of semistructured interviews with significant mental health commissioners and senior managers, and with service-users and their key workers. Focus groups sessions were also completed with mental health professionals, service-users, and carers. Data collection occurred between December 2014 and June 2015. Thematic analysis was used to identify key issues. The findings identified that considerable progress had been made not only in the development of mental health services in the last decade, but also highlighted the significant limitations in current services. Most notably, strengths in provision included the transition from long-stay hospital care to community-based services and person-centred approaches. The researchers identified the need to improve funding, address problems with fragmentation, and gaps in service provision. Based on these findings, the authors consider the implications for practice and policy relating to the human and organisational aspects of service development. In particular, services should be developed focusing on a recovery ethos and on person-centred and relationship-based approaches. The needs of carers should additionally be considered and programmes developed to tackle stigma.
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Affiliation(s)
- Lorna Montgomery
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - George Wilson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Stanley Houston
- School of Social Work & Social Policy, Trinity College Dublin, Dublin, Ireland
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Colin Harper
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
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Newbigging K, Ridley J. Epistemic struggles: The role of advocacy in promoting epistemic justice and rights in mental health. Soc Sci Med 2018; 219:36-44. [DOI: 10.1016/j.socscimed.2018.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
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Stomski NJ, Morrison P, Whitely M, Brennan P. Mental Health Consumers' Motives for Seeking Advocacy Support: A Qualitative Exploration. Community Ment Health J 2018; 54:607-615. [PMID: 29094230 DOI: 10.1007/s10597-017-0177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
Advocacy plays a vital role in ensuring that mental health consumers' rights are maintained. However, the primary issues for which consumers seek advocacy support remain unknown. Understanding these issues provides a sound basis from which advocacy organisations may develop a clear service delivery focus. This study addresses the literature gap through presenting a qualitative analysis of 60 records from an advocacy service. Four major themes emerged, across which two key issues were dominant: the sense of fearfulness and disempowerment. These issues accentuate the importance of advocates in enhancing the agency of mental health consumers.
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Affiliation(s)
- N J Stomski
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA, 6150, Australia.
| | - P Morrison
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA, 6150, Australia
| | - M Whitely
- Health Policy and Research, Health Consumers Council (WA), 40 Lord St, East Perth, 6004, Western Australia, Australia
| | - P Brennan
- Health Consumers Council (WA), 40 Lord St, East Perth, 6004, Western Australia, Australia
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Dixon J, Laing J, Valentine C. A human rights approach to advocacy for people with dementia: A review of current provision in England and Wales. DEMENTIA 2018; 19:221-236. [DOI: 10.1177/1471301218770478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article, we review current advocacy services for people with dementia in England and Wales (provided, respectively, under the Mental Capacity Act 2005 , the Mental Health Act 1983 /2007 and the Care Act 2014) through the lens of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We examine what a human rights’ approach to advocacy support would entail, and whether current frameworks in England and Wales are adequate for this approach and provide a sufficient safeguard. First, we consider how the human rights of persons with dementia have become increasingly important and the extent to which the CRPD provides an opportunity to bolster safeguards and protection. Second, we discuss cause and case advocacy, and how these advocacy models could be shaped by the CRPD to promote the rights of persons with dementia at each stage of the disease. Third, we highlight current dilemmas and challenges in the provision of advocacy support in England and Wales by focusing on case law, commissioning of services and current practice. In particular, we analyse how the different legislative schemes have given rise to some confusion about the various advocacy provisions, as well as potential for overlap and discrepancies between different regimes. We also highlight the need for further research to address important gaps in knowledge, including the scale of need, patterns of referral and attitudes to advocacy services. The article concludes by highlighting how advocacy support could be recalibrated as a universal right to promote the aims and aspirations of the CRPD, and how education is needed to address the stigma of dementia and promote the benefits of advocacy in protecting the rights of those with dementia.
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Affiliation(s)
- Jeremy Dixon
- Department of Social & Policy Sciences, University of Bath, UK
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Decision-Making Behaviour under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: An English Perspective. LAWS 2018. [DOI: 10.3390/laws7020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rose D, Perry E, Rae S, Good N. Service user perspectives on coercion and restraint in mental health. BJPsych Int 2017; 14:59-61. [PMID: 29093946 PMCID: PMC5618900 DOI: 10.1192/s2056474000001914] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Coercion remains a central aspect of many people's mental healthcare. It can include the use of legislation to restrict freedoms, the use of physical restraint, the restriction of freedom of movement and/or association, and the forced or covert administration of medication. There is good evidence that the use of such measures can traumatise service users. This article reports the findings of a survey of service users regarding their experiences of coercion and restraint and embeds this in the wider international and institutional environment.
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Affiliation(s)
- Diana Rose
- Professor of User-Led Research and Co-director of Service User Research Enterprise (SURE), King's College London, UK; email
| | - Emma Perry
- Research Project Coordinator, National Survivor User Network (NSUN), UK
| | - Sarah Rae
- Cambridgeshire and Peterborough NHS Foundation Trust (CPNHSFT) and joint lead of the Promise initiative, UK
| | - Naomi Good
- Networking and Research manager, National Survivor User Network (NSUN)
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Morrison P, Stomski NJ, Whitely M, Brennan P. Understanding advocacy practice in mental health: a multidimensional scalogram analysis of case records. J Ment Health 2017; 27:127-134. [PMID: 28480771 DOI: 10.1080/09638237.2017.1322183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have examined mental health consumers' motives for seeking advocacy assistance. AIMS This study aimed to identify factors that influenced mental health consumers' use of advocacy services. METHODS The analysis was based on 60 case records that were sourced from a community advocacy service. Each record was dichotomously coded across 11 variables to generate a series of categorical data profiles. The data set was then analysed using multidimensional scalogram analysis to reveal key relationships between subsets of variables. RESULTS The results indicated that mental health consumers commonly reported a sense of fear, which motivated them to contact the advocacy service in the hope that advocates could intervene on their behalf through effective communication with health professionals. Advocates often undertook such intervention either through attending meetings between the consumer and health professionals or contacting health professionals outside of meetings, which was typically successful in terms of achieving mental health consumers' desired outcome. The resolution of most concerns suggests that they were often legitimate and not the result of a lack of insight or illness symptoms. CONCLUSION Health professionals might consider exploring how they respond when consumers or carers raise concerns about the delivery of mental health care.
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Affiliation(s)
- Paul Morrison
- a School of Health Professions, Murdoch University , Murdoch , Western Australia , Australia
| | - Norman J Stomski
- a School of Health Professions, Murdoch University , Murdoch , Western Australia , Australia
| | - Martin Whitely
- b Health Policy and Research, Health Consumers Council (WA) , East Perth , Western Australia , Australia , and
| | - Pip Brennan
- c Health Consumers Council (WA) , East Perth , Western Australia , Australia
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Stomski N, Morrison P, Whitely M, Brennan P. Advocacy processes in mental health: a qualitative study. QUALITATIVE RESEARCH IN PSYCHOLOGY 2017. [DOI: 10.1080/14780887.2017.1282567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Norman Stomski
- Murdoch University, School of Health Professions, Murdoch, Australia
| | - Paul Morrison
- Murdoch University, School of Health Professions, Murdoch, Australia
| | | | - Pip Brennan
- Health Consumers Council, East Perth, Australia
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