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Open Advocacy Protocol

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OPEN ADVOCACY PROTOCOL

PROTOCOL REFERENCE NUMBER

MHA 024/1

DATE RATIFIED August 2014

NEXT REVIEW DATE August 2017

APPROVED BY MH Clinical Policy Council

ACCOUNTABLE DIRECTOR Director of Nursing

PROTOCOL AUTHOR Mental Health Senior Nurse

Protocol Statement/Key Objective:

The Trust requires arrangements to be in

place to ensure that qualifying patients access

Independent Mental Health Advocacy (IMHA)

services. This protocol provides LCFT staff

with guidance on their roles and

responsibilities within the open advocacy (opt-

out) model.


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Executive Summary Title of Protocol: Open Advocacy Protocol

Subject: Access and referral to IMHAs

Applicable to: (state Network,

Services and staff groups)

All Networks, Ward and Community Staff,

Mental Health Act Administrators and

Advocacy Provider Services.

Key Protocol Issues: Information to Service Users, Mental

Health Act Code of Practice, Referral to

IMHAs, Mental Capacity Act, Best Interest

Decisions, Confidentiality.

Original Issue Date: February 2014 (Adult Mental Health)

Issue Date August 2014

Dates Protocol Reviewed: N/A new document

Next Review Date: August 2017

Protocol written by: Senior Mental Health Nurse

Protocol Lead: Senior Mental Health Nurse

In Consultation with: Operational Services Managers, MHA

Administrators, Network Director, Modern

Matrons, Director of Nursing, Networks

Leads, Trust Solicitor, Trust Legal Advisor,

Social Care Leads, Advocacy Focus,

Advocacy Experience, Real Advocacy and

MHA/MCA Committee members.

Monitoring Arrangements: See page 13

Approved by: Mental Health Clinical Policy Council

Authorised by: Director of Nursing

Related Procedural Documents: Code of Practice Mental Health Act. Code

of Practice Mental Capacity Act.

Data Protection Act.

CL 048a MCA Deprivation of Liberty

Safeguards, Managing Authority

Procedure

Links to CQC lines of enquiry: Safe, Effective, Caring, Responsive, Well

Led


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Table of Contents

1.0 Introduction....................................................................................................... 4

2.0 Scope ............................................................................................................... 4

3.0 Definitions......................................................................................................... 4

4.0 Duties ............................................................................................................... 5

5.0 The Protocol ................................................................................................ 6-12

6.0 Training .......................................................................................................... 12

7.0 Monitoring (including Standards) .................................................................... 13

8.0 References ..................................................................................................... 13

9.0 IMHA and Advocacy Providers for LCFT ……………………………………….14 Appendix 1 Record of Patient Rights Under Section 132 MHA 1983……………15 -16

Appendix 2 Qualifying Patient Information Leaflet…………………………………17- 27

Flow chart for Open Advocacy and referral to IMHA…………………………………..27


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1.0 Introduction

Independent Mental Health Advocacy services (IMHAs) provide an additional safeguard

for Service Users who are subject to the Mental Health Act (MHA). IMHAs are specialist

advocates who are trained specifically to work within the framework of the MHA to meet

the needs of Service Users. IMHAs do not replace any other advocacy and support

services that are available to Service Users, but are intended to operate in conjunction

with those services. Department of Health (DH) (2008) Code of Practice: Mental

Health Act 1983, p157.

The Health Committee of the House of Commons (2013) recommended that IMHAs

become an opt-out rather than an opt-in service to help address the difficulties Service

Users face in accessing advocacy and to eliminate some of the practical problems

clinicians face in making Service Users aware of their right to request an IMHA. The DH

is considering this recommendation and it is likely that guidance will become available.

In the interim, the Trust has developed this open advocacy protocol. It is intended that

this protocol will raise awareness in relation to individuals’ right to IMHAs, will improve

practice around Best Interest decision making within the Mental Capacity Act framework

and will improve the access and uptake of IMHA provision.

This protocol provides staff with guidance on their roles and responsibilities within

the open advocacy model.

2.0 Scope

This protocol is applicable to all Mental Health Act Administrators; ward and

community staff providing services to “qualifying patients” (see 5.0 page 6).

3.0 Definitions

CAMHS Child and Adolescent Mental Health Services ECR Electronic Care Record

IMHAs Independent Mental Health Advocacy services

IMHA Independent Mental Health Advocate

LCFT Lancashire Care Foundation Trust

IMCA Independent Mental Capacity Advocate MHA Mental Health Act

MHAA Mental Health Act Administrator


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MCA Mental Capacity Act

DH Department of Health

AMHP Approved Mental Health Practitioner

4.0 Duties

4.1 Trust Board

The Trust Board has responsibility for ensuring that policies and procedures are

implemented effectively across the Trust.

