A range of people in different circumstances and times of life may come into contact with mental health services and so benefit with the help of an Independent Mental Health Advocate (IMHA). An IMHA may work with a person who has been detained in hospital for the first time following their very first experience of mental illness, or someone sentenced to prison for a serious criminal offence who has been transferred to a secure hospital for treatment, or someone subject to a Community Treatment Order living at home after being discharged from a period of treatment in hospital. No matter what the person’s situation, IMHAs exist as an additional safeguard for those involved in mental health services to help them to understand and exercise their rights.

About the IMHA Role

What is an 'IMHA'?

Independent Mental Health Advocates or ‘IMHAs’ are statutory advocates providing a legal safeguard for people impacted by the Mental Health Act 1983. Where a person is detained in hospital or is subject to a community or Guardianship order under the Mental Health Act, they have the right to receive help from an IMHA, including help to understand and exercise their rights under the Act. For more information on the help an IMHA can offer, see FAQs below.

How can someone get help from an IMHA?

People eligible for help from an IMHA are referred to by the Mental Health Act as ‘qualifying patients’. This is because people who have help from an IMHA are receiving or being assessed for treatment by a mental health service. A person may request the support of an IMHA at any time once they become a qualifying patient but do not have to accept help from an IMHA if they do not want it and can choose to end the support they are receiving from an IMHA at any time. Qualifying patients should be provided with relevant information about who provides IMHA services in their area. For more information on who is a qualifying patient for the purposes of IMHA, see FAQs below.

The Mental Health Act Code of Practice states that Approved Mental Health Professionals (referred to as ‘AMHP’s) and responsible clinicians should consider requesting an IMHA to visit a qualifying patient if they think that the patient might benefit from an IMHA’s visit but is unable, or unlikely, for whatever reason to request an IMHA’s help themselves. If a patient lacks capacity to decide whether to seek help from an IMHA, an IMHA should be introduced to the patient.

IMHAs must comply with any reasonable request to visit and meet with a qualifying patient, if the request is made by the patient’s nearest relative, an AMHP or the patient’s responsible clinician. However, before requesting an IMHA to visit a patient, professionals should, where possible, first discuss the idea with the patient, and give them the opportunity to decide for themselves whether to request an IMHA’s help. There are legal duties for hospital managers, local authorities and relevant professionals to provide information about IMHA services to someone who becomes a ‘qualifying patient’ and to their nearest relative (except for informal patients) and to be aware of people who may need encouragement and assistance to seek the support of an IMHA, including if they have limited capacity, have a sensory impairment, are from a minority ethnic community, or are under 18.

What help can an IMHA offer?

IMHAs are specialist advocates trained specifically to work within the framework of the Mental Health Act. IMHAs will normally have a good understanding of the relevant clinical approaches to assessing and treating ‘mental disorders’ as well as extensive experience working with people experiencing and living with different forms of mental illness. IMHAs will usually work by agreeing with the person the outcomes that they want and agreeing the level of help the IMHA will provide, including giving information, attending meetings, representing the person and helping them to a point of being able to self-advocate.

The IMHA role can be divided into two key functions. The first is to help patients to obtain and understand information, including about how the Act applies to them and others (such as their nearest relative) as well as related treatments they are receiving or may receive. The second function is to help patients to exercise their rights, including by representing them. IMHAs will usually aim to help patients get to a point of feeling comfortable advocating for themselves, making informed choices and participating in decision-making. Where a person has limited capacity to make relevant decisions, IMHAs will work with them try to support the person to make the decision, where this may be because of difficulty understanding, retaining, using or weighing information or communicating a decision. If the person lacks mental capacity to decide whether to take up help from an IMHA, the IMHA will meet with them and, if the person is unable to decide whether to take up help from an IMHA, the IMHA will determine if the person will benefit from non-instructed advocacy for a particular issue, for example, to represent them when their medication is being reviewed because there are no family or significant others who can support or represent them. Where an IMHA does this, they will regularly review whether non-instructed advocacy is appropriate and seek to facilitate the person to reach a point of decision-making capacity about whether to have IMHA help. For more information on the help an IMHA can offer, see FAQs below.

IMHA FAQs

1. When does someone qualify for IMHA help?

In England, patients are eligible for support from an IMHA, irrespective of their age, if they are:

  • Detained under the Mental Health Act or liable to be detained under the Act (such as patients who are currently on leave of absence from hospital or absent without leave)
  • A conditionally discharged restricted patient
  • Subject to a guardianship order
  • Subject to a community treatment order (CTO)
  • Being considered for a treatment to which section 57 applies (‘section 57 treatment’ mentioned above), irrespective of whether they are otherwise subject to the Act
  • Under 18 and being considered for electro-convulsive therapy (ECT) or other treatment to which section 58A applies (‘section 58A treatment’), irrespective of whether they are otherwise subject to the Act

In England, voluntary (also known as ‘informal’) patients using secondary mental health services, unless being considered for section 57 treatment or under 18 and being considered for section 58A treatment, are not eligible for help from an IMHA. In Wales, voluntary patients also have the right to an IMHA if they are an in-patient in hospital or registered establishment and receiving assessment of and / or treatment for a mental disorder.

However, non-statutory mental health advocacy services for voluntary patients in England may be commissioned locally. Contact your local authority for further information.

2. What rights can an IMHA help a patient to exercise?

IMHAs can help patients to: challenge the use of the Mental Health Act by accessing and finding legal representation for the Mental Health Tribunal; request a review of their detention or community order by the relevant hospital managers and support and represent the person at the review hearing; make a complaint about the relevant mental health service; exercise their human rights in relation to the use of the Act, such as interference with the right to family and private life; relevant aftercare provision following admission to hospital.

Further Reading: Chapter 6 of Mental Health Act 1983 Code of Practice or page 19 of the Easy Read version

IF YOU THINK THAT YOU OR SOMEONE YOU KNOW WOULD BENEFIT FROM HELP FROM AN ADVOCATE, CONTACT US VIA THE ‘CONTACT’ LINK ABOVE OR CLICK ‘MAKE A REFERRAL’.