New research to guide commissioning of Independent Mental Health Advocacy


Independent Mental Health Advocates (IMHAs) help patients who are under the Mental Health Act to understanding the position they are in, look after their rights and make the right decisions about their care and treatment.

Independent advocacy has been around for many years, but there have been very few evaluations of mental health advocacy to guide commissioners. This new research report (funded by the Department of Health) aims to:

Review the extent to which IMHA services in England are providing accessible, effective and appropriate support for the diversity of qualifying patients, and to better understand the factors that affect quality. It was intended that the study would obtain robust evidence to inform the commissioning and delivery of high quality IMHA services.

The research used a variety of methods to gather information about how IMHA services are working in practice, including a literature review, focus groups, shadowing IMHA visits, case studies, questionnaires, interviews and analysis of key reports and service records.

As you would expect, the research team included people with experience of using mental health services and of the Mental Health Act.

Here’s what they found:

  • The majority of people who qualify for IMHA services do not take up the opportunity
  • People who need IMHA the most are using it the least, this includes:
    • People on Community Treatment Orders
    • People from black and minority ethnic communities
    • Children and young people
    • Older adults
    • People with sensory impairment
    • People with learning disabilities
  • People who understand what IMHA services are, tend to use them the most
  • IMHA services are not always well advertised
  • Some health professionals don’t understand that it is their responsibility to promote IMHA or IMHAs’ right to see patient records
  • There is little evidence to show that service user needs are considered when IMHA services are first commissioned
  • The is a lack of clear records showing that patients are given the service they need

The researchers present a number of recommendations for action:

  • Service users should get an advocate automatically and if they don’t want one then they can tell them that
  • All the different groups who find it hard to get an IMHA need to be top of the list and a close eye kept so they get the service they need
  • Non-instructed advocacy needs to be readily available. This is when an IMHA acts on behalf of someone who lacks capacity to safeguard their rights
  • Information that mental health professionals and IMHA services keep about the involvement of advocates needs to be clear and with clear standards so the same type of records are kept
  • Mental health services need to support the role of IMHAs by making sure the IMHA can meet people who qualify for their services in private and be involved with the service user at key meetings
  • Resources such as money will be needed to ensure that these important suggestions happen. But some things are about changing attitudes too
  • It is important that service users give their point of view about how these services are planned and go forward


Newbigging, K. et al The Right to Be Heard: Review of the Quality of Independent Mental Health Advocate (IMHA) Services in England. Research report (PDF). University of Central Lancashire, 21 June 2012.


Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

More posts - Website

Follow me here –