4.2 Chief Executive

As Accountable Officer, the Chief Executive must ensure that effective systems and

processes are in place to ensure that qualifying patients access IMHA services.

Responsibility for ensuring that this takes place is delegated to an appropriate

Executive lead and this is the Director of Nursing.

4.3 Director of Nursing

The Director of Nursing is responsible for ensuring that effective systems and

processes are in place to ensure that qualifying patients access IMHA services and for

providing assurances to the Executive Management Team (EMT) and the Trust Board

of compliance with this protocol.

4.4 MHA Committee

The committee will receive assurance that this protocol is being implemented.

4.5 Network and Clinical Directors

The Network and Clinical Directors have a responsibility for ensuring the effective

implementation of Mental Health Act, Mental Capacity Act and Data Protection

Codes of Practice and policies.

4.6 Modern Matrons/Service Managers

The Modern Matrons/Service Managers are responsible for ensuring this protocol is

fully adhered to and implemented within their specific area of responsibility.

4.7 Ward/Community Team Managers

The Team Managers are responsible for ensuring that this protocol is understood

and implemented on a day-to-day basis.

4.8 Ward and Community Staff

Staff are responsible for reading and adhering to this protocol on a day-to-day basis and

understanding their professional role and responsibilities under the MHA Code of

Practice and Mental Capacity Act.


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4.9 Mental Health Act Administrators (MHAA)

The Mental Health Act Administrators have responsibility for maintaining confidentiality.

They must collate information from the s132 rights form and forward qualifying patient’s

details to IMHAs where implied consent or a best interest decision has been

documented by qualified staff.

4.10 Advocacy Providers

Advocacy Focus, Advocacy Experience and Real Advocacy representatives will attend

the MHAA meeting on a quarterly basis to optimize learning from good practice

and consider any barriers to the open advocacy model.

5.0 The Protocol

Mental Health Act Administrators, ward and community staff have a central role in

ensuring that qualifying patients access IMHAs.

Criteria for “qualifying patients”;

• Service Users Detained under the Mental Health Act 1983

(However, IMHA services do not apply to s4, s5 or s135/136).

• Service Users Subject to a Guardianship Order

• Service Users on Supervised Community Treatment

• Conditionally discharged, restricted Service Users

• Service Users being considered for Section 57 or 58A Treatment.

(Section 58A Service Users qualify if they are under 18).

Please refer to Chapter 20: MHA Code of Practice for further information.

5.1 The Open Advocacy Model

The role of the Independent Mental Health Advocate (IMHA) is not just to give

information but to ensure that staff provide information to Service Users in a way that

elicits understanding and empowerment. IMHAs are not intended to replace legal

representation.

Role of the IMHA

To provide information to Service Users about their rights under the MHA.

To support the Service Users to understand their care and treatment plan and to

support them to express their views and wishes.

To provide information about people’s responsibilities under the MHA.

To plan for and provide support at tribunals and hospital managers meetings.

To contact the Service User’s solicitor and other agencies like social services.

To provide information and support with complaints.


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It also includes helping Service Users to exercise their rights, which can

include representing them and speaking on their behalf.

IMHAs may also support Service Users in a range of other ways to ensure

they can participate in the decisions that are made about their care and

treatment.

Staff have a duty to inform “qualifying patients” about the availability of IMHAs. Staff

must take whatever steps are practicable to ensure that Service Users understand that

support is available to them and how they can obtain that support. This must include

giving the relevant information both orally and in writing.

5.2 Providing information

When a Service User is detained under the Mental Health Act 1983 and meets the

criteria for a “qualifying patient” information about IMHAs must be given to the

Service User as soon as is practicable. This must be done is conjunction with S132

giving of rights and documented on the “Record of Patient Rights under Section 132

MHA 1983” form. (Appendix 1) The original copy must be sent to the MHA

administrator. A daily record detailing the information provided will also be documented

on ECR.

The role of IMHAs must be verbally explained and supported by an information

leaflet (Appendix 2 page 18). To enable IMHAs to be an opt-out rather than an opt-in

service staff must advise Service Users that they will be automatically referred to

the IMHA service unless they object. This discussion must be recorded on the Daily

Records of ECR and included in the Service User care plan.

In order to provide valid consent the person must be competent to make the

particular decision, not be acting under duress and have received sufficient information

to take the decision.

5.3 Assessing mental capacity

The MHA Code of Practice advises that AMHPs and responsible clinicians should

consider requesting an IMHA visit to a qualifying patient if they think that the patient

might benefit from an IMHA visit but is unable or unlikely to request an IMHAs help

themselves. This consideration must be evidenced on the MHA action form.

Advocacy providers can provide non instructed support for Service Users who lack

capacity around identified areas of their care and treatment as identified by the care

team (See 5.5 Non-Instructed Advocacy page 9).

