Mental Health Independent Advocacy
The Mental Health (Care & Treatment) (Scotland) Act 2003, states that any person with a mental health disorder has a right to access Independent Advocacy. The recently updated Mental Health (Care & Treatment) (Scotland) Act 2015 builds on the right of the 2003 Act to Independent Advocacy Services. It requires Local Authorities, Health Boards, and the State Hospitals Board for Scotland to provide information to the Mental Welfare Commission about how they are meeting their duties under the 2003 Act to provide Independent Advocacy Services, at least every two years.
If you are suffering from mental health issues, then this mental health law gives you the right to Independent Advocacy whoever or wherever you are in Scotland. You do not have to be in hospital or on any kind of order.
Many people find that when they feel unwell it is not as easy to say what they want as it is at other times.
Independent Advocacy is a way to help you to make your voice stronger and to have as much control as possible over your own life. Independent Advocacy Workers will work closely with you to explore your options, explain your basic human rights, and assist you through whatever issues you may have. Independent Advocacy Workers do not make decisions on your behalf nor do they put words in your mouth. Under the Mental Health (Care and Treatment) (Scotland) Act 2003, people with learning disabilities and people with a mental illness have a right to Independent Advocacy Support. You do not have to be in hospital, or under any Mental Health Act to get this right to Independent Advocacy. This means that you should be able to access an Independent Advocacy Worker.
Many people will suffer with a mental health issue at some point in their lives. Advocacy Western Isles have 2 trained Mental Health Independent Advocacy Workers, one in Lewis & Harris, and another in Uist in Barra, who have worked in the field of Mental Health for a number of years. They are trained to offer Independent Advocacy to people who may experience various difficult issues at some point in their lives and who may need additional help during this time.
There are over 200 types of mental illnesses. Some of the most common are clinical depression, Obsessive Compulsive Disorder (OCD), Paranoid Schizophrenia, Bi-polar Disorder, Borderline Personality Disorders (BPD), Bulimia and Anorexia. People who suffer from mental health issues can often find themselves vulnerable and anxious, finding it hard to speak up for themselves to get the assistance they need when faced with extraordinary circumstances that may occur during their lives.
An Independent Advocacy Worker will listen to your views, support you to speak up for yourself and speak for you when you feel unable to. An Independent Advocacy Worker will explore options with you for solutions and find out what your rights are, allowing you to make informed choices over your life. Many people find that when they feel ill or upset, they are not as good at saying what they want, and they may need Independent Advocacy to ensure that their voice is being heard and that they are being listened to. There are times when it is especially important for you to get Independent Advocacy: when you are in hospital or attending a Mental Health Tribunal, attending an appointment with your psychiatrist or psychologist and support you to access your right to Mental Health Services in the Community.
Below are just a few examples of when you may need Independent Advocacy support.
Definition of Mental Health
The definition of Mental Health, as defined by the World Health Organisation (WHO, 1986) states that “Mental Health is the emotional and spiritual resilience which allows us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of well being and an underlying belief in our own, and others, dignity and worth.”
Mental Health Tribunals
Many people can find themselves subject to detentions such as Compulsory Treatment Orders or Short-Term Detention Certificates, whether in hospital or in the community. If you are subject to any compulsory measures, you are entitled to Legal Aid to exercise your legal rights of appeal, regardless of your means. You have the right to access Legal Aid regardless of your income or savings. Your Independent Mental Health Advocacy Worker can help you to access representation from a solicitor with years of mental health legal experience. Your Independent Advocacy Worker will advocate on your behalf throughout the process, ensuring that your views are heard and your rights are upheld.
A Mental Health Tribunal is an independent organisation set up to make decisions on the compulsory care and treatment of people with mental disorders in Scotland.
The Tribunal has a President and 300 members around Scotland. There will be a group of three people – a doctor (psychiatrist), a lawyer and another person with relevant skills and experience, e.g. a nurse, social worker or someone with personal experience of mental illness, learning disability or related condition. The Tribunal must hear and read all the information about you and your case. They then decide what to do about your care and treatment.
The main role of the Tribunal is to consider and determine applications for Compulsory Treatment Orders (CTOs) under the 2003 Act. It also considers appeals against compulsory measures such as Short-Term Detention Certificates. You may be on an order which says that you must stay in hospital, you can only stay out of hospital on certain conditions, or you can be given treatment even if you do not want it. Your doctors, nurses, social workers and mental health officers should make sure you know about Independent Advocacy, and help you get it. Your Independent Advocacy Worker will ensure that your views are heard and considered at your Tribunal.
