Mental health special 2: Patient advocacy is about listening

Advocacy is quite simply, standing up for the mentally ill – individually and collectively – for the purpose of improving their confidence and quality of life. In practice it means getting a desperate plea for help from somebody that has been labelled as being ‘mentally ill’, as opposed to being ‘normal’, whatever that’s supposed to be. My job is not to question their degree of illness or their current treatment, but to answer their call for help. It doesn’t matter to me what their needs are – from benefit problems, being conned by a retail store, arguments within their family, or simply listening to them in their moment of distress.

Spotlight on Mental Health In a week it was revealed that Catherine Zeta Jones has suffered from bipolar disorder, we continue our series of articles on the experience and treatment of mental illness in Wales. Tomorrow Phil Carradice describes a writers’ project that is bringing some sanity to Whitchurch Hospital in Cardiff. On Monday Elin Jones describes how her experience of dealing with her husband’s schizophreia led her to become chair of the Welsh mental illness charity Hafal.

Establishing yourself as someone who is ‘there’ for them and who will listen, is the first step in good advocacy. Believe me when I say, I have heard everything possible during such calls, and only speak to convince them of one thing. I will help them, regardless of the nature or complexity of their problems. This may involve listening about the same problem through several calls, or it may involve meeting them, in a place where they feel most safe and comfortable. Establishing a good means of communicating is therefore imperative, as is establishing trust in me as a fellow sufferer and someone who knows the system and has a wide experience of life problems. I have never failed to help any patient, because I am empathetic and have a dogged persistence that is hard to defeat.

The next most important factor is to know when it is time to refer your new friend on to someone properly qualified to provide professional help. This may be their GP, a Community Psychiatric Service, Social Services, the Citizens Advice Bureau, a solicitor or, rarely, police community officers. Although I know a great deal about the legislation pertaining to Mental Health Care, I am never prescriptive beyond the most simple of problems. However, I will accompany them to any such meeting and am quite capable of representing them at a Tribunal, if necessary.

Currently, the biggest form of anxiety to my ‘clients’ is the new process of assessing them as being capable for work. Justifiably, they feel that this is merely a ploy to make them do minimal physical tasks, thereby demonstrating their ‘fitness to work’. In my opinion, no one with a diagnosable mental or physical condition should be assessed by a nurse, completing a script on a computer screen. I always accompany my ‘client’, and ask the same question – “Are you making a mental or physical assessment, and are you qualified to do either?”

Qualified assessment is one of the hardest meetings for someone to achieve.  Although Conservative AM Jonathan Morgan has successfully completed a Local Competence Order, making such assessments essential, the successful implementation of the legislation will take some considerable time.

Care – real, genuine care – is most important and, although the quasi legislation is full of rhetoric about care, the current system is not conducive to fulfilling this need. This is particularly pertinent to the adult acutely mentally ill, who fall within the criteria of the Mental Health Act, and are subjected to being ‘sectioned’ when they are deemed to be a danger to themselves and sometimes, though rarely, others – usually relatives, such as a mother. These poor souls may be visited by the police, ‘clapped in irons’, and carted off to their nearest hospital or crisis centre, providing there is a Section 136 room, or a vacancy in a Psychiatric Intensive Care Unit available for them.

I have known many patients kept locked in police vans for hours, awaiting for approval to deliver them to an available unit. Clearly, this is not the best way of persuading a distressed patient to accept what passes for ‘care’ when the time comes for the cuffs to be removed. In these circumstances dignity and the need for basic personal facilities are often ignored, as the direct cause of an inadequate system that has been substantially decreased, when the incidence of such problems have substantially increased.

Over 70 per cent of mental health beds have been cut since July 1992, with 191 of these being for the care of the Elderly Mentally Infirm (incurable dementia or Alzheimer’s patients). As a result we have a huge problem facing us, now and in the future. The need for mental health care (for all degrees of illness ) is being reduced at a time when the need for such essential services is growing exponentially. Care in the Community is seen as being panacea for the mentally ill, even though existing resources are greatly overstretched, with no further resources forthcoming at present.

The new phrase in mental health ‘care’ is ‘the Recovery Model’, that nobody understands or can explain. This leaves patients, and doctors, feeling helpless, with no confidence whatsoever in future mental health care. In addition, the government persists in ignoring patients and the public, contrary to Section 11 guidelines of the Health and Social Care Act 2001. Instead, it holds more sham consultations, whilst introducing legislation restricting the advocacy available to patients. In future patients are likely to be offered government-funded bureaucrats who will offer the concerned patient a cul-de-sac of dismissive gibberish.