Mental capacity is the ability to make a decision. When there is no doubt that the

Service User has capacity staff must respect the Service User’s view. However,

when there is doubt of a Service Users capacity there must be an assessment of


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their capacity to make this decision. Staff must be guided by the Mental Capacity Act

Code of Practice.

Diagnostic Test

Anyone assessing someone’s capacity to make a decision for themselves should

use the two-stage test of capacity;

Functional Test

• Does the person have an impairment of the mind or brain, or is there some sort of

disturbance affecting the way their mind or brain works? (It doesn’t matter whether

the impairment or disturbance is temporary or permanent.)

• If so, does that impairment or disturbance mean that the person is unable to make the

decision in question at the time it needs to be made?

Assessing ability to make a decision

• Does the person have a general understanding of what decision they need to make

and why they need to make it?

• Does the person have a general understanding of the likely consequences of

making, or not making, this decision?

• Is the person able to understand, retain, use and weigh up the information relevant to

this decision?

• Can the person communicate their decision (by talking, using sign language or any

other means)?

The Service User is assessed as having capacity to make the decision and

objects to the referral;

1. The assessment of the Service User’s capacity to make the decision and discussion

must be recorded on the daily records of ECR and included in the Service User care

plan.

2. Staff must ensure that Service Users who have capacity and decide to object to

referral are regularly reminded of the availability of the IMHA service. Any such

discussions must be recorded on the daily records of ECR.

3. Staff must not release the names of Service Users who have capacity and object

to referral. This would be a breach of confidentiality.

5.4 Making the referral

The Service User is assessed as having capacity, is fully informed to make the

decision and does not object to referral;

1. The referral process must be explained and the Service User must be supported

to make referral to the IMHAs. If the Service User would like a discussion with

IMHAs a referral can be made using telephone number;


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ADULT MENTAL HEALTH AND OLDER ADULTS

Advocacy Focus - 0300 323 0965

SPECIALIST SERVICES (GUILD LODGE)

Advocacy Experience – 01772 773 520

TIER 4 CAMHS

Real Advocacy - 07919246261

2. If the Service User does not want to speak directly to IMHAs the referral will be

accepted via the MHAA admissions report. The Service User must be made

aware that the process can take up to 3 days.

3. The assessment of the Service User’s capacity to make the decision and

discussion must be recorded on the daily records of ECR and included in the

Service User care plan.

The Service User is assessed as not having capacity to make the decision

One of the key principles of the Mental Capacity Act is that any decision made on

behalf of a person who lacks capacity must be done, or made, in that person’s best

interests. As long as decisions are in the best interests of the person who lacks

capacity to make the decision for themselves then the decision-maker will be protected

from liability. (MCA Code of Practice p64)

1. The assessment of the Service User’s lack of capacity to make the decision and

rationale for the best interest decision must be recorded on MCA module on ECR

and included in the Service User care plan.

2. The referral process must be explained to the Service User and they must be

made aware that this can take up to 3 days. If the Service User would like a

discussion with IMHAs a referral can be made using telephone number;





TIER 4 CAMHS


3. If the Service User does not want to speak directly to IMHAs the referral will be

accepted via the MHHA admissions report.


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5.5 Non-Instructed Advocacy

Non-Instructed Advocacy is a safeguard that ensures that those who are unable to

express their wishes clearly (or at all) or who otherwise lack the capacity either

temporarily or permanently to instruct or direct an advocate are represented by

someone independent of those who have responsibility for making decisions on their

behalf.

Central to non-instructed advocacy practice is the assertion that everyone has

certain needs that are fundamental to their well-being – even if they are unable to

express them. These include;

• Access to satisfactory care

• Freedom of choice

• Promoting self-value

• Opportunities for progression

When it has not been possible to establish communications with an individual, or

their wishes and views are unclear, the care team should consider using a non-

instructed advocate. This will include circumstances where it is unclear if the Service

User fully understands the issues related to their care and treatment, or key

decisions that are to be made about their future.

The focus of non-instructed advocacy is to ensure that basic rights and entitlements are

asserted on behalf of people who are unable to assert them for themselves. This

includes advocating on behalf of those who are unable personally to communicate their

own wishes and views.

The advocate will work towards non instructed advocacy principles to ensure that the

qualifying patient’s perspective is at the centre of any decisions made, and also

establish the person's wishes, preference and values. It is not the role of the

advocate to offer their own views or opinions as to what is in the person’s best interests.

If a Service User meets the criteria for Non-Instructed Advocacy contact;





TIER 4 CAMHS



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5.6 The role of the MHA Administrator in supporting open advocacy

The MHA Administrators (MHAA) will collate information from the s132 rights form

(Appendix 1) to produce a weekly report. This report must be edited to remove the

names of Service Users who have capacity and object to IMHAs referral. MHA

Administrators must not release the names of Service Users who fall into this category

as this would be a breach of confidentiality. The edited report with details of Service

Users who did not object or if lacking capacity where a best interest decision to refer

has been made, must be forwarded to local IMHAs providers. All reports must be

password protected or sent through secure NHS email. The MHAA must ensure that

this report is forwarded at least once a week.

