Speaking for Yourself: Self Advocacy

When you or someone you care for has been detained ('sectioned') under the Mental Health Act, it can be difficult time as you or your loved one may experience deprivation of liberty (your freedom to go where you like within the normal limits of the law) and be given treatment without consent.


However, being detained can be a positive experience if you get the treatment and care you need.  Having a say in your treatment and care and can help you to get the right care and treatment. The views and experience of your Nearest Relative or carer can also be included in decisions about your care and treatment if you wish.  


If you are not able to access an independent mental health advocate (IMHA) in good time, please email IMHA Society and request a self advocacy form, which is designed to help you put forward your views about your treatment and care. You should fill out this form with your Responsible Clinician (this is the professional in charge of your care) on your admission to hospital or a mental health unit.  You should read out or get help to read out the questions to your Responsible Clinician and record or get help to record the answers given. If you have permission from the patient and you are the patient's Nearest Relative or Main Carer or IMHA you can read out the questions and record the answers.


If the Responsible Clinician does not agree to your use of the form and you think it would be helpful to have written down information about your care and treatment, please contact the PALS service of your Mental Health Trust or IMHA Society for help.    


Advanced Decision (used to be called Advanced Directive)  


An advanced decision is a written statement by anyone who wants specific instructions to be followed about what should happen to them if they have to go in to hospital or receive care but do not have mental capacity at the relevant time to make an informed decision. An advanced decision can be very helpful if there are certain types of treatment that are known not to be suitable for you, for example because of the side-effects or if you have particular beliefs that you wish to be respected. It does not have to be written in a particular way but must contain all the information required to make it legally binding.  


 You should ask your Main Carer, Nearest Relative or an independent professional such as an IMHA or solicitor to help you write out what you want to say in an advanced decision. It may be hard to think of what you may want to say, so ask those helping you to guide you in this. The advanced decision document has to be signed by you and this has to be witnessed by an independent witness such as your GP, solicitor or other healthcare professional, who should check you have the mental capacity to make the decision. When it has been witnessed and signed, give a copy to your Mental Health Trust so that they have it in case it is needed in the future. It would be sensible to give a copy to your GP too. It is also useful for people who regularly care for you to know you have made an advance decision and what it means. 


An advance decision that is recognised by law (in England and Wales) is made using the Mental Capacity Act: the Act cannot be used to give treatment if someone has made a valid advance decision refusing it. An advance decision made under the Mental Capacity Act can be set aside by the Mental Health Act. However, the contents of the Advanced Decision must be considered by the Responsible Clinician in deciding about Appropriate Medical Treatment for a patient if they have been detained under the Mental Health Act and particularly if they have clearly stated there are certain medications or treatments they do not wish to receive. Please email IMHA Society for an example template of an advanced decision.