Compulsory Treatment Orders
A Compulsory Treatment Order (CTO) allows for a person to be treated for their mental illness. The CTO will set out a number of conditions that you will need to comply with. These conditions will depend on whether you have to stay in hospital or are in the community. Your Mental Health Officer (MHO) will make an application for a CTO to the Mental Health Tribunal. The application must include two medical reports, an MHO report and a proposed Care Plan. You and your named person should be informed if an application for a CTO is to be made. The Tribunal decides whether a CTO is to be granted. You have the right to be heard by the Tribunal and your Independent Advocacy Worker will ensure that this happens. Your Independent Advocacy Worker an attend your Tribunal with you or attend on your behalf, ensuring that your views are heard and any relevant evidence is given in support of your case. A CTO can last up to six months, can be extended for a further six months and then for periods of twelve months at a time.
You can be given medical treatment while on a CTO if the Tribunal agree to it, or in an emergency. Your responsible medical officer (RMO) must follow the safeguards outlined in part 16 of the Mental Health Act when giving you treatment.
During this process, you have the right to an Independent Advocacy Worker who can help you say what you think about your treatment. Your MHO should let you know how to get help from an Independent Advocacy Worker.
If a CTO is made, you can apply to the Tribunal for it to be removed, once the order has been in force for three months. Your Independent Mental Health Advocacy Worker will ensure you have been informed of your rights to free legal mental health representation and assist you in accessing this. Your mental health solicitor will take instruction from you and will make legal representation for you at the Tribunal. Your RMO should keep the need for the order under constant review, and can revoke it, if you no longer need to be subject to the order.
There are five criteria that must be met in order that an application for a CTO can be made. These are:
- You have a mental disorder
- Medical treatment is available which will stop your condition getting worse or help treat some of the symptoms.
- If that medical treatment was not provided, there would be a significant risk to you, or to any other person.
- Because of your mental disorder, your ability to make decisions about medical treatment is significantly impaired.
- The use of compulsory powers is necessary.
Home Care/Social Care Assessments
When you are receiving any type of social or home care package, you may feel that you may not be getting the right support you need from Social Services. You have the right to ask for a review of your circumstances. The local council must provide you with someone to support you if you can’t speak up for yourself or have difficulty understanding others.
If you suffer from a mental illness or are particularly vulnerable, an Independent Advocacy Worker can assist you in helping you organise an assessment, explore your options and make sure your voice is heard when the assessment takes place.
Care Program Approach Plan
A Care Programme Approach (CPA) is a package of care for people with mental health issues. CPA support may be offered from the Department of Psychology or Psychiatry if you have a severe mental disorder, are at risk of suicide, self-harm, have been sectioned in the past, recently been admitted to a psychiatric unit or feel that you need more support than you are getting. You are entitled to an assessment of your needs and to have a care plan that is regularly reviewed. An Independent Advocacy Worker can support you through the process.
Psychiatric Appointments/Psychology Appointments/GP Appointments
Sometimes you may be asked to attend appointments with your GP, Psychiatrist or Psychology regarding your mental health. These appointments may include the discussion of prescription changes, discussing what may or may not be working with regards to your recovery or addressing concerns that you may have. Independent Advocacy Workers can support you by attending these appointments with you and making sure that your concerns are expressed in the way you want them to be, empowering you to have more control over the decisions which may be made on your behalf.
This is only a snapshot of the services that an Independent Advocacy Worker can offer you regarding Mental Health issues. There are many other ways in which you may receive support. Independent Advocacy is a service completely independent from any other service. Our loyalty is solely to the person that we are supporting and the service is of no charge to you.
If you have an issue that you want to discuss with an Independent Advocacy Worker to see if we can be of service, please contact us.
Some useful links for more information are listed below.
MIND – For Better Mental Health
Covers a wide range of topics related to Mental Health
0300 123 3393 or Text 86463
Scottish Association for Mental Health
0141 530 1000
General Mental Health enquiries and advice on legal and benefits issues.
The Mental Welfare Commission for Scotland
0800 389 6809
Provides advice and information on rights under mental health and incapacity law.
Scottish Independent Advocacy Alliance
0131 524 1975
Additional information on Independent Advocacy and how it works.