Advocacy Focus - Secure Email: [email protected]

5.7 Supporting IMHAs

MHA Administrators, as well as ward and community based staff, must ensure that they

have a supply of up to date information about all of the IMHA services in their area and

that qualifying patients have access to the information (Appendix 2 and 3).

Ward and community staff must ensure that consideration is provided to involve the

IMHA in relevant meetings by timetabling key meetings and providing advance

notice to the qualifying patients and their IMHA.

Ward and community staff must ensure that “qualifying patients” can contact and meet

their IMHA in private.

5.8 Confidentiality and open advocacy

All staff must demonstrate that information governance issues have been considered

and addressed prior to sharing patient identifiable information. This includes

ensuring that reports are password protected or sent through secure NHS email. The

open advocacy model can be made compliant with the law on information sharing

provided that: Service Users are first informed about the role of IMHA when

provisions of the MHA are to be invoked. Staff must advise Service Users that they

will be automatically referred to the IMHA service unless they object.

For Service Users assessed as lacking capacity to decide whether they agree to a

referral, a best interest decision about the referral would authorise release of their

name.

Staff must not release the names of Service Users who have capacity and object

to referral. This would be a breach of confidentiality and may be unlawful.

Therefore these Service Users cannot be included in the referral list.

mailto:[email protected]



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5.9 Access to records

If the Service User consents (which presumes capacity) then the IMHA will have the

right to see any care records held by the detaining authority or social services authority.

IMHAs also have a right to visit and speak to any person who is currently professionally

concerned with a Service User’s medical treatment, provided it is for the purpose of

supporting that Service User in their capacity as an IMHA.

When a Service User lacks capacity, access to care records should not be

automatic. Ward and community staff must ask the IMHA to provide reasons why

they believe it to be relevant and appropriate. “The key consideration will therefore

be whether the disclosure is in the Service User’s best interests. Record holders

should start from a general presumption that it is likely to be in the Service

User’s best interests to be represented by an IMHA who is knowledgeable about

their case. But each decision must be taken on its merits”. Any such

considerations must be documented in ECR within the daily record. Please refer

to MHA Code of Practice, Chapter 20, for further information.

6.0Training

Clinical staff must be appropriately trained in assessing and recording whether

the Service User has mental capacity to make decisions and whether they

consent to treatment. All relevant staff identified by the Network training matrix

must complete MCA and information governance training.

Staff working with Service Users subject to Supervised Community Treatment

should receive further training about their obligation to inform qualifying service

user about their right to, and eligibility for, an IMHA.


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7.0Monitoring Standard Time frame How Whom

A representative from

Advocacy Focus, Advocacy

Experience and Real

Advocacy will attend the MH

Act Administrators meeting to

optimize learning from good

practice and consider any

barriers to the open advocacy

model.

Quarterly Standing agenda item on the

MHA Administrators meeting.

Barriers to open advocacy to be

escalated to the Mental Health

Senior Nurse by the MHAA,


Experience and Real Advocacy.


Experience and Real Advocacy

will provide a quarterly report on

referral uptake and activity.

The MHA Manager will provide a

highlight report to the locality

governance meetings and the

Quality and Effectiveness Boards.

MHAA

Manager Advocacy

Focus Advocacy

Experience Real

Advocacy

Report on open advocacy

referral activity and outcomes

to be submitted to the MHA

committee

Quarterly Report from the MHA

Administrators meeting. This will

include the IMHA referral, uptake

and activity information provided

by Advocacy Focus, Advocacy

Experience and Real Advocacy.

MHAA

Manager

8.0 References and related documents

1. Data Protection Act (1998).

2. DH (2008) Code of Practice: Mental Health Act 1983.

3. DH (2005) Code of Practice: Mental Capacity Act.

4. DH (2009) Reference guide to consent for examination or treatment.

5. House of Commons (2013) Post-legislative scrutiny of the Mental Health Act

2007. First Report of Session 2013–14.

6. MHA 024 - Section132: Policy for the giving of information to patients and

nearest relatives.

http://trustnet/docs/policies/DOCUMENTS%20POLICIES/Section%20132%20

Policy.pdf

7. SLAM (2013) The Maze: Third Edition.

8. UCLAN (2103) The right to be heard.

www.uclan.ac.uk/research/environment/projects/the_right_to_be_heard.php

9. http://www.parliament.uk/business/committees/committees-a-z/commons-

select/health-committee/news/13-08-14-mha2007cs/

http://trustnet/docs/policies/DOCUMENTS%20POLICIES/Section%20132%20Policy.pdf




http://www.uclan.ac.uk/research/environment/projects/the_right_to_be_heard.php

http://www.uclan.ac.uk/research/environment/projects/the_right_to_be_heard.php

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/13-08-14-mha2007cs/

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/13-08-14-mha2007cs/


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9.0 IMHA and Advocacy Services for LCFT

Advocacy Focus provide IMHA services to qualifying patients receiving care

and treatment from LCFT’s adult mental health and older adult mental health.

