The BIG ‘A’ versus the small ‘a’

‘Advocate’ is a job title. It’s the name of a job so it’s a noun, right? We’re Independent Mental Health Advocates. Capital ‘A’. I’m a not-so-secret linguistics nerd and grammar pedant in residence here at Advent Advocacy and so this point feels pretty damn important to me ...

Picture the scene: February 2015 and I’m 3 weeks into my role as an Independent Mental Health Advocate. Now, at this point I was careening towards my late thirties so was self-assured that my role would have a positive impact for people. However, a ward manager in a service I visited in Yorkshire said something to me that stopped me in my tracks. I’d met with the ward manager on behalf of a client who was detained in a medium secure service. The client and I were working on some concerns he had over his medication. The ward manager and I discussed the matter at hand, and I made notes to discuss with my client on his return from some overnight leave the day after. At the end of the meeting the ward manager said, “You know Lindsey, I don’t wish this to sound rude, but I do sometimes wonder why patients need advocates. I advocate for the patients here so why do they need you?’

My ‘week 3 into the job’ brain skidded to a screaming halt I’m afraid. I remember blithering an answer lifted straight outta Chapter 6 of the Mental Health Act Code of Practice. My answer can’t have been great as I don’t really remember the specifics, but I’ve never forgotten the question.

If the same ward manager had asked me today (I’m now on week 249 into my career as an advocate – blimey!) I know I would have said something quite different that, I hope, would have shaped his understanding of the role and, with a bit of luck, aided his ability to signpost the IMHA service to future patients.

Don’t get me wrong, I know what he meant. He meant that he, with a small ‘a,’ advocates for people; highlighting aspects of care that could be better, listening to people’s views and acting on concerns where he can. Week 249 me has seen a huge number of mental health professionals who small ‘a’ advocate for people with passion, conviction and knowledge. But, and here’s the kicker. It’s not the same is it?

Ultimately, these same mental health professionals are likely to be part of the decision-making team for the person and can/ and often do, advise people on courses of action to take. The power of us capital ‘A’ Advocates is that we aren’t part of a decision-making team. We don’t advise. We don’t persuade. We don’t make decisions. What we do is we advocate for people’s views almost as if they were our own. We channel these views using the words and frames of reference of the individual. We represent people in a way that’s personal and true to them, their past, their present and their future. We are trained to have a clear understanding of mental health legislation, the Human Rights Act, Equality Act and Mental Capacity Act so we can advocate for people’s rights using the law as a framework.

For people who can’t instruct us directly we are trained in the four key principles of Non-Instructed Advocacy, principles that give us a framework for person centred advocacy on behalf of our advocacy partners. These same principles equip us to use systemic advocacy to make changes or improvements on matters that affect a number of people within a service.

People who we work for give us very useful feedback on our advocacy service and people often remark on their advocacy service in such a way as to lodge themselves into your collective brain as a team. Consider these comments made by people who my colleagues have work with recently:

‘Advocacy is a gateway to a better future’

‘Advocacy is a key part of the system’

‘I use advocacy to help me navigate my way through things… it always feels more complicated when it’s all about you’.

I had a role defining moment pretty early on in my career. At the end of a meeting with a client, we summarised what we’d discussed and put the items in a priority order. At this point I asked my client how we’d go forward with these matters. My client smiled and said, ‘Ah, no need for you to do anything more thank you. I can take things from here. I like to use advocacy as a confidential sounding board, helps me process my thoughts you see. I like to speak with someone independent because I know what we discuss is confidential and won’t appear in the daily notes in my care file’.

I will never forget this. I share it whenever I can with fellow (capital A) Advocates.

If (when!) the recommendations within the Mental Health Act Review become statutory we will see Advocacy become an opt-out service that anyone in a service (detained or informal) will be statutorily entitled. The prospect of this fills week 249 me with optimism and hope for the reach of Advocacy and the impact it will continue to have for people.

Lindsey Martin, Operations Director at Advent Advocacy