Telephone: 0300 323 0965

Email: [email protected]

Secure Email: [email protected]

Write to: Advocacy Focus, 54 Blackburn Road, Accrington, BB5 1LE

Advocacy Experience provide IMHA services to qualifying patients receiving

care and treatment from LCFT’s specialist services based a Guild Lodge.

Telephone: 01772 773 520

Real Advocacy provide IMHA services to qualifying patients receiving care

and treatment from LCFT’s Tier 4 specialist Child and Adolescent Mental

Health Service.

Telephone: 07919246261

Email: [email protected]

http://www.advocacyfocus.org.uk/

http://www.advocacyfocus.org.uk/





http://www.advocacyexperience.com/

http://www.advocacyexperience.com/




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2

3

4

5(4)

5(2)

17A

35

36

37

37/41

38

48/49 or other please state section of MHA:

Appendix 1- Record of Patient Rights under Section 132 MHA 1983

Patient’s Name: Ward: NHS No.

PATIENT’S RIGHTS

This is to certify that the above named was given notice, orally and in writing of his/her* rights, whilst detained under section: - Please circle as appropriate:

The reason for the rights to be read was due to (please circle as appropriate):

Admission Inter-Ward Transfer

Renewal of Section

Regrade of Section

(inc 5(4) & 5(2)

Restricted (Annually)

The rights were given by name/designation: Signature:

At time: am/pm* on date:

He/She* Understood / Did not understand / Lacked capacity / Refused

Entry onto ECR made Yes/No*

If the patient is incapable of understanding their rights, further attempts to notify him/her* will be on-going as per their care plan and recorded accordingly.

INDEPENDENT MENTAL HEALTH ADVOCATE REFERRAL

IMHA services do not apply to Sections 4, 5(4), 5(2), 135 or 136

Is the Service User a qualifying patient? Yes/No*

Patient’s right to an IMHA discussed and the ‘Open Advocacy’ model explained / leaflet provided?

Yes/No*

(A) The Service User is assessed as having capacity to make the decision and is fully informed

The Service User objects / does not object* to referral to IMHA.

IF SERVICE USER OBJECTS DO NOT RELEASE THEIR DETAILS

(B) The Service User is assessed as not having capacity to make the decision

The rationale for the best interest decision to refer to IMHA has been recorded in the MCA module on ECR and the care plan.

Yes/No*

Were any special circumstances used to assist with this undertaking of reading their rights?

Yes/No*

If yes what were these circumstances:

Please Turn Over (PTO)


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NEAREST RELATIVE INFORMATION

(Not applicable to patients detained under: Sections 35, 36, 37/41, 38, 45A, 47, 47/49, 48, 48/49)

The patient has/has not* agreed that their nearest relative can be notified. (* Please delete as appropriate)

The nearest relatives’ relationship to the patient (please refer to AMHP application for identification of Nearest Relative):

Name of the nearest relative:

Address of the nearest relative:

I have had my rights read to me / declined to have them read to me

Patients Signature: Date:

TO BE COMPLETED BY MENTAL HEALTH ACT ADMINISTRATOR ONLY Letter sent notifying the patients’ nearest relative of their rights, and a copy of the rights leaflet was sent on

Date:

Letter sent notifying the patient of their rights, and a copy of the rights leaflet was sent on

Date:

Referral to IMHA service if applicable Date

Signed: (Mental Health Act Administrator)

Date:

This form is to be completed ON ADMISSION, INTER-TRANSFER, REGRADE, RENEWAL OF MHA SECTION AND RESTRICTED SECTIONS ANNUALLY and sent to the MHA Administrator.

A copy must be made and placed in the patients’ notes.

GUIDANCE NOTES

This form is designed to be completed at the following events:

On Admission to each clinical area- including inter-ward transfers. On each subsequent attempt if rights refused, service user lacked capacity or

did not understand.

Upon renewal of MHA Section

Upon re-grade of MHA Section

Upon restricted section annually

A care plan must be completed on ECR for all those who did not understand their rights on the first attempt.

Monthly rights need to be clearly documented within the Record of Care and the appropriate monthly record of rights form needs to be completed.


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Appendix 2

How to access

Advocacy Services

While you are under the protection of the Mental Health Act (1983)

you have the right to the services of an Advocate.

This leaflet will give you information about how to contact an

Advocate, and how they can support you.


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Independent Mental Health Advocacy ~ ‘IMHA’

IMHA’s are Advocates specifically for people who are subject to the Mental Health

Act. Advocacy services are provided in each area by specialised teams and are

independent from Lancashire Care NHS Foundation Trust staff.

The service is completely free and works in conjunction with other Advocacy services. They

don’t make decisions for you and they don’t make judgments about you.

It is your choice to have help from an IMHA, and having help from an IMHA does

not stop you having help from another Advocate or a Lawyer.

An IMHA advocate can:

Provide information to Service Users about their rights under the MHA.

Support the Service Users to understand their care and treatment plan

and to support them to express their views and wishes.

Provide information about people’s responsibilities under the MHA.

Plan for and provide support at tribunals and hospital managers meetings.

Contact your solicitor and other agencies like social services.

Provide information and support with complaints.

How do I contact an Advocate?

Service Area Provider Service Telephone Inpatient units

Adult Mental Health

and Older Adult

Services

0300 323 0965

In Lancashire and for

those subject to

Supervised Community

Treatment, Conditional

Discharge and

Guardianship.

Specialist Services

01772 773 520

Guild Lodge

Child & Adolescent

Mental Health

Services

07919246261

For young people at

The Platform and The

Junction (Tier 4).


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You can telephone the Advocacy Service yourself, your nearest relative can make

contact for you or you can ask a member of staff to contact them for you.

You are a qualifying in-patient If you are subject to the Mental Health Act 1983 (MHA 1983), you will be given

information about your Rights under the MHA 1983 and you will be told about your

right to see an Advocate.

To qualify for Advocacy support, you must be subject to the Mental Health Act 1983.

Sections that do not qualify are Section 4, Section 5(4), Section 5(2) Section 135 and

Section 136.

You will be automatically referred to the Advocacy (IMHA) service unless you object.

If your nurse thinks that you are too unwell to make a decision about seeing an

Advocate they may ask for you to be seen. You can still decide if you do not wish to

see the Advocate again. You will be given a leaflet and be told about your Rights, and when you may appeal

against your detention. The leaflet also explains about medication. A list of questions

you might want to ask about you medication are included on page 4.

You may appeal to the First Tier (mental health) Tribunal and/or to the Hospital

Managers dependent on your Section type. Information about these services and

application forms can be found on pages 7 and 8.

You are a qualifying community patient if you are on Supervised Community

Treatment, Conditional Discharge and Guardianship. If you are subject Mental Health Act 1983 (MHA 1983) in the Community, you will be

given information about your Rights under the MHA 1983 and you will be told about

your right to see an Advocate.

Details of who to contact can be found on page 2. You will be given a leaflet and be told about your Rights, and when you may appeal

against your detention. The leaflet also explains about medication. A list of questions

you might want to ask about you medication are included on page 4.

You may appeal to the First Tier (mental health) Tribunal and/or to the Hospital

Managers dependent on your Section type. Information about these services and

application forms can be found on pages 7 and 8.


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Questions to ask about your Medication

Your Doctor will tell you about any rules that apply to your medication while you

are subject to the MHA 1983.

You may want to ask some questions about the medication and how it might

affect you. Below are some suggested questions that might help you.

Why am I being given this medication?

How does it work?

What is the usual dose?

What dose will I be given?

When should I take this medication?

Do I have to take this medication every day?

Does this medication have any side effects?

Are there any special side effects that I need to watch out for?

What should I do if I have any side effects?

How long will it take for the medication to work?

How will I know if the medication is working?

When can I stop taking the medication?

What happens if it doesn’t work?

Does alcohol affect this medication?

Is this the only medication available?

What other treatments are available?

Are there any natural remedies I should not take with this medication?


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How do I Appeal?

Mental Health Act Administrators will make sure you have information about

your rights under the Mental Health Act 1983 and can help you with your

appeal

To appeal to the Hospital Managers

You may complete an application form, which is on page 7.

You may write a letter to the MHA administrator asking for an appeal to be

arranged.

You can ask an IMHA (Advocate).

You may ask a Solicitor to make an appeal on your behalf. A list of Solicitors

is on page 11.

To appeal to the First Tier Mental Health Tribunal

You may complete an application form, which is on page 8.

You may write a letter to the MHA administrator asking for an appeal to be

arranged.

Your can ask an IMHA (Advocate).

You may ask a Solicitor to make an appeal on your behalf. A list of Solicitors

is on page 11.

If you do not feel well enough to contact a Solicitor yourself, your nurse, Care

Coordinator or the MHA Administrator can ask for a Solicitor on your behalf.

Further information about the Mental Health Act and how to appeal can be found

online at http://www.lancashirecare.nhs.uk/about-us/Mental-Health-Act-

Information.php

http://www.lancashirecare.nhs.uk/about-us/Mental-Health-Act-Information.php





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APPLICATION FOR A HOSPITAL MANAGERS REVIEW

Please complete this form as far as you are able. If you are unsure how to complete it, you can ask anyone at the hospital, a relative or friend, to help.

I am detained in hospital under the Mental Health Act 1983 and I wish to apply for a Hospital Managers’ Review.

1. My full name is

2. I am detained under Section of the Mental Health Act 1983.

3. I would like you to notify and invite my nearest relative to the review hearing:

My nearest relative’s name is_

4. I would like to be legally represented at the hearing.

Yes No

5. I intend to appoint a Solicitor myself

6. I would like to discuss the appointment of a Solicitor with the Mental Health

Act Administrator. Signed Dated

Send completed application form to Mental Health Act Administrator

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Open Advocacy Protocol Office stamp


APPLICATION TO FIRST TIER TRIBUNAL (MENTAL HEALTH) Mental Health Act 1983 (as amended)

The Tribunal Procedure (First-tier Tribunal) (HESC) Rules 2008

Please tick the relevant application type

Application by or on behalf of a patient detained for assessment (S.2)

Application by or on behalf of a patient subject to a Guardianship Order

Application by or on behalf of a non-restricted patient detained for treatment

Other application by a non- restricted patient (specify *)

Application by or on behalf of a patient subject to a Community Treatment Order

Application by the patient’s Nearest Relative (specify *)

Application by or on behalf of a RESTRICTED patient

*

Please complete all information requested in this part of the application form. An application must, if possible, contain all the information requested.

If you cannot provide the information required below, please give reasons. The tribunal may return an incomplete application form.

Patients Full Name1

Date of Birth1

Provision /Section under which the patient is detained, liable to be detained, or subject to an

Order under the Act1

Date(s) of relevant Section, Admission, and/or Order

1

Hospital (where patient is, or is liable to be, detained)1

Responsible Authority1

(Name & Address - see Guidance)

LANCASHIRE CARE NHS FOUNDATION TRUST

For patients in the community please give

1) Patient’s address and

2) Name and address of

Community Supervisor or

Care Coordinator1

1 Parties must cooperate with the tribunal and this information is required to enable the tribunal to deal

with the case effectively and to avoid delay. An incomplete application form may be returned.

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Nearest Relative details if known

Name:

Address:

Relationship to patient:

Solicitor’s details if known

Name of solicitor:

Name & address of solicitor’s firm:

Telephone number:

Secure email address:

Unrepresented: *Delete as appropriate

I intend to appoint a solicitor myself*

I would like a solicitor to be appointed on my behalf*

I do not wish to appoint a solicitor as I intend to represent myself at the hearing*

Does the patient require an interpreter/have other special requirements?

If an interpreter is required please enter the language and dialect required

Please tell us of any other special requirements

DECLARATION (*Delete as appropriate)This application is submitted by the patient or nearest relative OR This application is submitted on behalf of the patient or nearest relative, who has personally authorised me to submit this application on their behalf.

Signature

Print Name

Date

Completed forms should be sent by secure email to: [email protected] (if you have a CJSM account then you should send to [email protected]) or by first class post to: The Tribunal Service (Mental Health), PO Box 8793, 5

th Floor, Leicester

LE1 8BN. Please do not submit the form more than once.






SOLICITORS LIST Blackburn

Roebucks Solicitors 12 Richmond Terrace Blackburn BB1 7BG Keith Adamson Gina Steele Barbara Howarth David Griffiths

07903 559909

Louise Neville Tel: 01254 274000

01254 52821 Fax: 01254 274001

Blackburn Lisa Marie McNulty Solicitors 756 Whalley New Road Blackburn BB1 9BA Lisa Marie McNulty Alison Cox Annette Bateman Debbie Kempson Ruth Sagar

Rachael Glover

Tel: 01254 248209 Fax: 01254 246795

Bradford Switalski’s Solicitors 2a Darley Street Bradford BD1 3HH

Lynn Melia

07891 341831 Katherine McCabe Angela Hunt

Tel: 01274 720314 Fax:

Harrogate Francina Whelan & Co New Barn House Hall Mews Clifford Road Boston Spa LS23 6DT

Francina Whelan

Tel: 01937 534022 Fax: 01937 534022

Liverpool Jackson & Canter 40 St Mary’s Road Garston Liverpool L19 2JD

Mike Davies

Tel: 0151 282 1782

Carlisle Carlisle Law Chambers 8 Spencer Street Carlisle CA1 1DG

Margaret Payne

Tel: 01228 521383 Fax: 01228 818169

Burnley Southerns Solicitors PO Box 21 Mackenzie House 66/68 Bank Parade Burnley BB11 1UB

Neil Cronin Rachel Eastham Henry Saunders Emma Jackson

Tel: 01282 422711 Fax: 01282 470320

Preston O’Donnells Solicitors 68 Glovers Court Preston PR1 3LS

John O’Donnell Laura Wilson Ruth Muncaster Phillippa Curran

Tel: 01772 881000 Fax: 01772 883178

Bolton Fieldings Porter Silverwell House Silverwell Street Bolton BL1 1PT

Basil Herwald

Tel: 01204 540900 / 591123 Fax: 01204 305345

Hoylake Peter Edwards Law Ventura House 8 Market Street Hoylake CH47 2AE

Salil Kumar Steven Beard Paul Williams Andrew Perks

Tel: 0151 632 6699 Fax: 0151 632 6606

Manchester Rowlands Otten Penna 339 Palatine Road Northenden Manchester M22 4HH

Ruth Edwards Gareth Miller Susan Cragg Morna Rivers

Tel: 0161 945 1431 Fax: 0161 946 0408

Manchester John Black Solicitors 64 Cross Street Sale Manchester M33 7AN Fay Acklam Joanne Black Tel: 0161 972 5999

Manchester

Blavo & Co Solicitors 3 Piccadilly Place Manchester M1 3BN

Sian Bradley

Tel 01612 421 222

Oldham Quality Solicitors Gruber

Garratt King Street Buildings Manchester Street Oldham, OL8 1DH

Andrew Cole

Tel: 0161 665 3502 Fax 0161 665 4060

Liverpool Hogans Solicitors 10 Station Street Prescot MerseysideL35 0LP

Kevin Lloyd Caroline Sims Robert Beech

Tel: 0151 430 7529

Liverpool Swain & Co 2

nd Floor

Bulloch House 10 Rumford Place Liverpool L3 9DG Joanna Dean Adrian Syms

Tel: 0151 255 2286

Liverpool RMNJ Solicitors 63 Hamilton Square Birkenhead Wirral, CH41 5JF Richard Nicholas Nicola Cho Louise Wilson Fay Acklam Ian McEvoy

Tel: 0151 647 0000

Harrow Duncan Lewis Spencer House 29 Grove Hill Road Harrow On the Hill Middlesex HA1 3BN

Peter Wusu

Tel: 0203 114 1124

London Nieko Solicitors (London) Rachel House 214-218 High Road London N15 4NP

Michael Curwen

Tel: 0208 808 3067


Page 26 of 27



Page 27 of 27

LCFT Flow Chart for Open Advocacy and Referral to IMHA

Service User admitted to Inpatient Services who is detained under the Mental Health Act

1983 and meets the criteria for a “Qualifying Patient”.

Qualifying Patient

Service Users detained under the Mental Health Act 1983

However, IMHA services do not apply to s4, s5 or s135/136

Service Users Subject to a Guardianship Order

Service Users on Supervised Community Treatment

Conditionally discharged, restricted Service Users

Service Users being considered for Section 57 or 58A Treatment

Section 58A Service Users qualify if they are under 18.

Information about IMHAs must be given to the Service User as soon as is practicable.

This must be done is conjunction with S132 giving of rights. Staff must advise Service

Users that they will be automatically referred to the IMHA service unless they

object.

The Service User is assessed

as having capacity, is fully

informed to make the

decision and does not object

to referral

The referral process must be

explained and the Service User

must be supported to make

referral to the IMHAs. If the

Service User would like a

discussion with IMHAs a referral

can be made using the telephone

numbers below.

If the Service User does not want

to speak directly to IMHAs the

referral will be accepted via the

MHHA report. The Service User

must be made aware that the

process can take up to 3 days.

The Service User is assessed as not

having capacity to make the decision

The assessment of the Service Users

lack of capacity to make the decision

and rationale for the best interest

decision must be recorded on MCA

module on ECR and included in the

Service User care plan

The referral process must be explained

to the Service User and they must be

made aware that this can take up to 3

days. If the Service User would like a

discussion with IMHAs a referral can be

made using telephone numbers below.

If the Service User does not want to

speak directly to IMHAs the referral will

be accepted via the MHHA report.

The Service User is assessed as

having capacity to make the

decision and objects to the

referral. Staff must not release

the names of Service Users

who have capacity and object

to referral. This would be a

breach of confidentiality.

Staff must regularly remind the

Service User of the availability of the

IMHA service. Any such discussions

should be recorded on the daily

records of ECR.

The Service User is assessed as

having capacity, is fully informed to

make the decision and does not

object to referral

How to Make a Referral for IMHA

The assessment of the Service

Users capacity to make the

decision and discussion must be

recorded on the daily records of

ECR and included in the Service

User care plan.

The Independent Mental Health Advocacy Service

An IMHA is an advocate that helps support the rights of service users who are

detained under the Mental Health Act 1983. The Advocate will work with

health and social professionals to help support the service user and to ensure

their voices are heard.

Adult Mental Health & Older Adults

Advocacy Focus

By Telephone: 0300 323 0965 By Email at: [email protected]

Specialist Services (Guild Lodge)

Advocacy Experience

By Telephone: 01772 773 520

Tier 4 CAMHS

Real Advocacy

By Telephone: 07919246261

